Today, the U.S. Supreme Court issued its highly anticipated ruling in a challenge to Obamacare, King v. Burwell. The high court upheld tax subsidies of the federal insurance exchanges in a 6-3 decision. The lawsuit had challenged the authority of the federal government subsidizing Obamacare exchanges in the 36 states that haven’t set up their own insurance marketplaces. Specifically, it challenged the IRS regulations that provide tax-credit subsidies for coverage purchased through exchanges established by the federal government at healthcare.gov under Section 1321 of the Patient Protection and Affordable Care Act. The language in the Act had only authorized subsidies for those participating in state exchanges. The four plaintiffs lived in Virginia, which does not have a state-run exchange, and argued that the federal subsidies were illegal.

The law was written the way it was deliberately as an incentive for the states to develop their own exchanges. But many of the states tried and failed at setting up their own exchanges, while others simply opted out. The court could have struck down the expansive interpretation, and left the language for Congress to fix.

Proponents of Obamacare loudly protested that ending the subsidy would leave millions of lower income people without affordable healthcare. Justice Sonia Sotomayor warned during oral arguments that the plaintiffs’ reading of the law would have devastating consequences. “We’re going to have the death spiral that this system was enacted to avoid,” she said. Of the 10.2 million people who have signed up for Obamacare, 8.7 million receive an average subsidy of $272 a month to help pay their insurance premiums. Those living in states without Obamacare exchanges, 6.4 million, would have lost those subsidies if the court had struck down the subsidies.

The decision hinged on the language “established by the states.” Proponents claimed it was merely a “drafting error” in the legislation and that the language should have included the federal government too. Chief Justice Roberts, writing for the majority, began his opinion by lavishly praising Obamacare. “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” he wrote. He said that is why it was necessary to interpret the law more broadly than it had been written.  “If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”

Roberts candidly admitted he was going against a basic rule of statutory construction: “In this instance, the context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.”

While it was expected the other justices would come down on their expected right and left sides of the aisle, Roberts and Anthony Kennedy were considered the potential swing votes. Roberts had already ruled against an Obamacare challenge in 2012, NFIB v. Sebelius.  There, he held that the penalty for not having health insurance was merely a tax, not a mandate, so it passed constitutional muster. Kennedy, on the other hand, joined the dissent, saying that Congress had exceeded its authority by requiring Americans to buy Obamacare or pay a penalty.

Justice Antonin Scalia, in a typical scathing dissent, said the decision “rewrote the law … We should start calling this law SCOTUScare.” He labeled the Court’s reasoning “jiggery-pokery” and  observed, “It is bad enough for a court to cross out ‘by the State’ once. But seven times?” He ridiculed the decision, “Equating establishment ‘by the State’ with establishment by the Federal Government makes nonsense of other parts of the Act. ” He went on, “The Secretary of Health and Human Services is not a state. Words no longer have meaning if an exchange that is not established by a state is ‘established by the state.’ “[T]he cases will publish forever the discouraging truth that the Supreme Court of the United States favors some laws over others, and is prepared to do whatever it takes to uphold and assist its favorites.”

He pointed out that the Court was breaking from precedent, “This Court ‘does not revise legislation … just because the text as written creates an apparent anomaly,’ citing Michigan v. Bay Mills Indian Community.

Contrary to Roberts’ lofty words about Obamacare, critics have noted that the cost of insurance continues to rise and waiting times for doctors hasn’t decreased, something proponents had promised.

There has been talk in recent years that Chief Justice Roberts has succumbed to the D.C. cocktail circuit, and fitting in with the Washington establishment has influenced his rulings. Whatever his motivations, the decision marks a significant intrusion by the judicial branch into the legislative realm. It represents two things: 1), the Court is veering into a more activist era, and 2), Roberts can no longer be relied upon as one of the conservative justices, shifting the balance of power over to the left-leaning justices.

The silver lining: Republicans are not giving up the fight, and say they will revisit the law in Congress.