SCOTUS Upholds Obamacare, Leaders React

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Chief Justice John G. Roberts wrote for the majority.

In a decisive 6-3 ruling, the U.S. Supreme Court on Thursday turned back the latest legal challenge to the Patient Protection and Affordable Care Act.

The ruling handed down in King v. Burwell rejects the plaintiffs' assertion that the ACA does not statutorily authorize the federal government to provide premium subsidies for people buying health insurance in 34 states that rely upon the federal HealthCare.gov exchange.

The plaintiffs in the case had challenged the specific wording "through an Exchange established by the state," located in Section 36B of the 974-page law.

The Obama Administration and Democrats in Congress had argued that the phrase was simply an error in wording in a massive piece of legislation, and that the clear intent of the bill was to expand health insurance coverage to as many people as possible.

The high court agreed.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Chief Justice John G. Roberts wrote for the majority.

"If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter. Section 36B can fairly be read consistent with what we see as Congress's plan, and that is the reading we adopt."

Hospital CEOs Weigh In on King v. Burwell Ruling

Joining Roberts in the majority where Justices Anthony M. Kennedy, Ruth Bader Ginsburg, Sonia Sotomayor, Stephen G. Breyer and Elena Kagan.

Justices Antonin Scalia, Clarence Thomas, and Samuel A. Alito, Jr. ruled for the plaintiffs.

In a blistering dissent, Scalia sarcastically suggested that "we should start calling this law SCOTUScare" because Thursday's ruling marks the second time in three years that the high court has intervened to save the ACA.

Scalia accused his colleagues in the majority of "interpretive jiggery-pokery" in attempting to ascertain the intent of Congress.

"Let us not forget that the term 'Exchange established by the State' appears twice in 36B and five more times in other parts of the Act that mention tax credits," Scalia wrote. "What are the odds, do you think, that the same slip of the pen occurred in seven separate places? No provision of the Act—none at all—contradicts the limitation of tax credits to state Exchanges. And as I have already explained, uses of the term 'Exchange established by the State' beyond the context of tax credits look anything but accidental. If there was a mistake here, context suggests it was a substantive mistake in designing this part of the law, not a technical mistake in transcribing it."

Reaction

President Obama had maintained over the past several months that the plaintiffs' argument in King v. Burwell was frivolous. Earlier this month he told reporters that the case never should have made it to the U.S. Supreme Court.

Frivolous or not, the stakes in the case were high.

Had the high court ruled for the plaintiffs, more than 6.4 million lower- and middle-income Americans living in the 34 states that relied upon the federal exchanges could have lost their subsidies, which for many of them would have made the premiums unaffordable.

President Obama praised the ruling Thursday morning in a brief meeting with reporters at the White House. He suggested that it was time for partisan opponents of the ACA to accept defeat and move on. "After more than 50 votes in Congress to repeal or weaken this law, after a presidential election based in part on preserving or repealing this law, after multiple challenges to this law in the Supreme Court, the Affordable Care Act is here to stay," Obama said.

The President added that the ACA "is in many ways… working better than we expected it to," with 16 million Americans gaining health insurance coverage and uninsured rate that is the lowest "since we began to take records."

"For all the misinformation campaigns, all the doomsday predictions, all the talk of death panels, [and] job disruptions, for all the repeal attempts, this law is now helping tens of millions of Americans."

Despite the high court's decisive ruling, Republicans remained unanimous in their public avowals to repeal the ACA.

"ObamaCare is fundamentally broken, increasing health care costs for millions of Americans. Today's ruling doesn't change that fact," House Speaker John Boehner, (R-Ohio), said in prepared remarks. "Republicans will continue to listen to American families and work to protect them from the consequences of ObamaCare. And we will continue our efforts to repeal the law and replace it with patient-centered solutions that meet the needs of seniors, small business owners, and middle-class families."

At last count, the 13 or more Republican candidates for president blasted the ruling and most pledged to repeal the law if elected.

Democratic frontrunner Hillary Clinton Tweeted:

Healthcare Sector Praises Ruling

The high court's ruling was greeted enthusiastically in the healthcare sector.

Joel Allison, CEO of Dallas, TX-based Baylor Health Care System and Baylor Scott & White Health, told HealthLeaders Media that "all of the hospitals and health systems in Texas and across the nation were relieved by the ruling and pleased to see it."

"This is a big win for Texans who have gone on the exchanges and received the subsidies," Allison says. "To have lost that would have been significant. We would have had more than 800,000 Texans who would not have been able to keep their subsidies and that equals about $2.5 billion so you can see the financial impact. We have more than 1.2 million Texans who made health plan selections through the marketplace. It is very positive for the hospitals and health systems in Texas, particularly in that we are the state with the highest rate of uninsured."

"We continue to occupy that No. 1 position," Allison says. "However, we have seen the rate of Texans without health insurance fall eight percentage points over the last couple of years due to the federal exchanges. If these folks had lost their subsidies, it would have been very challenging for the health system and the health insurance industry.

The Texas Hospital Association has estimated that the state's hospitals spend $5.5 billion annually in uncompensated care, and that an adverse ruling for the plaintiffs in King v. Burwell could have added another $1 billion to $1.5 billion in uncompensated care costs.

"That would have hit us as well," Allison says, "because we have a mission of serving all people and we are a large healthcare system, this would have had a very negative financial impact on us because these people now would be totally without insurance again."

Nationally, the leading hospital, physician, and health insurance lobbies, all of which had a key role in passing the PPACA in 2010, praised the Supreme Court's ruling.

American Medical Association President Steven J. Stack, MD, said in prepared remarks that "physicians know that the uninsured live sicker and die younger, so the AMA has been a leading voice in support of expanding health insurance access to ensure patients can get the care they require."

"The subsidies upheld today help patients afford health insurance so they can see a doctor when they need one and not have to wait until a small health problem becomes a crisis. The subsidies provide patients with peace of mind that they will not risk bankruptcy should they become seriously ill or injured and experience catastrophic health care costs," Stack said.

Rich Umbdenstock, president and CEO of the American Hospital Association, said in a statement released by his office that the ruling "ensures continued access to health insurance subsidies for so many Americans. In the short time the subsidies have been available, hard-working people who are sick, need care for chronic conditions, or want preventive care have been able to seek care more easily. Most significantly, providing access to primary and preventive care helps improve the health and well-being of individuals, family and communities."

Dan Durham, interim CEO of America' Health Insurance Plans, said that "with the certainty provided by the Supreme Court's decision, now is the time to focus on what matters most to consumers—ensuring access to affordable coverage and high-quality healthcare."