David King v. Sylvia Burwell

PUBLISHED

UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT

No. 14-1158

DAVID KING; DOUGLAS HURST; BRENDA LEVY; ROSE LUCK,

Plaintiffs - Appellants,

v.

SYLVIA MATTHEWS BURWELL, in her official capacity as U.S.
Secretary of Health and Human Services; UNITED STATES
DEPARTMENT OF HEALTH & HUMAN SERVICES; JACOB LEW, in his
official capacity as U.S. Secretary of the Treasury; UNITED
STATES DEPARTMENT OF THE TREASURY; INTERNAL REVENUE SERVICE;
JOHN KOSKINEN, in his official capacity as Commissioner of
Internal Revenue,

Defendants – Appellees,

------------------------------

SENATOR JOHN CORNYN; SENATOR TED CRUZ; SENATOR ORRIN HATCH;
SENATOR MIKE LEE; SENATOR ROB PORTMAN; SENATOR MARCO RUBIO;
CONGRESSMAN DARRELL ISSA; PACIFIC RESEARCH INSTITUTE; THE
CATO INSTITUTE; THE AMERICAN CIVIL RIGHTS UNION;
JONATHAN H. ADLER; MICHAEL F. CANNON; STATE OF OKLAHOMA;
STATE OF ALABAMA; STATE OF GEORGIA; STATE OF WEST VIRGINIA;
STATE OF NEBRASKA; STATE OF SOUTH CAROLINA; CONSUMERS’
RESEARCH; STATE OF KANSAS; THE GALEN INSTITUTE,

Amici Supporting Appellants,

COMMONWEALTH OF VIRGINIA; AMERICA’S HEALTH INSURANCE PLANS;
AMERICAN CANCER SOCIETY; AMERICAN CANCER SOCIETY CANCER
ACTION NETWORK; AMERICAN DIABETES ASSOCIATION; AMERICAN
HEART ASSOCIATION; PUBLIC HEALTH DEANS, CHAIRS, AND FACULTY;
MEMBERS OF CONGRESS AND STATE LEGISLATURES; AMERICAN
HOSPITAL ASSOCIATION; ECONOMIC SCHOLARS; FAMILIES USA; AARP;
NATIONAL HEALTH LAW PROGRAM,

Amici Supporting Appellees.
Appeal from the United States District Court for the Eastern
District of Virginia, at Richmond. James R. Spencer, Senior
District Judge. (3:13-cv-00630-JRS)

Argued: May 14, 2014 Decided: July 22, 2014

Before GREGORY and THACKER, Circuit Judges, and DAVIS, Senior
Circuit Judge.

Affirmed by published opinion. Judge Gregory wrote the opinion,
in which Judge Thacker and Senior Judge Davis joined. Judge
Davis wrote a concurring opinion.

ARGUED: Michael Anthony Carvin, JONES DAY, Washington, D.C., for
Appellants. Stuart F. Delery, UNITED STATES DEPARTMENT OF
JUSTICE, Washington, D.C., for Appellees. Stuart Alan Raphael,
OFFICE OF THE ATTORNEY GENERAL OF VIRGINIA, Richmond, Virginia,
for Amicus Commonwealth of Virginia. ON BRIEF: Yaakov M. Roth,
Jonathan Berry, JONES DAY, Washington, D.C., for Appellants.
Dana J. Boente, United States Attorney, OFFICE OF THE UNITED
STATES ATTORNEY, Alexandria, Virginia; Beth S. Brinkmann, Deputy
Assistant Attorney General, Mark B. Stern, Alisa B. Klein, Civil
Division, UNITED STATES DEPARTMENT OF JUSTICE, Washington, D.C.,
for Appellees. Michael E. Rosman, CENTER FOR INDIVIDUAL RIGHTS,
Washington, D.C.; Carrie Severino, THE JUDICIAL EDUCATION
PROJECT, Washington, D.C.; Charles J. Cooper, David H. Thompson,
Howard C. Nielson, Jr., Brian W. Barnes, COOPER & KIRK, PLLC,
for Amici Senator John Cornyn, Senator Ted Cruz,
Senator Orrin Hatch, Senator Mike Lee, Senator Rob Portman,
Senator Marco Rubio, and Congressman Darrell Issa.
C. Dean McGrath, Jr., MCGRATH & ASSOCIATES, Washington, D.C.;
Ilya Shapiro, CATO INSTITUTE, Washington, D.C.; Bert W. Rein,
William S. Consovoy, J. Michael Connolly, WILEY REIN LLP,
Washington, D.C., for Amici Pacific Research Institute, The Cato
Institute, and The American Civil Rights Union.
Andrew M. Grossman, BAKER HOSTETLER, Washington, D.C., for Amici
Jonathan H. Adler and Michael F. Cannon. E. Scott Pruitt,
Attorney General, Patrick R. Wyrick, Solicitor General, OFFICE
OF THE ATTORNEY GENERAL OF OKLAHOMA, Oklahoma City, Oklahoma;
Luther Strange, Attorney General, OFFICE OF THE ATTORNEY GENERAL
OF ALABAMA, Montgomery, Alabama; Sam Olens, Attorney General,

2
OFFICE OF THE ATTORNEY GENERAL OF GEORGIA, Atlanta, Georgia;
Patrick Morrisey, Attorney General, OFFICE OF THE ATTORNEY
GENERAL OF WEST VIRGINIA, Charleston, West Virginia;
Jon Bruning, Attorney General, Katie Spohn, Deputy Attorney
General, OFFICE OF THE ATTORNEY GENERAL OF NEBRASKA, Lincoln,
Nebraska; Alan Wilson, Attorney General, OFFICE OF THE ATTORNEY
GENERAL OF SOUTH CAROLINA, Columbia, South Carolina, for Amici
State of Oklahoma, State of Alabama, State of Georgia, State of
West Virginia, State of Nebraska, and State of South Carolina.
Rebecca A. Beynon, KELLOGG, HUBER, HANSEN, TODD, EVANS & FIGEL,
P.L.L.C., Washington, D.C., for Amicus Consumers’ Research.
Derek Schmidt, Attorney General, Jeffrey A. Chanay, Deputy
Attorney General, Stephen R. McAllister, Solicitor General,
Bryan C. Clark, Assistant Solicitor General, OFFICE OF THE
ATTORNEY GENERAL OF KANSAS, Topeka, Kansas; Jon Bruning,
Attorney General, OFFICE OF THE ATTORNEY GENERAL OF NEBRASKA,
Lincoln, Nebraska, for Amici State of Kansas and State of
Nebraska. C. Boyden Gray, Adam J. White, Adam R.F. Gustafson,
BOYDEN GRAY & ASSOCIATES, Washington, D.C., for Amicus The Galen
Institute. Mark R. Herring, Attorney General,
Cynthia E. Hudson, Chief Deputy Attorney General, Trevor S. Cox,
Deputy Solicitor General, OFFICE OF THE ATTORNEY GENERAL OF
VIRGINIA, Richmond, Virginia, for Amicus Commonwealth of
Virginia. Joseph Miller, Julie Simon Miller, AMERICA’S HEALTH
INSURANCE PLANS, Washington, D.C.; Andrew J. Pincus,
Brian D. Netter, MAYER BROWN LLP, Washington, D.C., for Amicus
America’s Health Insurance Plans. Mary P. Rouvelas, AMERICAN
CANCER SOCIETY CANCER ACTION NETWORK, Washington, D.C.;
Brian G. Eberle, SHERMAN & HOWARD L.L.C., Denver, Colorado, for
Amici American Cancer Society, American Cancer Society Cancer
Action Network, American Diabetes Association, and American
Heart Association. Clint A. Carpenter, H. Guy Collier,
Ankur J. Goel, Cathy Z. Scheineson, Lauren A. D'Agostino,
MCDERMOTT WILL & EMERY LLP, Washington, D.C., for Amicus Public
Health Deans, Chairs, and Faculty. Elizabeth B. Wydra,
Douglas T. Kendall, Simon Lazarus, Brianne J. Gorod,
CONSTITUTIONAL ACCOUNTABILITY CENTER, Washington, D.C., for
Amicus Members of Congress and State Legislators.
Melinda Reid Hatton, Maureen Mudron, AMERICAN HOSPITAL
ASSOCIATION, Washington, D.C.; Dominic F. Perella, Sean Marotta,
HOGAN LOVELLS US LLP, Washington, D.C., for Amicus American
Hospital Association. Matthew S. Hellman, Matthew E. Price,
Julie Straus Harris, Previn Warren, JENNER & BLOCK LLP,
Washington, D.C., for Amicus Economic Scholars.
Robert N. Weiner, Michael Tye, ARNOLD & PORTER LLP, Washington,
D.C., for Amicus Families USA. Stuart R. Cohen,

