Jacqueline Halbig v. Sylvia Mathews Burwell

758 F.3d 390, 411 U.S. App. D.C. 199, 2014 WL 3579745, 114 A.F.T.R.2d (RIA) 5225, 2014 U.S. App. LEXIS 13880
CourtCourt of Appeals for the D.C. Circuit
DecidedJuly 22, 2014
Docket14-5018
StatusPublished
Cited by16 cases

This text of 758 F.3d 390 (Jacqueline Halbig v. Sylvia Mathews Burwell) is published on Counsel Stack Legal Research, covering Court of Appeals for the D.C. Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Jacqueline Halbig v. Sylvia Mathews Burwell, 758 F.3d 390, 411 U.S. App. D.C. 199, 2014 WL 3579745, 114 A.F.T.R.2d (RIA) 5225, 2014 U.S. App. LEXIS 13880 (D.C. Cir. 2014).

Opinions

Opinion for the Court filed by Circuit Judge GRIFFITH.

Concurring opinion filed by Senior Circuit Judge RANDOLPH.

Dissenting opinion filed by Senior Circuit Judge EDWARDS.

GRIFFITH, Circuit Judge:

Section 36B of the Internal Revenue Code, enacted as part of the Patient Protection and Affordable Care Act (ACA or the Act), makes tax credits available as a form of subsidy to individuals who purchase health insurance through marketplaces — known as “American Health Benefit Exchanges,” or “Exchanges” for short — that are “established by the State under section 1311” of the Act. 26 U.S.C. § 36B(c)(2)(A)(i). On its face, this provision authorizes tax credits for insurance purchased on an Exchange established by one of the fifty states or the District of Columbia. See 42 U.S.C. § 18024(d). But the Internal Revenue Service has interpreted section 36B broadly to authorize the subsidy also for insurance purchased on an Exchange established by the federal government under section 1321 of the Act. See 26 C.F.R. § 1.36B-2(a)(i) (hereinafter “IRS Rule”).

Appellants are a group of individuals and employers residing in states that did not establish Exchanges. For reasons we explain more fully below, the IRS’s interpretation of section 36B makes them subject to certain penalties under the ACA that they would rather not face. Believing that the IRS’s interpretation is inconsistent with section 36B, appellants challenge the regulation under the Administrative Procedure Act (APA), alleging that it is not “in accordance with law.” 5 U.S.C. § 706(2)(A).

On cross-motions for summary judgment, the district court rejected that challenge, granting the government’s motion and denying appéllants’. See Halbig v. Sebelius, No. 13 Civ. 623(PLF), — F.Supp.3d -, 2014 WL 129023 (D.D.C. Jan. 15, 2014). After resolving several threshold issues related to its jurisdiction, the district court held that the ACA’s text, structure, purpose, and legislative history make “clear that Congress intended to make premium tax credits available on both state-run and federally-facilitated Exchanges.” Id. at -, 2014 WL 129023 at *18. Furthermore, the court held that even if the ACA were ambiguous, the IRS’s regulation would represent a permissible construction entitled to deference under Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 104 S.Ct. 2778, 81 L.Ed.2d 694 (1984).

' Appellants timely appealed the district court’s orders, and we have jurisdiction under 28 U.S.C. § 1291. Our review of the orders is de novo, and “[o]n an independent review of the record, we will uphold an agency action unless we find it to be ‘arbitrary, capricious, an abuse of discretion, or otherwise not in accordance [394]*394with law.’ ” Holland v. Nat’l Mining Ass’n, 309 F.3d 808, 814 (D.C.Cir.2002) (quoting 5 U.S.C. § 706(2)(A)). Because we conclude that the ACA unambiguously restricts the section 36B subsidy to insurance purchased on Exchanges “established by the State,” we reverse the district court and vacate the IRS’s regulation.

