Supreme Court Allows Nationwide Health Care Subsidies

WASHINGTON — The Supreme Court ruled on Thursday that President Obama’s health care law may provide nationwide tax subsidies to help poor and middle-class people buy health insurance.

Chief Justice John G. Roberts Jr. wrote the majority opinion in the 6-to-3 decision. The court’s three most conservative members — Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. — dissented.

The case concerned a central part of the Affordable Care Act, Mr. Obama’s signature legislative achievement. The law created marketplaces, known as exchanges, to allow people who lack insurance to shop for individual health plans.

Some states set up their own exchanges, but about three dozen allowed the federal government to step in to run them. Across the nation, about 85 percent of customers using the exchanges qualify for subsidies to help pay for coverage, based on their income.

The question in the case, King v. Burwell, No. 14-114, was what to make of a phrase in the law that seems to say the subsidies are available only to people buying insurance on “an exchange established by the state.”

Four plaintiffs, all from Virginia, sued the Obama administration, saying the phrase meant that the law forbids the federal government to provide subsidies in states that do not have their own exchanges. Congress made the distinction, they said, to encourage states to create their own exchanges.

The plaintiffs challenged an Internal Revenue Service regulation that said subsidies were allowed whether the exchange was run by a state or by the federal government. They said the regulation was at odds with the Affordable Care Act.

Lawyers for the administration said the balance of the law demonstrated that Congress could not have intended to limit the subsidies. Accepting the plaintiffs’ position, the lawyers said, would affect more than six million people and create havoc in the insurance markets.

They added that the phrase, noticed by almost no one until long after the law was enacted, was a curious way to encourage states to establish exchanges.

In July, the United States Court of Appeals for the Fourth Circuit, in Richmond, Va., ruled against the challengers.

Judge Roger L. Gregory, writing for a three-judge panel of the court, said the contested phrase was “ambiguous and subject to multiple interpretations.” That meant, he said, that the I.R.S. interpretation was entitled to deference.

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