3
Michael Schuster, AARP FOUNDATION LITIGATION, Washington, D.C.;
Martha Jane Perkins, NATIONAL HEALTH LAW PROGRAM, Carrboro,
North Carolina, for Amici AARP and National Health Law Program.

4
GREGORY, Circuit Judge:

The plaintiffs-appellants bring this suit challenging the

validity of an Internal Revenue Service (“IRS”) final rule

implementing the premium tax credit provision of the Patient

Protection and Affordable Care Act (the “ACA” or “Act”). The

final rule interprets the ACA as authorizing the IRS to grant

tax credits to individuals who purchase health insurance on both

state-run insurance “Exchanges” and federally-facilitated

“Exchanges” created and operated by the Department of Health and

Human Services (“HHS”). The plaintiffs contend that the IRS’s

interpretation is contrary to the language of the statute,

which, they assert, authorizes tax credits only for individuals

who purchase insurance on state-run Exchanges. For reasons

explained below, we find that the applicable statutory language

is ambiguous and subject to multiple interpretations. Applying

deference to the IRS’s determination, however, we uphold the

rule as a permissible exercise of the agency’s discretion. We

thus affirm the judgment of the district court.

I.

In March of 2010, Congress passed the ACA 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,

132 S. Ct. 2566, 2580 (2012) (NFIB). To increase the

5
availability of affordable insurance plans, the Act provides for

the establishment of “Exchanges,” through which individuals can

purchase competitively-priced health care coverage. See ACA

§§ 1311, 1321. Critically, the Act provides a federal tax

credit to millions of low- and middle-income Americans to offset

the cost of insurance policies purchased on the Exchanges. See

26 U.S.C. § 36B. The Exchanges facilitate this process by

advancing an individual’s eligible tax credit dollars directly

to health insurance providers as a means of reducing the up-

front cost of plans to consumers.

Section 1311 of the Act provides that “[e]ach State shall,

not later than January 1, 2014, establish an American Health

Benefit Exchange.” ACA § 1311(b)(1). However, § 1321 of the

Act clarifies that a state may “elect” to establish an Exchange.

Section 1321(c) further provides that if a state does not

“elect” to establish an Exchange by January 1, 2014, or fails to

meet certain federal requirements for the Exchanges, “the

Secretary [of HHS] shall . . . establish and operate such

exchange within the State . . . .” ACA § 1321(c)(1). Only

sixteen states plus the District of Columbia have elected to set

up their own Exchanges; the remaining thirty-four states rely on

federally-facilitated Exchanges.

Eligibility for the premium tax credits is calculated

according to 26 U.S.C. § 36B. This section defines the annual

6
“premium assistance credit amount” as the sum of the monthly

premium assistance amounts for “all coverage months of the

taxpayer occurring during the taxable year.” Id. § 36B(b)(1).

A “coverage month” is one in which the taxpayer is enrolled in a

health plan “through an Exchange established by the State under

section 1311.” Id. § 36B(c)(2)(A)(i); see also id.

§ 36B(b)(2)(A)-(B) (calculating the premium assistance amount in

relation to the price of premiums available and enrolled in

“through an Exchange established by the State under [§] 1311”).

In addition to the tax credits, the Act requires most

Americans to obtain “minimum essential” coverage or pay a tax

penalty imposed by the IRS. Id. § 5000A; NFIB, 132 S. Ct. at

2580. However, the Act includes an unaffordability exemption

that excuses low-income individuals for whom the annual cost of

health coverage exceeds eight percent of their projected

household income. 26 U.S.C. § 5000A(e)(1)(A). The cost of

coverage is calculated as the annual premium for the least

expensive insurance plan available on an Exchange offered in a

consumer’s state, minus the tax credit described above. Id.

§ 5000A(e)(1)(B)(ii). The tax credits thereby reduce the number

of individuals exempt from the minimum coverage requirement, and

in turn increase the number of individuals who must either

purchase health insurance coverage, albeit at a discounted rate,

or pay a penalty.

7
 The IRS has promulgated regulations making the premium tax

credits available to qualifying individuals who purchase health

insurance on both state-run and federally-facilitated Exchanges.

See 26 C.F.R. § 1.36B-1(k); Health Insurance Premium Tax 7

Credit, 77 Fed. Reg. 30,377, 30,378 (May 23, 2012) (collectively

the “IRS Rule”). The IRS Rule provides that the credits shall

be available to anyone “enrolled in one or more qualified health

plans through an Exchange,” and then adopts by cross-reference

an HHS definition of “Exchange” that includes any Exchange,

“regardless of whether the Exchange is established and operated

by a State . . . or by HHS.” 26 C.F.R. § 1.36B-2; 45 C.F.R.

§ 155.20. Individuals who purchase insurance through federally-

facilitated Exchanges are thus eligible for the premium tax

credits under the IRS Rule. In response to commentary that this

interpretation might conflict with the text of the statute, the

IRS issued the following explanation:

The statutory language of section 36B and other
provisions of the Affordable Care Act support the
interpretation that credits are available to taxpayers
who obtain coverage through a State Exchange, regional
Exchange, subsidiary Exchange, and the Federally-
facilitated Exchange. Moreover, the relevant
legislative history does not demonstrate that Congress
intended to limit the premium tax credit to State
Exchanges. Accordingly, the final regulations
maintain the rule in the proposed regulations because
it is consistent with the language, purpose, and
structure of section 36B and the Affordable Care Act
as a whole.

77 Fed. Reg. at 30,378.

8
 The plaintiffs in this case are Virginia residents who do

not want to purchase comprehensive health insurance. Virginia

has declined to establish a state-run Exchange and is therefore

served by the prominent federally-facilitated Exchange known as

HealthCare.gov. Without the premium tax credits, the plaintiffs

would be exempt from the individual mandate under the

unaffordability exemption. With the credits, however, the

reduced costs of the policies available to the plaintiffs

subject them to the minimum coverage penalty. According to the

plaintiffs, then, as a result of the IRS Rule, they will incur

some financial cost because they will be forced either to

purchase insurance or pay the individual mandate penalty.

The plaintiffs’ complaint alleges that the IRS Rule exceeds

the agency’s statutory authority, is arbitrary and capricious,

and is contrary to law in violation of the Administrative

Procedure Act (“APA”), 5 U.S.C. § 706. The plaintiffs contend

that the statutory language calculating the amount of premium

tax credits according to the cost of the insurance policy that

the taxpayer “enrolled in through an Exchange established by the

State under [§ 1311]” precludes the IRS’s interpretation that

the credits are also available on national Exchanges. 26 U.S.C.

§ 36B(b)(2)(A), (c)(2)(A)(i) (emphasis added). The district

court disagreed, finding that the statute as a whole clearly

evinced Congress’s intent to make the tax credits available

9
nationwide. The district court granted the defendants’ motion

to dismiss, and the plaintiffs timely appealed.

