WASHINGTON — The U.S. Supreme Court on Thursday upheld a major component of President Barack Obama’s landmark health care reform, in a ruling that preserves health insurance for millions of Americans.
The decision is a major victory for one of Obama’s most significant domestic achievements. The law, which was passed in 2010 without a single Republican vote, prevents insurance companies from denying coverage because of “pre-existing” health conditions. It requires almost everyone in the U.S. to be insured and provides financial help to consumers who otherwise would spend too much on their health insurance payments. The United States is the only major world economy that does not have a comprehensive state health care system.
Obama greeted news of the decision by declaring the health care law, called the Affordable Care Act, “is here to stay.” He said the law is no longer about politics, but the benefits millions of people are receiving.
While the court’s ruling was an important victory for Obama and Democrats, it could also be useful for Republicans as the 2016 presidential and congressional elections heat up. It takes them off the hook, to a degree, from needing to draw up an alternative to Obamacare. Also, it leaves them with the issue to hammer home with their base of support where the law is unpopular.
The Supreme Court justices said in a 6-3 ruling that 8.7 million Americans are entitled to continue receiving nationwide tax subsidies to make health insurance affordable regardless of local regulations in their states.
Chief Justice John Roberts voted with his liberal colleagues in support of the law. “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Roberts wrote in the majority opinion.
Republicans declined to concede defeat. Congressman John Boehner said Republicans, who have voted more than 50 times to undo the law, will “continue our efforts to repeal the law and replace it with patient-centred solutions that meet the needs of seniors, small business owners, and middle-class families.”
Nationally, 10.2 million people have signed up for health insurance under the Obama health overhaul. That includes the 8.7 million people who are receiving an average subsidy of $272 a month to help cover their insurance costs.
Of those receiving subsidies, 6.4 million people were at risk of losing that aid because they live in states that did not set up their own health insurance exchanges.
The challenge was devised by die-hard opponents of the health care law, often derided by critics as “Obamacare. The law’s opponents argued that the vast majority of people who now get help paying for their insurance coverage are ineligible for their federal tax credits. That is because roughly three dozen states opted against creating their own health insurance marketplaces, or exchanges, and instead rely on a federal platform to help people find coverage if they don’t get insurance through their jobs or the government.
The Obama administration, congressional Democrats and 22 states responded that it would make no sense to construct the law the way its opponents suggested. The idea behind the law’s structure was to decrease the number of uninsured. The point of the subsidies is to keep enough people in the pool of insured to avoid triggering a so-called death spiral of declining enrolment, a growing proportion of less healthy people and payment increases by insurers.
Several portions of the law indicate that consumers can claim tax credits no matter where they live. No member of Congress said that subsidies would be limited, and several states said in a separate brief to the court that they had no inkling they had to set up their own exchange for their residents to get tax credits.
The 2012 challenge took place in the midst of Obama’s re-election campaign, when he touted the largest expansion of the social safety net since the advent of a national social insurance program for the elderly nearly a half-century earlier. But at the time, the benefits of the Affordable Care Act were mostly in the future. Many of its provisions had yet to take effect.
The health insurance industry breathed a big sigh of relief Thursday, and a national organization representing state regulators from both political parties said the court’s decision will mean stable markets for consumers.
“This decision allows (state officials) to move forward with a level of confidence that their markets will not see significant disruption due to a paradigm shift,” said Ben Nelson, CEO of the National Association of Insurance Commissioners.