More significant, the act wouldn’t make sense if it were read the way the D.C. Circuit suggests. That is the point that a group of scholars (including one of the authors of this Op-Ed) made in an amicus brief in the case. These 48 experts in health economics — among them two Nobel laureates and appointees from the administrations of Presidents Johnson, Ford, Carter, George H.W. Bush, Clinton, George W. Bush and Obama — explained that the reform does not work if subsidies aren’t available on all the exchanges, and that members of Congress understood this at the time they passed the ACA.

Near-universal coverage is the central goal of the act. The law achieves this goal by relying on a three-legged stool: nondiscrimination (letting everyone get insurance, despite preexisting conditions); an individual mandate (requiring almost everyone to buy insurance or pay a penalty so that both sick and healthy people will populate risk pools); and subsidies (so that people will be able to afford to buy the mandated insurance). Economic models demonstrate that without the subsidies in question, average premiums would double and approximately 6.5 million fewer people could get insurance.