II.

We must first address whether the plaintiffs’ claims are

justiciable. The defendants make two arguments on this point:

(1) that the plaintiffs lack standing; and (2) that the

availability of a tax-refund action acts as an independent bar

to the plaintiffs’ claims under the APA.

A.

We review de novo the legal question of whether plaintiffs

have standing to sue. Wilson v. Dollar General Corp., 717 F.3d

337, 342 (4th Cir. 2013). Article III standing requires a

litigant to demonstrate “an invasion of a legally protected

interest” that is “concrete and particularized” and “‘actual or

imminent.’” Lujan v. Defenders of Wildlife, 504 U.S. 555, 560

(1992) (quoting Whitmore v. Arkansas, 495 U.S. 149, 155 (1990)).

The plaintiffs premise their standing on the claim that, if they

were not eligible for the premium tax credits, they would

qualify for the unaffordability exemption in 26 U.S.C. § 5000A

and would therefore not be subject to the tax penalty for

failing to maintain minimum essential coverage. Thus, because

of the credits, the plaintiffs argue that they face a direct

10
financial burden because they are forced either to purchase

insurance or pay the penalty.

We agree that this represents a concrete economic injury

that is directly traceable to the IRS Rule. The IRS Rule forces

the plaintiffs to purchase a product they otherwise would not,

at an expense to them, or to pay the tax penalty for failing to

comply with the individual mandate, also subjecting them to some

financial cost. Although it is counterintuitive, the tax

credits, working in tandem with the Act’s individual mandate,

impose a financial burden on the plaintiffs.

The defendants’ argument against standing is premised on

the claim that the plaintiffs want to purchase “catastrophic”

insurance coverage, which in some cases is more expensive than

subsidized comprehensive coverage required by the Act. The

defendants thus claim that the plaintiffs have acknowledged they

would actually expend more money on a separate policy even if

they were eligible for the credits. Regardless of the viability

of this argument, it rests on an incorrect premise. The

defendants misread the plaintiffs’ complaint, which, while

mentioning the possibility that several of the plaintiffs wish

to purchase catastrophic coverage, also clearly alleges that

each plaintiff does not want to buy comprehensive, ACA-compliant

coverage and is harmed by having to do so or pay a penalty. The

harm in this case is having to choose between ACA-compliant

11
coverage and the penalty, both of which represent a financial

cost to the plaintiffs. That harm is actual or imminent, and is

directly traceable to the IRS Rule. The plaintiffs thus have

standing to present their claims.

B.

The defendants also argue that the availability of a tax-

refund action bars the plaintiffs’ claims under the APA. The

defendants assert that the proper course of action for the

plaintiffs is to pay the tax penalty and then present their

legal arguments against the IRS Rule as part of a tax-refund

action brought under either 26 U.S.C. § 7422(a) (“No suit or

proceeding shall be maintained in any court for the recovery of

any internal revenue tax alleged to have been erroneously or

illegally assessed or collected, . . . until a claim for refund

or credit has been duly filed . . . .”), or the Little Tucker

Act, 28 U.S.C. § 1346 (granting district courts jurisdiction to

hear “[a]ny civil action against the United States for the

recovery of any internal-revenue tax alleged to have been

erroneously or illegally assessed or collected, or any penalty

claimed to have been collected without authority or any sum

alleged to have been excessive or in any manner wrongfully

12
collected under the internal-revenue laws”). 1 The defendants do

not, nor could they, assert this as a jurisdictional bar, but

instead point to “general equitable principles disfavoring the

issuance of federal injunctions against taxes, absent clear

proof that available remedies at law [are] inadequate.” Bob

Jones Univ. v. Simon, 416 U.S. 725, 742 n.16 (1974). The

defendants argue that a tax refund action presents an “adequate

remedy” that the plaintiffs must first pursue before challenging

the IRS Rule directly under the APA. See 5 U.S.C. § 704

(“Agency action made reviewable by statute and final agency

action for which there is no other adequate remedy in a court

are subject to judicial review.”).

The defendants’ arguments are not persuasive. First, they

fail to point to a single case in which a court has refused to

entertain a similar suit on the grounds that the parties were

required to first pursue a tax-refund action under 26 U.S.C.

§ 7422(a) or 28 U.S.C. § 1346. Moreover, the plaintiffs are not

seeking a tax refund; they ask for no monetary relief, alleging

instead claims for declaratory and injunctive relief in an

attempt to forestall the lose-lose choice (in their minds) of

1
Although 26 U.S.C. § 7422(a) does not appear to
specifically authorize suits, § 6532 speaks of refund suits
filed “under § 7422(a).” See also Cohen v. United States, 650
F.3d 717, 731, n.11 (D.C. Cir. 2011) (en banc).

13
purchasing a product they do not want or paying the penalty.

Section 7422(a) does not allow for prospective relief. Instead,

it bars suit “for the recovery of any internal revenue tax

alleged to have been erroneously or illegally assessed or

collected.” 26 U.S.C. 7422(a) (emphasis added); see also Cohen,

650 F.3d at 732 (“[Section 7422(a)] does not, at least

explicitly, allow for prospective relief.”). Similarly, “[t]he

Little Tucker Act does not authorize claims that seek primarily

equitable relief.” Berman v. United States, 264 F.3d 16, 21

(1st Cir. 2001) (citing Richardson v. Morris, 409 U.S. 464, 465

(1973); Bobula v. United States Dep’t of Justice, 970 F.2d 854,

858-59 (Fed. Cir. 1992)).

It is clear, then, that the alternative forms of relief

suggested by the defendants would not afford the plaintiffs the

complete relief they seek. This is simply not a typical tax

refund action in which an individual taxpayer complains of the

manner in which a tax was assessed or collected and seeks

reimbursement for wrongly paid sums. The plaintiffs here

challenge the legality of a final agency action, which is

consistent with the APA’s underlying purpose of “remov[ing]

obstacles to judicial review of agency action.” Bowen v.

Massachusetts, 487 U.S. 879, 904 (1988). Requiring the

plaintiffs to choose between purchasing insurance and thereby

waiving their claims or paying the tax and challenging the IRS

14
Rule after the fact creates just such an obstacle. We therefore

find that the plaintiffs’ suit is not barred under the APA.

III.

Turning to the merits, “we review questions of statutory

construction de novo.” Orquera v. Ashcroft, 357 F.3d 413, 418

(4th Cir. 2003). Because this case concerns a challenge to an

agency’s construction of a statute, we apply the familiar two-

step analytic framework set forth in Chevron U.S.A., Inc. v.

Natural Res. Def. Council, Inc., 467 U.S. 837 (1984). At

Chevron’s first step, a court looks to the “plain meaning” of

the statute to determine if the regulation responds to it.

Chevron, 467 U.S. at 842-43. If it does, that is the end of the

inquiry and the regulation stands. Id. However, if the statute

is susceptible to multiple interpretations, the court then moves

to Chevron’s second step and defers to the agency’s

interpretation so long as it is based on a permissible

construction of the statute. Id. at 843.

A.

At step one, “[i]f the statute is clear and unambiguous

‘that is the end of the matter, for the court, as well as the

agency, must give effect to the unambiguously expressed intent

of Congress.’” Bd. of Governors of the Fed. Reserve Sys. v.

