Once again the Supreme Court will rely on Chief Justice Roberts to craft a political decision in the King v. Burwell case that no one likes but allows the federal government to subsidize health insurance in states that did not set up exchanges. In this case I would not be surprised that he leans with the conservative side. It is obvious that this bill needs to go back to Congress to fix and deferring to the IRS to authorize billions of dollars of subsidies without the very, very clear intention of Congress is just too big a step. Somewhere along the way the judicial system is going to remind Congress that there are consequences in writing ambiguous laws. The obvious choice is to make a Sophie’s Choice type decision and allow the people in those states that did not setup exchanges to avoid the individual mandate penalty and for companies to avoid the employer mandate penalty. That is what the plaintiffs want. This decision would be the natural sequel to Roberts’ previous political decision on the Affordable Care Act. Like Sophie who had to send one of her children to the gas chamber, Justice Roberts may choose to send the subsidized exchange system to the gas chamber so that the subsidized health insurance lives. This decision has political value in that it allows each side to claim they won something. For the Affordable Care Act supporters they get federal subsidies for health insurance. For the Affordable Care Act critics they get out of the hated mandates and America gets another chance to see if exchanges are sustainable or just the most recent example of cronyism in health care leading to higher costs. If the Affordable Care Act supporters are right that both the individual and employer mandates are necessary for sustainable exchanges then they can make their case to the American people. If the critics are right then they can make the case that we should replace the exchanges with something that is more efficient and sustainable. The exchanges are dead! Long live the exchanges!