Today's ruling in Berwell essentially says that the Secretary of Health and Human Services is a State. I'm not sure what the word for this form of government is, but it clearly isn't what the design used to be.
Justice Scalia wrote:
[T]he court “accepts that the ‘most natural sense’ of the phrase ‘Exchange established by the State’ is an Exchange established by a State” but then “continues, with no semblance of shame, that ‘it is also possible that the phrase refers to all Exchanges—both State and Federal.’”Tomorrow or Monday, I expect them to rule that gay marriage is the law of the land. Right behind that, I expect freedom of religion to be rescinded, along with the freedom of conscience.
Words no longer have meaning if an Exchange that is not established by a State is “established by the State.” It is hard to come up with a clearer way to limit tax credits to state Exchanges than to use the words “established by the State.” And it is hard to come up with a reason to include the words “by the State” other than the purpose of limiting credits to state Exchanges. (Scalia's dissent, page 28 of pdf)