Dimension Fin. Corp., 474 U.S. 361, 368 (1986) (quoting Chevron,

15
467 U.S. at 842-43). A statute is ambiguous only if the

disputed language is “reasonably susceptible of different

interpretations.” Nat’l R.R. Passenger Corp. v. Atchison Topeka

& Santa Fe Ry. Co., 470 U.S. 451, 473 n.27 (1985). “The

objective of Chevron step one is not to interpret and apply the

statute to resolve a claim, but to determine whether Congress’s

intent in enacting it was so clear as to foreclose any other

interpretation.” Grapevine Imports, Ltd. v. United States, 636

F.3d 1367, 1377 (Fed. Cir. 2011). Courts should employ all the

traditional tools of statutory construction in determining

whether Congress has clearly expressed its intent regarding the

issue in question. Chevron, 467 U.S. at 843 n.9; Nat’l Elec.

Mfrs. Ass’n v. U.S. Dep’t of Energy, 654 F.3d 496, 504 (4th Cir.

2011).

1.

In construing a statute’s meaning, the court “begin[s], as

always, with the language of the statute.” Duncan v. Walker,

533 U.S. 167, 172 (2001). As described above, 26 U.S.C. § 36B

provides that the premium assistance amount is the sum of the

monthly premium assistance amounts for all “coverage months” for

which the taxpayer is covered during a year. A “coverage month”

is one in which “the taxpayer . . . is covered by a qualified

health plan . . . enrolled in through an Exchange established by

the State under [§] 1311 of the [Act].” 26 U.S.C.

16
§ 36B(b)(2)(A). Similarly, the statute calculates an

individual’s tax credit by totaling the “premium assistance

amounts” for all “coverage months” in a given year. Id.

§ 36B(b)(1). The “premium assistance amount” is based in part

on the cost of the monthly premium for the health plan that the

taxpayer purchased “through an Exchange established by the State

under [§] 1311.” Id. § 36B(b)(2).

The plaintiffs assert that the plain language of both

relevant subsections in § 36B is determinative. They contend

that in defining the terms “coverage months” and “premium

assistance amount” by reference to Exchanges that are

“established by the State under [§] 1311,” Congress limited the

availability of tax credits to individuals purchasing insurance

on state Exchanges. Under the plaintiffs’ construction, the

premium credit amount for individuals purchasing insurance

through a federal Exchange would always be zero.

The plaintiffs’ primary rationale for their interpretation

is that the language says what it says, and that it clearly

mentions state-run Exchanges under § 1311. If Congress meant to

include federally-run Exchanges, it would not have specifically

chosen the word “state” or referenced § 1311. The federal

government is not a “State,” and so the phrase “Exchange

established by the State under [§] 1311,” standing alone,

supports the notion that credits are unavailable to consumers on

17
federal Exchanges. Further, the plaintiffs assert that because

state and federal Exchanges are referred to separately in § 1311

and § 1321, the omission in 26 U.S.C. § 36B of any reference to

federal Exchanges established under § 1321 represents an

intentional choice on behalf of Congress to exclude federal

Exchanges and include only state Exchanges established under

§ 1311.

There can be no question that there is a certain sense to

the plaintiffs’ position. If Congress did in fact intend to

make the tax credits available to consumers on both state and

federal Exchanges, it would have been easy to write in broader

language, as it did in other places in the statute. See 42

U.S.C. § 18032(d)(3)(D)(i)(II) (referencing Exchanges

“established under this Act”).

However, when conducting statutory analysis, “a reviewing

court should not confine itself to examining a particular

statutory provision in isolation. Rather, [t]he meaning – or

ambiguity – of certain words or phrases may only become evident

when placed in context.” Nat’l Ass’n of Home Builders v.

Defenders of Wildlife, 551 U.S. 644, 666 (2007) (internal

citation and quotation marks omitted). With this in mind, the

defendants’ primary counterargument points to ACA §§ 1311 and

1321, which, when read in tandem with 26 U.S.C. § 36B, provide

an equally plausible understanding of the statute, and one that

18
comports with the IRS’s interpretation that credits are

available nationwide.

As noted, § 1311 provides 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”)[.]” It

goes on to say that “[a]n Exchange shall be a governmental

agency or nonprofit entity that is established by a State,”

apparently narrowing the definition of “Exchange” to encompass

only state-created Exchanges. ACA § 1311(d)(1). Similarly, the

definitions section of the Act, § 1563(b), provides that “[t]he

term ‘Exchange’ means an American Health Benefit Exchange

established under [§] 1311,” further supporting the notion that

all Exchanges should be considered as if they were established

by a State.

Of course, § 1311’s directive that each State establish an

Exchange cannot be understood literally in light of § 1321,

which provides that a state may “elect” to do so. Section

1321(c) provides that if a state fails to establish an Exchange

by January 1, 2014, the Secretary “shall . . . establish and

operate such Exchange within the State and the Secretary shall

take such actions as are necessary to implement such other

requirements.” (emphasis added). The defendants’ position is

that the term “such Exchange” refers to a state Exchange that is

set up and operated by HHS. In other words, the statute

19
mandates the existence of state Exchanges, but directs HHS to

establish such Exchanges when the states fail to do so

themselves. In the absence of state action, the federal

government is required to step in and create, by definition, “an

American Health Benefit Exchange established under [§] 1311” on

behalf of the state.

Having thus explained the parties’ competing primary

arguments, the court is of the opinion that the defendants have

the stronger position, although only slightly. Given that

Congress defined “Exchange” as an Exchange established by the

state, it makes sense to read § 1321(c)’s directive that HHS

establish “such Exchange” to mean that the federal government

acts on behalf of the state when it establishes its own

Exchange. However, the court cannot ignore the common-sense

appeal of the plaintiffs’ argument; a literal reading of the

statute undoubtedly accords more closely with their position.

As such, based solely on the language and context of the most

relevant statutory provisions, the court cannot say that

Congress’s intent is so clear and unambiguous that it

“foreclose[s] any other interpretation.” Grapevine Imports, 636

F.3d at 1377.

2.

We next examine two other, less directly relevant

provisions of the Act to see if they shed any more light on

20
Congress’s intent. Food and Drug Admin. v. Brown & Williamson

Tobacco Corp., 529 U.S. 120, 132-33 (2000) (“A court must . . .

interpret the statute as a symmetrical and coherent regulatory

scheme, and fit, if possible, all parts into a harmonious

whole.”) (citation and internal quotation marks omitted).

First, the defendants argue that reporting provisions in

§ 36B(f) conflict with the plaintiffs’ interpretation and

confirm that the premium tax credits must be available on

federally-run Exchanges. Section 36B(f) – titled

“Reconciliation of credit and advance credit” – requires the IRS

to reduce the amount of a taxpayer’s end-of-year premium tax

credit by the amount of any advance payment of such credit. See

26 U.S.C. § 36B(f)(1) (“The amount of the credit allowed under

this section for any taxable year shall be reduced (but not

below zero) by the amount of any advance payment of such

credit[.]”). To enable the IRS to track these advance payments,

the statute requires “[e]ach Exchange (or any person carrying

out 1 or more responsibilities of an Exchange under section

1311(f)(3) or 1321(c) of the [Act])” to provide certain

information to the Department of the Treasury. Id. § 36B(f)(3)

(emphasis added). There is no dispute that the reporting

requirements apply regardless of whether an Exchange was

established by a state or HHS. The Exchanges are required to

report the following information:

21
 (A) The level of coverage described in section
1302(d) of the Patient Protection and Affordable
Care Act and the period such coverage was in
effect.

(B) The total premium for the coverage without regard
to the credit under this section or cost-sharing
reductions under section 1402 of such Act.

(C) The aggregate amount of any advance payment of
such credit or reductions under section 1412 of
such Act.

(D) The name, address, and TIN of the primary insured
and the name and TIN of each other individual
obtaining coverage under the policy.

(E) Any information provided to the Exchange,
including any change of circumstances, necessary
to determine eligibility for, and the amount of,
such credit.

(F) Information necessary to determine whether a
taxpayer has received excess advance payments.

Id.

