Supreme Court upholds nationwide health care law subsidies

SEATTLE — Washington officials are celebrating the U.S. Supreme Court’s decision on the federal health care reform law, even though it doesn’t appear to directly affect the Washington exchange.

State Insurance Commissioner Mike Kreidler says he’s relieved the court looked past political rhetoric and did what was in the best interests of individuals and families who have found affordable health care.

Attorney General Bob Ferguson says a different decision by the Supreme Court could have affected Washington, by starting a “death spiral” and undermining the Affordable Care Act.

U.S. Rep. Dave Reichert says the Supreme Court’s decision issued Thursday does not change the fact that the health care law is fundamentally flawed and hurts families and businesses. The Republican congressman from Washington state says the law has caused people to pay more for insurance and lose access to their preferred insurance plans.

Five years ago, after nearly a century of talk, decades of trying, a year of bipartisan debate, we finally declared that in America, health care is not a privilege for a few, but a right for all.

Over those five years, as we’ve worked to implement the Affordable Care Act, there have been successes and setbacks. The setbacks I remember clearly. But as the dust has settled, there can be no doubt that this law is working. It has changed, and in some cases saved, American lives. It set this country on a smarter, stronger course.

And today, 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 before the Supreme Court — the Affordable Care Act is here to stay.

This morning, the court upheld a critical part of this law — the part that’s made it easier for Americans to afford health insurance regardless of where you live. If the partisan challenge to this law had succeeded, millions of Americans would have had thousands of dollars’ worth of tax credits taken from them. For many, insurance would have become unaffordable again. Many would have become uninsured again. Ultimately, everyone’s premiums could have gone up. America would have gone backward. And that’s not what we do. That’s not what America does. We move forward.

So today is a victory for hardworking Americans all across this country whose lives will continue to become more secure in a changing economy because of this law.

If you’re a parent, you can keep your kids on your plan until they turn 26 — something that has covered millions of young people so far. That’s because of this law.

If you’re a senior or an American with a disability, this law gives you discounts on your prescriptions — something that has saved 9 million Americans an average of $1,600 so far.

If you’re a woman, you can’t be charged more than anybody else — even if you’ve had cancer or your husband had heart disease or just because you’re a woman. Your insurer has to offer free preventive services like mammograms. They can’t place annual or lifetime caps on your care because of this law.

Because of this law and because of today’s decision, millions of Americans who I hear from every single day will continue to receive the tax credits that have given about 8 in 10 people who buy insurance on the new marketplaces the choice of a health care plan that costs less than $100 a month.

And when it comes to pre-existing conditions — someday, our grandkids will ask us if there was really a time when America discriminated against people who get sick. Because that is something this law has ended for good. That affects everybody with health insurance, not just folks who got insurance through the Affordable Care Act. All of America has protections it didn’t have before.

As the law’s provisions have gradually taken effect, more than 16 million uninsured Americans have gained coverage so far. Nearly 1 in 3 Americans who was uninsured a few years ago is insured today. The uninsured rate in America is the lowest since we began to keep records. And that is something we can all be proud of.

Meanwhile, the law has helped hold the price of health care to its slowest growth in 50 years. If your family gets insurance through your job — so you’re not using the Affordable Care Act — you’re still paying about $1,800 less per year on average than you would be if we hadn’t done anything. By one leading measure, what business owners pay out in wages and salaries is now finally growing faster than what they spend on health insurance. That hasn’t happened in 17 years, and that’s good for workers and it’s good for the economy.

The point is, this is not an abstract thing anymore. This is not a set of political talking points. This is reality. We can see how it is working. This law is working exactly as it’s supposed to. In many ways, this law is working better than we expected it to. For all the misinformation campaigns, all the doomsday predictions, all the talk of death panels and job destruction, for all the repeal attempts, this law is now helping tens of millions of Americans.

And they’ve told me that it has changed their lives for the better. I’ve had moms come up and say, ‘My son was able to see a doctor and get diagnosed, and catch a tumor early, and he’s alive today because of this law.’ This law is working. And it’s going to keep doing just that.

Five years in, this is no longer about a law. This is not about the Affordable Care Act as legislation, or Obamacare as a political football. This is health care in America.

And unlike Social Security or Medicare, a lot of Americans still don’t know what Obamacare is beyond all the political noise in Washington. Across the country, there remain people who are directly benefiting from the law but don’t even know it. And that’s OK. There’s no card that says “Obamacare” when you enroll. But that’s by design, for this has never been a government takeover of health care, despite cries to the contrary. This reform remains what it’s always been: a set of fairer rules and tougher protections that have made health care in America more affordable, more attainable, and more about you — the consumer, the American people. It’s working.

And with this case behind us, let’s be clear, we’ve still got work to do to make health care in America even better. We’ll keep working to provide consumers with all the tools you need to make informed choices about your care. We’ll keep working to increase the use of preventive care that avoids bigger problems down the road. We’ll keep working to boost the steadily improving quality of care in hospitals, and bring down costs even lower, make the system work even better. Already we’ve seen reductions, for example, in the number of readmissions at hospitals. That saves our society money, it saves families money, makes people healthier.

