On June 25, the Supreme Court upheld the availability of subsidies in all 50 states under the Patient Protection and Affordable Care Act. The court affirmed in a 6–3 vote that the language in PPACA allows the government to help people buy insurance (through subsidies or tax credits) anywhere in the country and not only in states that have established their own insurance exchanges. Chief Justice John Roberts wrote for the majority. Justices Scalia, Thomas and Alito dissented.

The court cited examples in the PPACA of “inartful drafting” and found “relevant provisions to be ambiguous.” The court further explained that the tax credits were necessary for the federal exchanges to function like state exchanges to avoid “the type of calamitous result that Congress plainly meant to avoid.” Justice Scalia wrote in his sharp dissent to the decision that “words no longer have meaning if an exchange that is not established by a state is ‘established by the State.’”

The King v. Burwell ruling is the second case where the Supreme Court has decided in favor of the PPACA, allowing millions of qualified individuals to keep the tax subsidies that help them afford to purchase health insurance coverage on a state or federal exchange.