The defendants argue, sensibly, that if premium tax credits

were not available on federally-run Exchanges, there would be no

reason to require such Exchanges to report the information found

in subsections (C), (E), and (F). It is therefore possible to

infer from the reporting requirements that Congress intended the

tax credits to be available on both state- and federally-

facilitated Exchanges. The plaintiffs acknowledge that some of

the reporting requirements are extraneous for federally-run

Exchanges, but note that the other categories of reportable

information, i.e., subsections (A), (B), and (D), remain

relevant even in the absence of credits. The plaintiffs suggest

22
that Congress was simply saving itself the trouble of writing

two separate subsections, one for each type of Exchange, by

including a single comprehensive list.

The second source of potentially irreconcilable language

offered by the defendants concerns the “qualified individuals”

provision under ACA § 1312. That section sets forth provisions

regarding which individuals may purchase insurance from the

Exchanges. It provides that only “qualified individuals” may

purchase health plans in the individual markets offered through

the Exchanges, and explains that a “qualified individual” is a

person who “resides in the State that established the Exchange.”

ACA § 1312. The defendants argue that unless their reading of

§ 1321 is adopted and understood to mean that the federal

government stands in the shoes of the state for purposes of

establishing an Exchange, there would be no “qualified

individuals” existing in the thirty-four states with federally-

facilitated Exchanges because none of those states is a “State

that established the Exchange.” This would leave the federal

Exchanges with no eligible customers, a result Congress could

not possibly have intended.

The plaintiffs acknowledge that this would be untenable,

and suggest that the residency requirement is only applicable to

state-created Exchanges. They note that § 1312 states that a

“qualified individual” – “with respect to an Exchange” – is one

23
who “resides in the State that established the Exchange.” ACA

§ 1312(f)(1)(A) (emphasis added). Accordingly, because

“Exchange” is defined as an Exchange established under § 1311,

i.e., the provision directing states to establish Exchanges, the

residency requirement only limits enrollment on state Exchanges.

Having considered the parties’ competing arguments on both

of the above-referenced sections, we remain unpersuaded by

either side. Again, while we think the defendants make the

better of the two cases, we are not convinced that either of the

purported statutory conflicts render Congress’s intent clear.

Both parties offer reasonable arguments and counterarguments

that make discerning Congress’s intent difficult. Additionally,

we note that the Supreme Court has recently reiterated the

admonition that courts avoid revising ambiguously drafted

legislation out of an effort to avoid “apparent anomal[ies]”

within a statute. Michigan v. Bay Mills Indian Cmty., No. 12-

515, 572 U.S. ___, ___, slip op. at 10 (May 27, 2014). It is

not especially surprising that in a bill of this size – “10

titles stretch[ing] over 900 pages and contain[ing] hundreds of

provisions,” NFIB, 132 S. Ct. at 2580, – there would be one or

more conflicting provisions. See Bay Mills, at 10-11 (“Truth be

told, such anomalies often arise from statutes, if for no other

reason than that Congress typically legislates by parts

. . . .”). Wary of granting excessive analytical weight to

24
relatively minor conflicts within a statute of this size, we

decline to accept the defendants’ arguments as dispositive of

Congress’s intent.

3.

The Act’s legislative history is also not particularly

illuminating on the issue of tax credits. See Philip Morris

USA, Inc. v. Vilsack, 736 F.3d 284, 289 (4th Cir. 2013)

(considering legislative history at Chevron step one). But see

Nat’l Elec. Mfrs. Ass’n, 654 F.3d at 505 (noting that, “in

consulting legislative history at step one of Chevron, we have

utilized such history only for limited purposes, and only after

exhausting more reliable tools of construction”). As both

parties concede, the legislative history of the Act is somewhat

lacking, particularly for a bill of this size. 2 Several floor

statements from Senators support the notion that it was well

understood that tax credits would be available for low- and

middle-income Americans nationwide. For example, Senator Baucus

stated that the “tax credits will help to ensure all Americans

2
As another court considering a similar challenge to the
IRS Rule recently noted, “[b]ecause the House and Senate
versions of the Act were synthesized through a reconciliation
process, rather than the standard conference committee process,
no conference report was issued for the Act, and there is a
limited legislative record relating to the final version of the
bill.” Halbig v. Sebelius, No. 13-623, 2014 WL 129023, at *17
n.13 (D.D.C. Jan. 15, 2014).

25
can afford quality health insurance.” 155 Cong. Rec. S11,964

(Nov. 21, 2009). He later estimated that “60 percent of those

who are getting insurance in the individual market on the

exchange will get tax credits . . . .” 155 Cong. Rec. S12,764

(Dec. 9, 2009). Similarly, Senator Durbin stated that half of

the “30 million Americans today who have no health insurance

. . . will qualify for . . . tax credits to help them pay their

premiums so they can have and afford health insurance.” 155

Cong. Rec. S13,559 (Dec. 20, 2009). These figures only make

sense if all financially eligible Americans are understood to

have access to the credits.

However, it is possible that such statements were made

under the assumption that every state would in fact establish

its own Exchange. As the district court stated, “Congress did

not expect the states to turn down federal funds and fail to

create and run their own Exchanges.” King v. Sebelius, No.

3:13-cv-630, 2014 WL 637365, at *14 (E.D. Va. Feb. 18, 2014).

The Senators’ statements therefore do not necessarily address

the question of whether the credits would remain available in

the absence of state-created Exchanges. The plaintiffs argue

extensively that Congress could not have anticipated that so few

states would establish their own Exchanges. Indeed, they argue

that Congress attempted to “coerce” the states into establishing

Exchanges by conditioning the availability of the credits on the

26
presence of state Exchanges. The plaintiffs contend that

Congress struck an internal bargain in which it decided to favor

state-run Exchanges by incentivizing their creation with

billions of dollars of tax credits. According to the

plaintiffs, however, Congress’s plan backfired when a majority

of states refused to establish their own Exchanges, in spite of

the incentives. The plaintiffs thus acknowledge that the lack

of widely available tax credits is counter to Congress’s

original intentions, but consider this the product of a

Congressional miscalculation that the courts have no business

correcting.

Although the plaintiffs offer no compelling support in the

legislative record for their argument, 3 it is at least plausible

that Congress would have wanted to ensure state involvement in

the creation and operation of the Exchanges. Such an approach

would certainly comport with a literal reading of 26 U.S.C.

§ 36B’s text. In any event, it is certainly possible that the

Senators quoted above were speaking under the assumption that

3
The plaintiffs take an isolated, stray comment from
Senator Baucus during a Senate Finance Committee hearing well
out of context, see J.A. 285-87, and similarly place too much
emphasis on a draft bill from the Senate Health, Education,
Labor, and Pensions Committee that would have conditioned
subsidies for a state’s residents on the state’s adoption of
certain “insurance reform provisions,” see S. 1679, § 3104(a),
(d)(2), 111th Cong. (2009).

27
each state would establish its own Exchange, and that they could

not have envisioned the issue currently being litigated.

Although Congress included a fallback provision in the event the

states failed to act, it is not clear from the legislative

record how large a role Congress expected the federal Exchanges

to play in administering the Act. We are thus of the opinion

that nothing in the legislative history of the Act provides

compelling support for either side’s position.

Having examined the plain language and context of the most

relevant statutory sections, the context and structure of

related provisions, and the legislative history of the Act, we

are unable to say definitively that Congress limited the premium

tax credits to individuals living in states with state-run

Exchanges. We note again that, on the whole, the defendants

have the better of the statutory construction arguments, but

that they fail to carry the day. Simply put, the statute is

ambiguous and subject to at least two different interpretations.

As a result, we are unable to resolve the case in either party’s

favor at the first step of the Chevron analysis.

B.

Finding that Congress has not “directly spoken to the

precise question at issue,” we move to Chevron’s second step.