I

Congress enacted the Patient Protection and Affordable Care Act in 2010 “to increase the number of Americans covered by health insurance and decrease the cost of health care.” Nat’l Fed’n of Indep. Bus. v. Sebelius (NFIB), — U.S. -, 132 S.Ct. 2566, 2580, 183 L.Ed.2d 450 (2012). The ACA pursues these goals through a complex network of interconnected policies focused primarily on helping individuals who do not receive coverage through an employer or government program to purchase affordable insurance directly. Central to this effort are the Exchanges. 42 U.S.C. § 18031(b)(1). Exchanges are “governmental agenc[ies] or nonprofit entities]” that serve as both gatekeepers and gateways to health insurance coverage. See id. § 18031(d)(1). Among their many functions as gatekeepers, Exchanges determine which health plans satisfy federal and state standards, and they operate websites that allow individuals and employers to enroll in those that do. See id. § 18031(b)(1), (d)(i)(d)(4). Section 1311 of the ACA delegates primary responsibility for establishing Exchanges to individual states. See id. § 18031(b)(1) (providing that “[e]ach State shall, not later than January 1, 2014, establish an American Health Benefit Exchange (referred to in this title as an ‘Exchange’) for the State”). However, because Congress cannot require states to implement federal laws, see Printz v. United States, 521 U.S. 898, 904-05, 935, 117 S.Ct. 2365, 138 L.Ed.2d 914 (1997), if a state refuses or is unable to set up an Exchange, section 1321 provides that the federal government, through the Secretary of Health and Human Services (HHS), “shall ... establish and operate such Exchange within the State.” 42 U.S.C. § 18041(c)(1). As of today, only fourteen states and the District of Columbia have established Exchanges. The federal government has established Exchanges in the remaining thirty-six states, in some cases with state assistance but in most cases not. See Richard Cauchi, State Actions To Address Health Insurance Exchanges, Nat’l Conference of State Legislatures (May 9, 2014), http:// www.ncsl.org/research/health/state-aetions-to-implement-the-health-benefit.aspx.

Under section 36B, Exchanges also serve as the gateway to the refundable tax credits through which the ACA subsidizes health insurance. See 26 U.S.C. § 36B(a). Generally speaking, section 36B authorizes credits for “applicable taxpayer[s],” id., defined as those with household incomes between 100 and 400 percent of the federal poverty line, id. § 36B(c)(l)(A). But section 36B’s formula for calculating the credit works further limits on who may receive the subsidy. According to that formula, the credit is to equal the sum of the “premium assistance amounts” for each “coverage month.” Id. § 36B(b)(Z). The “premium assistance amount” is based on the cost of a “qualified health plan ... enrolled in through an Exchange established by the State under [section] 1311 of the [ACA].” Id. § 36B(b)(2); see also 42 U.S.C. §§ 18021(a)(1), 18031(c)(1) (establishing requirements for “qualified health plans”). Likewise, a “coverage month” is a month for which, “as of the first day of such month the taxpayer ... is covered by a qualified health plan ... that was enrolled in through an Exchange established by the State under section 1311 of the [ACA].” 26 [395]*395U.S.C. § 36B(c)(2)(A)(i).

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Optimal Wireless LLC v. IRS
77 F.4th 1069 (D.C. Circuit, 2023)
Doe v. Daversa Partners
District of Columbia, 2021
King v. Burwell
135 S. Ct. 2480 (Supreme Court, 2015)
Steven Hotze v. Sylvia Burwell, Secretary H
784 F.3d 984 (Fifth Circuit, 2015)
Northern Arapaho Tribe v. Burwell
90 F. Supp. 3d 1238 (D. Wyoming, 2015)
United States v. Subject A
579 F. App'x 37 (Second Circuit, 2014)
Oklahoma ex rel. Pruitt v. Burwell
51 F. Supp. 3d 1080 (E.D. Oklahoma, 2014)
Yari v. Commissioner
143 T.C. No. 7 (U.S. Tax Court, 2014)
Steven Yari v. Commissioner
143 T.C. No. 7 (U.S. Tax Court, 2014)
Indiana v. Internal Revenue Service
38 F. Supp. 3d 1003 (S.D. Indiana, 2014)

Cite This Page — Counsel Stack

Bluebook (online)
758 F.3d 390, 411 U.S. App. D.C. 199, 2014 WL 3579745, 114 A.F.T.R.2d (RIA) 5225, 2014 U.S. App. LEXIS 13880, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jacqueline-halbig-v-sylvia-mathews-burwell-cadc-2014.