We’re making progress. We’re going to keep working to get more people covered. I’m going to work as hard as I can to convince more governors and state legislatures to take advantage of the law, put politics aside, and expand Medicaid and cover their citizens. We’ve still got states out there that, for political reasons, are not covering millions of people that they could be covering, despite the fact that the federal government is picking up the tab.

So we’ve got more work to do. But what we’re not going to do is unravel what has now been woven into the fabric of America. And my greatest hope is that rather than keep refighting battles that have been settled again and again and again, I can work with Republicans and Democrats to move forward. Let’s join together, make health care in America even better.

Three generations ago, we chose to end an era when seniors were left to languish in poverty. We passed Social Security, and slowly it was woven into the fabric of America and made a difference in the lives of millions of people. Two generations ago, we chose to end an age when Americans in their golden years didn’t have the guarantee of health care. Medicare was passed, and it helped millions of people.

This generation of Americans chose to finish the job, to turn the page on a past when our citizens could be denied coverage just for being sick. To close the books on a history where tens of millions of Americans had no hope of finding decent, affordable health care, had to hang their chances on fate. We chose to write a new chapter, where in a new economy, Americans are free to change their jobs or start a business, chase a new idea, raise a family, free from fear, secure in the knowledge that portable, affordable health care is there for us and always will be. And that if we get sick, we’re not going to lose our home. That if we get sick, that we’re going to be able to still look after our families.

That’s when America soars, when we look out for one another, when we take care of each other, when we root for one another’s success, when we strive to do better and to be better than the generation that came before us, and try to build something better for generations to come. That’s why we do what we do. That’s the whole point of public service.

So this was a good day for America. Let’s get back to work.

WASHINGTON — The Supreme Court on Thursday upheld the nationwide tax subsidies underpinning President Barack Obama’s health care overhaul, rejecting a major challenge to the landmark law in a ruling that preserves health insurance for millions of Americans.

The justices said in a 6-3 ruling that the subsidies that 8.7 million people currently receive to make insurance affordable do not depend on where they live, as opponents contended.

The outcome was the second major victory for Obama in politically charged Supreme Court tests of his most significant domestic achievement. And it came the same day the court gave him an unexpected victory by preserving a key tool the administration uses to fight housing bias.

Obama greeted news of the decision by declaring the health care law “is here to stay.” He said the law is no longer about politics, but the benefits millions of people are receiving.

Declining to concede, House Speaker John Boehner of Ohio 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-centered solutions that meet the needs of seniors, small business owners, and middle-class families.”

At the court, Chief Justice John Roberts again voted with his liberal colleagues in support of the law. Roberts also was the key vote to uphold it in 2012. Justice Anthony Kennedy, a dissenter in 2012, was part of the majority on Thursday.

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Roberts declared in the majority opinion.

Limiting the subsidies only to individuals in states with their own exchanges could well push insurance markets in the other states “into a death spiral,” Roberts wrote.

Justice Antonin Scalia, in a dissent he summarized from the bench, strongly disagreed. “We should start calling this law SCOTUScare,” he said, using an acronym for the Supreme Court and suggesting his colleagues’ ownership by virtue of their twice stepping in to save the law from what he considered worthy challenges.

His comment drew a smile from Roberts, his seatmate and the object of Scala’s ire.

Scalia said that Roberts’ 2012 decision that upheld the law and his opinion on Thursday “will publish forever the discouraging truth that the Supreme Court of the United States favors some laws over others, and is prepared to do whatever it takes to uphold and assist its favorites.”

Justices Samuel Alito and Clarence Thomas joined the dissent, as they did in 2012.

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 pay their insurance premiums.

Of those receiving subsidies, 6.4 million were at risk of losing that aid because they live in states that did not set up their own health insurance exchanges.

The health insurance industry breathed a big sigh of relief, 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 and a former Democratic senator from Nebraska.

Shares of publicly traded hospital operators including HCA Holdings Inc. and Tenet Healthcare Corp. soared after the ruling relieved those companies of the prospect of having to deal with an influx of uninsured people. Investors had worried that many patients would drop their coverage if they no longer had tax credits to help pay.

The challenge devised by die-hard opponents of the law relied on four words — “established by the state” — in the more than 900-page law.

The law’s opponents argued that the vast majority of people who now get help paying for their insurance premiums 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 the federal healthcare.gov to help people find coverage if they don’t get insurance through their jobs or the government.

In the challengers’ view, the phrase “established by the state” demonstrated that subsidies were to be available only to people in states that set up their own exchanges.

The 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 law prevents insurers from denying coverage because of “pre-existing” health conditions. It requires almost everyone to be insured and provides financial help to consumers who otherwise would spend too much of their paycheck on their premiums.

The point of the last piece, the subsidies, is to keep enough people in the pool of insured to avoid triggering a disastrous decline in enrollment, a growing proportion of less healthy people and premium 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 case took place in the midst of Obama’s re-election campaign, when Obama touted the largest expansion of the social safety net since the advent of Medicare 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.

In 2015, the landscape has changed, although the partisan and ideological divisions remain for a law that passed Congress in 2010 with no Republican votes.

The case is King v. Burwell, 14-114.