467 U.S. at 842. At step two, we ask whether the “agency’s

[action] is based on a permissible construction of the statute.”

28
Id. at 843. We “will not usurp an agency’s interpretive

authority by supplanting its construction with our own, so long

as the interpretation is not ‘arbitrary, capricious, or

manifestly contrary to the statute.’ A construction meets this

standard if it ‘represents a reasonable accommodation of

conflicting policies that were committed to the agency’s care by

the statute.’” Philip Morris, 736 F.3d at 290 (quoting Chevron,

467 U.S. at 844, 845). We have been clear that “[r]eview under

this standard is highly deferential, with a presumption in favor

of finding the agency action valid.” Ohio Vall. Envt’l

Coalition v. Aracoma Coal Co., 556 F.3d 177, 192 (4th Cir.

2009).

As explained, we cannot discern whether Congress intended

one way or another to make the tax credits available on HHS-

facilitated Exchanges. The relevant statutory sections appear

to conflict with one another, yielding different possible

interpretations. In light of this uncertainty, this is a

suitable case in which to apply the principles of deference

called for by Chevron. See Scialabba v. Cuellar de Osorio, No.

12-930, 573 U.S. ___, ___, slip op. at 14 (June 9, 2014)

(“[I]nternal tension [in a statute] makes possible alternative

reasonable constructions, bringing into correspondence in one

way or another the section’s different parts. And when that is

so, Chevron dictates that a court defer to the agency’s choice

29
. . . .”) (plurality opinion); Nat’l Elec. Mfrs. Ass’n, 654 F.3d

at 505 (“[W]e have reached Chevron’s second step after

describing statutory language as ‘susceptible to more precise

definition and open to varying constructions.’”) (quoting Md.

Dep’t of Health and Mental Hygiene v. Centers for Medicare and

Medicaid Servs., 542 F.3d 424, 434 (4th Cir. 2008)). 4

What we must decide is whether the statute permits the IRS

to decide whether the tax credits would be available on federal

Exchanges. In answering this question in the affirmative we are

primarily persuaded by the IRS Rule’s advancement of the broad

4
We recognize that not every ambiguity in a statute gives
rise to Chevron deference. Often, but not always, courts will
yield to an agency’s interpretation only when the ambiguity
creates some discretionary authority for the agency to fulfill.
See Chamber of Commerce of U.S. v. N.L.R.B., 721 F.3d 152, 161
(4th Cir. 2013) (“‘Mere ambiguity in a statute is not evidence
of congressional delegation of authority.’ Rather, ‘[t]he
ambiguity must be such as to make it appear that Congress either
explicitly or implicitly delegated authority to cure that
ambiguity.’”) (quoting Am. Bar Ass’n v. F.T.C., 430 F.3d 457,
469 (D.C. Cir. 2005)) (alteration in original). However, given
the importance of the tax credits to the overall statutory
scheme, it is reasonable to assume that Congress created the
ambiguity in this case with at least some degree of
intentionality. See City of Arlington v. F.C.C., 133 S. Ct.
1863, 1868 (2013) (“Congress knows to speak in plain terms when
it wishes to circumscribe, and in capacious terms when it wishes
to enlarge, agency discretion.”). There are several possible
reasons for leaving an ambiguity of this sort: Congress perhaps
might not have wanted to resolve a politically sensitive issue;
additionally, it might have intended to see how large a role the
states were willing to adopt on their own before having the
agency respond with rules that could best effectuate the purpose
of the Act in light of the actual circumstances present several
years after the bill’s passage.

30
policy goals of the Act. See Vill. of Barrington v. Surface

Transp. Bd., 636 F.3d 650, 666 (D.C. Cir. 2011) (“[W]hen an

agency interprets ambiguities in its organic statute, it is

entirely appropriate for that agency to consider . . . policy

arguments that are rationally related to the [statute’s] goals.”

(internal quotation marks and citation omitted)); Ariz. Pub.

Serv. Co. v. EPA, 211 F.3d 1280, 1287 (D.C. Cir. 2000) (“[A]s

long as the agency stays within [Congress’s] delegation, it is

free to make policy choices in interpreting the statute, and

such interpretations are entitled to deference.”) (quotation

marks omitted). There is no question that the Act was intended

as a major overhaul of the nation’s entire health insurance

market. The Supreme Court has recognized the broad policy goals

of the Act: “to increase the number of Americans covered by

health insurance and decrease the cost of health care.” NFIB,

132 S. Ct. at 2580. Similarly, Title I of the ACA is titled

“Quality, Affordable Health Care for All Americans” (emphasis

added).

Several provisions of the Act are necessary to achieving

these goals. To begin with, the individual mandate requires

nearly all Americans to have health insurance or pay a fine.

Increasing the pool of insured individuals has the intended

side-effect of increasing revenue for insurance providers. The

increased revenue, in turn, supports several more specific

31
policy goals contained in the Act. The most prominent of these

are the guaranteed-issue and community-rating provisions. In

short, these provisions bar insurers from denying coverage or

charging higher premiums because of an individual’s health

status. See ACA § 1201. However, these requirements, standing

alone, would result in an “adverse selection” scenario whereby

individuals disproportionately likely to utilize health care

would drive up the costs of policies available on the Exchanges.

Congress understood that one way to avoid such price

increases was to require near-universal participation in the

insurance marketplace via the individual mandate. In

combination with the individual mandate, Congress authorized

broad incentives - totaling hundreds of billions of dollars – to

further increase market participation among low- and middle-

income individuals. A Congressional Budget Office report issued

while the Act was under consideration informed Congress that

there would be an “an influx of enrollees with below-average

spending for health care, who would purchase coverage because of

the new subsidies to be provided and the individual mandate to

be imposed.” J.A. 95. The report further advised Congress that

“[t]he substantial premium subsidies available in the exchanges

would encourage the enrollment of a broad range of people”; and

that the structure of the premium tax credits, under which

federal subsidies increase if premiums rise, “would dampen the

32
chances that a cycle of rising premiums and declining enrollment

would ensue.” J.A. 108-109. As the defendants further explain,

denying tax credits to individuals shopping on federal Exchanges

would throw a debilitating wrench into the Act’s internal

economic machinery:

Insurers in States with federally-run Exchanges would
still be required to comply with guaranteed-issue and
community-rating rules, but, without premium tax
subsidies to encourage broad participation, insurers
would be deprived of the broad policy-holder base
required to make those reforms viable. Adverse
selection would cause premiums to rise, further
discouraging market participation, and the ultimate
result would be an adverse-selection “death spiral” in
the individual insurance markets in States with
federally-run Exchanges.

Br. of Appellees, at 35; see also Amicus Br. of America’s Health

Insurance Plans, at 3-6; Amicus Br. for Economic Scholars, at 3-

6. 5

It is therefore clear that widely available tax credits are

essential to fulfilling the Act’s primary goals and that

Congress was aware of their importance when drafting the bill.

The IRS Rule advances this understanding by ensuring that this

5
Likewise, four Supreme Court Justices have remarked on the
importance of the tax credit system: “Without the federal
subsidies, individuals would lose the main incentive to purchase
insurance inside the exchanges, and some insurers may be
unwilling to offer insurance inside of exchanges. With fewer
buyers and even fewer sellers, the exchanges would not operate
as Congress intended and may not operate at all.” NFIB, 132 S.
Ct. at 2674 (Scalia, Kennedy, Thomas, and Alito, JJ.,
dissenting).

33
essential component exists on a sufficiently large scale. The

IRS Rule became all the more important once a significant number

of states indicated their intent to forgo establishing

Exchanges. With only sixteen state-run Exchanges currently in

place, the economic framework supporting the Act would crumble

if the credits were unavailable on federal Exchanges.

