Aside from his reputation as a towering conservative legal mind, Antonin Scalia was probably best known for his zingy dissents and equally sassy majority opinions on virtually every legal matter brought before the Supreme Court of the United States. Unsurprisingly, on healthcare issues, Scalia remained staunchly committed to the kind of originalism, textualism, and gloves-off humor he was best known for.

The most recent challenge to the Affordable Care Act, King vs. Burwell (2015), centered on the question of whether the ACA’s Exchanges, where subsidized health insurance would be sold, needed to be established “by the State” (as opposed to administered by the federal government) in order for purchasers to qualify for subsidies. If interpreted as written, the ACA would have been gutted of one of its central goals. But true to the text of the law, Scalia insisted that the ACA needed to be interpreted as it was written. “It is bad enough for a court to cross out ‘by the State’ once,” Scalia bemoaned, “But seven times?” While health policy wonks and economists were worried about the practical effects King could have on the viability of the ACA, Scalia worried about the future of the rule of law in a world where laws are conveniently reinterpreted to suit someone’s agenda: “Words no longer have meaning if an Exchange that is not established by a State is ‘established by the State.'”He  remained concerned about the precedent set by this style of interpretation, predicting that “The somersaults of statutory interpretation they have performed […] will be cited by litigants endlessly, to the confusion of honest jurisprudence.”

Scalia was no stranger to controversy, and this remained true on issues pertaining to healthcare, too. He wrote the majority opinion  in District of Columbia vs. Heller (2008), which supported the individual right to bear arms under the Second Amendment. In the face of revisionist arguments about the scope of what the Constitution could protect, Scalia admitted that while it was possible the Constitution could be outmoded, ultimately “[…] what is not debatable is that it is not the role of this court to pronounce the Second Amendment extinct.” Only the Legislature could do that.

In the world of patent law, Scalia also wrote a number of influential opinions that shaped the drug industry’s patent litigation strategies. In Commil v. Cisco (2015), most recently, the Court decided that believing in good faith that a patent was invalid is enough to absolve the defendant of infringing on the patent holder’s rights. Scalia defended that interpretation by writing that “Saying that infringement cannot exist without a valid patent does not ‘conflate the issues of infringement and validity’ any more than saying that water cannot exist without oxygen ‘conflates’ water and oxygen.” Understanding the intricacies of science necessary to making just determinations of law was a source of frustration for Scalia more than once. In Association of Molecular Pathology vs. Myriad Genetics (2013), where the Court needed to decide whether a company could patent a DNA sequence, he said “I am unable to affirm those details [of laboratory DNA synthesis] on my own knowledge or even my own belief. It suffices for me to affirm, having studied the opinions below and the expert briefs presented here, that the portion of DNA isolated from its natural state sought to be patented is identical to that portion of the DNA in its natural state; and that complementary DNA (cDNA) is a synthetic creation not normally present in nature.” Though Scalia probably never developed a coherent theory of intellectual property or patent law for that matter, his disdain for poor logic rang through the diverse opinions he penned in this field.

In an era of Congressional gridlock and dysfunction of the most dangerous branch of government, Scalia stood by his vision of lawmakers who actually wrote laws that made sense on their own terms, and that were true to the words they contained. He held himself to similarly high standards. If he could be faulted for occasional inaccuracies in his opinions and occasionally straying from his textualist roots, he was an inspirational leader when it came to being a vocal supporter of unpopular opinions at times. And perhaps — more importantly — a man who never let his robes disguise a wry sense of humor. He brought life and color to the dry legal battles that shape our rights, obligations, and opportunities as citizens — and healthcare professionals.

Other Resources:

1. A summary of upcoming SCOTUS cases that may be affected by the loss of a well-known conservative thinker on the bench.
2. SCOTUSBlog‘s coverage of Healthcare cases on the docket.
3. A 60 Minutes Episode on Justice Scalia.
4. The immediate impacts of Scalia’s death