As has been widely reported, on July 22, 2014, two circuit court panels handed down conflicting decisions on whether ACA insurance premium tax credits are available for insurance purchased on federal, rather than state, insurance Marketplaces/Exchanges. On the one hand, a three-judge panel of the U.S. Court of Appeals for the D.C. Circuit ruled 2-1 that insurance tax credits established by the ACA are “unambiguously: restricted to insurance purchased on Exchanges “established by the State.” The Court therefore vacated IRS regulations making tax credits available as a form of subsidy to individuals who purchase health insurance on an Exchange established by the federal government. Hours later, a three-judge panel of the Fourth Circuit Court of Appeals ruled unanimously that IRS can indeed extend credits to federal Exchanges; given that the “applicable statutory language is ambiguous and subject to multiple interpretations,” the IRS determination is “a permissible exercise of the agency’s discretion.” The Obama Administration will seek an en banc hearing before the D.C. Circuit, but the issue may ultimately be left to the Supreme Court. At stake is the continued availability of subsidies for individuals purchasing health insurance in the 36 states where the federal government – rather than the state — operates the health insurance Exchange.