Furthermore, without an exception to the individual mandate,

millions more Americans unable to purchase insurance without the

credits would be forced to pay a penalty that Congress never

envisioned imposing on them. The IRS Rule avoids both these

unforeseen and undesirable consequences and thereby advances the

true purpose and means of the Act.

It is thus entirely sensible that the IRS would enact the

regulations it did, making Chevron deference appropriate.

Confronted with the Act’s ambiguity, the IRS crafted a rule

ensuring the credits’ broad availability and furthering the

goals of the law. In the face of this permissible construction,

we must defer to the IRS Rule. See Scialabba, at 33 (“Whatever

Congress might have meant in enacting [the statute], it failed

to speak clearly. Confronted with a self-contradictory,

ambiguous provision in a complex statutory scheme, the Board

chose a textually reasonable construction consonant with its

view of the purposes and policies underlying immigration law.

Were we to overturn the Board in that circumstance, we would

34
assume as our own the responsible and expert agency’s role.”);

Nat’l Elec. Mfrs. Ass’n, 654 F.3d at 505 (“[W]e defer at

[Chevron’s] step two to the agency’s interpretation so long as

the construction is a reasonable policy choice for the agency to

make.”) (second alteration in original).

Tellingly, the plaintiffs do not dispute that the premium

tax credits are an essential component of the Act’s viability.

Instead, as explained above, they concede that Congress probably

wanted to make subsidies available throughout the country, but

argue that Congress was equally concerned with ensuring that the

states play a leading role in administering the Act, and thus

conditioned the availability of the credits on the creation of

state Exchanges. The plaintiffs argue that the IRS Rule exceeds

the agency’s authority because it irreconcilably conflicts with

Congress’s goal of ensuring state leadership. For the reasons

explained above, however, we are not persuaded by the

plaintiffs’ “coercion” argument and do not consider it a valid

basis for circumscribing the agency’s authority to implement the

Act in an efficacious manner.

The plaintiffs also attempt to avert Chevron deference by

arguing that ACA §§ 1311 and 1321 are administered by HHS and

not the IRS, and that as a result the IRS had no authority to

enact its final rule. However, the relevant statutory language

is found in 26 U.S.C. § 36B, which is part of the Internal

35
Revenue Code and subject to interpretation by the IRS. See 77

Fed. Reg. at 30,378 (describing the IRS Rule as a valid

interpretation of 26 U.S.C. § 36B). Although the IRS Rule

adopts by cross-reference an HHS definition of “Exchange,” 26

C.F.R. § 1.36B-1(k), the Act clearly gives to the IRS authority

to resolve ambiguities in 26 U.S.C. § 38B (“The Secretary shall

prescribe such regulations as may be necessary to carry out the

provisions of this section”). This clear delegation of

authority to the IRS relieves us of any possible doubt regarding

the propriety of relying on one agency’s interpretation of a

single piece of a jointly-administered statute.

Finally, the plaintiffs contend that a rule of statutory

construction that requires tax exemptions and credits to be

construed narrowly displaces Chevron deference in this case.

However, while the Supreme Court has stated that tax credits

“must be expressed in clear and unambiguous terms,” Yazoo &

Miss. Valley R.R. Co. v. Thomas, 132 U.S. 174, 183 (1889), the

Supreme Court has never suggested that this principle displaces

Chevron deference, and in fact has made it quite clear that it

does not. See Mayo Found. for Medical Educ. and Research v.

United States, 131 S. Ct. 704, 713 (2011) (“[T]he principles

underlying our decision in Chevron apply with full force in the

tax context.”); see also id. at 712 (collecting cases in which

36
the Supreme Court has applied Chevron deference interpreting IRS

regulations).

Rejecting all of the plaintiffs’ arguments as to why

Chevron deference is inappropriate in this case, for the reasons

explained above we are satisfied that the IRS Rule is a

permissible construction of the statutory language. We must

therefore apply Chevron deference and uphold the IRS Rule. 6

Accordingly, the judgment of the district court is

affirmed.

AFFIRMED

6
The Commonwealth of Virginia, acting as amicus on behalf
of the defendants, argues that the plaintiffs’ construction of
the statute violates the Constitution’s Spending Clause by
failing to provide Virginia with “clear notice” that receipt of
billions of dollars in tax credits for its low- and middle-
income citizens was contingent on establishing an Exchange. The
Commonwealth’s argument derives from Pennhurst State School &
Hospital v. Halderman, in which the Supreme Court stated that
“if Congress intends to impose a condition on the grant of
federal moneys, it must do so unambiguously. By insisting that
Congress speak with a clear voice, we enable the States to
exercise their choice knowingly, cognizant of the consequences
of their participation.” 451 U.S. 1, 17 (1981) (internal
citations omitted). Although ably advanced, we have no reason
to reach the Commonwealth’s constitutional argument because we
find the IRS Rule to be an appropriate exercise of the agency’s
authority under Chevron. See Norfolk S. Ry. Co. v. City of
Alexandria, 608 F.3d 150, 157 (4th Cir. 2010) (“The principle of
constitutional avoidance . . . requires the federal courts to
avoid rendering constitutional rulings unless absolutely
necessary.”) (citing Ashwander v. Tenn. Valley Auth., 297 U.S.
288, 347 (1936) (Brandeis, J., concurring)).

37
DAVIS, Senior Circuit Judge, concurring:

I am pleased to join in full the majority’s holding that

the Patient Protection and Affordable Care Act (the Act)

“permits” the Internal Revenue Service to decide whether premium

tax credits should be available to consumers who purchase health

insurance coverage on federally-run Exchanges. Maj. Op. at 30.

But I am also persuaded that, even if one takes the view that

the Act is not ambiguous in the manner and for the reasons

described, the necessary outcome of this case is precisely the

same. That is, I would hold that Congress has mandated in the

Act that the IRS provide tax credits to all consumers regardless

of whether the Exchange on which they purchased their health

insurance coverage is a creature of the state or the federal

bureaucracy. Accordingly, at Chevron Step One, the IRS Rule

making the tax credits available to all consumers of Exchange-

purchased health insurance coverage, 26 C.F.R. § 1.36B-1(k), 77

Fed. Reg. 30,377, 30,378 (May 23, 2012), is the correct

interpretation of the Act and is required as a matter of law.

Chevron U.S.A., Inc. v. Natural Resources Defense Council, Inc.,

467 U.S. 837, 842-43 (1984).

Although the Act expressly contemplates state-run

Exchanges, ACA § 1311(b)(1), Congress created a contingency

provision that permits the federal government, via the Secretary

of Health and Human Services, to “establish and operate such

38
Exchange within the State and . . . take such actions as are

necessary to implement such other requirements.” Id. §

1321(c)(1). This contingency provision is triggered when a state

elects not to set up an Exchange, when a state is delayed in

setting up an Exchange, or when a state Exchange fails to meet

certain statutory and regulatory requirements. Id. § 1321(c)(1).

Enter the premium tax credits, essentially a tax subsidy

for the purchase of health insurance. The amended tax code, 26

U.S.C. § 36B(b), sets forth the formula for calculating the

amount of a consumer’s premium tax credit. In general, the

credit is equal to the lesser of two amounts: the monthly

premium for a qualified health plan “enrolled in through an

Exchange established by the State,” or the excess of the

adjusted monthly premium for a certain type of health plan over

a percentage of the taxpayer’s household income. Id. §

36B(b)(2).

Appellants contend that the language “enrolled in through

an Exchange established by the State” precludes the IRS from

providing premium tax credits to consumers who purchase health

insurance coverage on federal Exchanges. To them, “established

by the State” in the premium tax credits calculation

subprovision is the sine qua non of this case. An Exchange

established by the State is not an Exchange established by the

federal government, they argue; thus, the equation for

39
calculating the amount of the premium tax credit is wholly

inapplicable to all consumers who purchase health insurance

coverage on federally-run Exchanges (the amount would be zero,

according to Appellants).

I am not persuaded and for a simple reason: “[E]stablished

by the State” indeed means established by the state - except

when it does not, i.e., except when a state has failed to

establish an Exchange and when the Secretary, charged with

acting pursuant to a contingency for which Congress planned, id.

§ 1321(c), establishes and operates the Exchange in place of the

state. When a state elects not to establish an Exchange, the

contingency provision authorizes federal officials to establish

and operate “such Exchange” and to take any action adjunct to

doing so.

That disposes of the Appellants’ contention. This is not a

case that calls up the decades-long clashes between textualists,

purposivists, and other schools of statutory interpretation. See

Abbe Gluck, The States As Laboratories of Statutory

Interpretation: Methodological Consensus and the New Modified

Textualism, 119 Yale L.J. 1750, 1762-63 (2010). The case can be

resolved through a contextual reading of a few different

subsections of the statute. If there were any remaining doubt

over this construction, the bill’s structure dispels it: The

contingency provision at § 1321(c)(1) is set forth in “Part III”

40
of the bill, titled “State Flexibility Relating to Exchanges,” a

section that appears after the section that creates the

Exchanges and mandates that they be operated by state

governments, ACA § 1311(b). What’s more, the contingency

provision does not create two-tiers of Exchanges; there is no

indication that Congress intended the federally-operated

Exchanges to be lesser Exchanges and for consumers who utilize

them to be less entitled to important benefits. Thus, I conclude

that a holistic reading of the Act’s text and proper attention

to its structure lead to only one sensible conclusion: The

premium tax credits must be available to consumers who purchase

health insurance coverage through their designated Exchange

regardless of whether the Exchange is state- or federally-

operated.

The majority opinion understandably engages with the

Appellants and respectfully posits they could be perceived to

advance a plausible construction of the Act, i.e., that Congress

may have sought to restrict the scope of the contingency

provision when it used the phrase “established by the State” in

the premium tax credits calculation subprovision. But as the

majority opinion deftly illustrates, a straightforward reading

of the Act strips away any and all possible explanations for why

Congress would have intended to exclude consumers who purchase

health insurance coverage on federally-run Exchanges from

41
qualifying for premium tax credits. (The best Appellants can

come up with seems to be some non-existent Congressional desire

for “state leadership” (whatever that means) in effecting a

comprehensive overhaul of the nation’s health insurance

marketplaces and related health care markets.) Such a reading,

the majority opinion persuasively explains, is not supported by

the legislative history or by the overall structure of the Act.

Maj. Op. at 27, 24. Moreover, the majority carefully and

cogently explains how “widely available tax credits are

essential to fulfilling the Act’s primary goals and [how]

Congress was aware of their importance when drafting the bill.”

Maj. Op. at 33. Thus, the majority correctly holds that Congress

did not intend a reading that has no legislative history to

support it and runs contrary to the Act’s text, structure, and

goals. Appellants’ “literal reading” of the premium tax credits

calculation subprovision renders the entire Congressional scheme

nonsensical. Cf. Maj. Op. at 27.

In fact, Appellants’ reading is not literal; it’s cramped.

No case stands for the proposition that literal readings should

take place in a vacuum, acontextually, and untethered from other

parts of the operative text; indeed, the case law indicates the

opposite. National Association of Home Builders v. Defenders of

Wildlife, 551 U.S. 644, 666 (2007). So does common sense: If I

ask for pizza from Pizza Hut for lunch but clarify that I would

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be fine with a pizza from Domino’s, and I then specify that I

want ham and pepperoni on my pizza from Pizza Hut, my friend who

returns from Domino’s with a ham and pepperoni pizza has still

complied with a literal construction of my lunch order. That is

this case: Congress specified that Exchanges should be

established and run by the states, but the contingency provision

permits federal officials to act in place of the state when it

fails to establish an Exchange. The premium tax credit

calculation subprovision later specifies certain conditions

regarding state-run Exchanges, but that does not mean that a

literal reading of that provision somehow precludes its

applicability to substitute federally-run Exchanges or erases

the contingency provision out of the statute.

That Congress sometimes specified state and federal

Exchanges in the bill is as unremarkable as it is unrevealing.

This was, after all, a 900-page bill that purported to

restructure the means of providing health care in this country.

Neither the canons of construction nor any empirical analysis

suggests that congressional drafting is a perfectly harmonious,

symmetrical, and elegant endeavor. See generally Abbe Gluck &

Lisa Schultz Bressman, Statutory Interpretation from the Inside:

An Empirical Study of Congressional Drafting, Delegation, and

the Canons: Part I, 65 Stan. L. Rev. 901 (2013). Sausage-makers

are indeed offended when their craft is linked to legislating.

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Robert Pear, If Only Laws Were Like Sausages, N.Y. Times, Dec.

5, 2010, at WK3. At worst, the drafters’ perceived

inconsistencies (if that is what they are at all) are far less

probative of Congress’ intent than the unqualified and broad

contingency provision.

Appellants insist that the use of “established by the

State” in the premium tax credits calculation subprovision is

evidence of Congress’ intent to limit the availability of tax

credits to consumers of state Exchange-purchased health

insurance coverage. Their reading bespeaks a deeply flawed

effort to squeeze the proverbial elephant into the proverbial

mousehole. Whitman v. American Trucking Associations, 531 U.S.

457, 468 (2001). If Congress wanted to create a two-tiered

Exchange system, it would have done so expressly in the section

of the Act that authorizes the creation of contingent,

federally-run Exchanges. If Congress wanted to limit the

availability of premium tax credits to consumers who purchase

health coverage on state-run Exchanges, it would have said so

rather than tinkering with the formula in a subprovision

governing how to calculate the amount of the credit.

The real danger in the Appellants’ proposed interpretation

of the Act is that it misses the forest for the trees by eliding

Congress’ central purpose in enacting the Act: to radically

restructure the American health care market with “the most

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expansive social legislation enacted in decades.” Sheryl Gay

Stolberg & Robert Pear, Obama Signs Health Care Overhaul Into

Law, With a Flourish, N.Y. Times, March 24, 2010, at A19. The

widespread availability of premium tax credits was intended as a

critical part of the bill, a point the President highlighted at

the bill signing. Transcript of Remarks by the President and

Vice President at Signing of the Health Insurance Reform Bill,

March 23, 2010 (“And when this exchange is up and running,

millions of people will get tax breaks to help them afford

coverage, which represents the largest middle-class tax cut for

health care in history. That's what this reform is about.”).

Appellants’ approach would effectively destroy the statute by

promulgating a new rule that makes premium tax credits

unavailable to consumers who purchased health coverage on

federal Exchanges. But of course, as their counsel largely

conceded at oral argument, that is their not so transparent

purpose.

Appellants, citizens of the Commonwealth of Virginia, do

not wish to buy health insurance. Most assuredly, they have the

right, but not the unfettered right, Nat’l Fed’n of Indep. Bus.

v. Sebelius, 132 S. Ct. 2566 (2012), to decline to do so. They

have a clear choice, one afforded by the admittedly less-than-

perfect representative process ordained by our constitutional

structure: they can either pay the relatively minimal amounts

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needed to obtain health care insurance as provided by the Act,

or they can refuse to pay and run the risk of incurring a tiny

tax penalty. Id. What they may not do is rely on our help to

deny to millions of Americans desperately-needed health

insurance through a tortured, nonsensical construction of a

federal statute whose manifest purpose, as revealed by the

wholeness and coherence of its text and structure, could not be

more clear.

As elaborated in this separate opinion, I am pleased to

concur in full in Judge Gregory’s carefully reasoned opinion for

the panel.

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