Justices sustain health law

Obama: It now can’t go away

President Barack Obama, joined by Vice President Joe Biden, speaking Thursday in the Rose Garden, said the Patient Protection and Affordable Care Act “is here to stay.”
President Barack Obama, joined by Vice President Joe Biden, speaking Thursday in the Rose Garden, said the Patient Protection and Affordable Care Act “is here to stay.”

WASHINGTON -- The U.S. Supreme Court upheld a core component of President Barack Obama's health care law, backing tax credits used by millions of Americans to buy insurance.

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AP

Interns for news outlets race across the Supreme Court plaza Thursday morning to deliver the justices’ ruling on the health care law in what is sometimes referred to as the “running of the interns.”

The 6-3 ruling eliminates the most potent legal challenge to a law designed to cover at least 30 million uninsured people and averts a predicted collapse in state insurance markets.

Chief Justice John Roberts and Justice Anthony Kennedy joined the court's four Democratic appointees in the majority. They said the 2010 Patient Protection and Affordable Care Act allows tax credits in all 50 states, not just the 16 that have authorized their own online insurance exchanges.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Roberts wrote. "If at all possible, we must interpret the act in a way that is consistent with the former, and avoids the latter."

The legal fight centered on a four-word phrase. The measure says people qualify for tax credits when they buy insurance on an exchange "established by the state."

The four Virginia residents challenging the law said that phrase meant subsidies weren't available in at least 34 states that never authorized their own exchanges. Residents of those states instead use the federal healthcare.gov system.

Experts said a ruling against the administration might have forced more than 6 million people to drop policies under the health care law because of tripling or quadrupling premiums. The subsidies are scaled to income and average $272 per month.

Roberts said other parts of the law suggested that "established by the state" might include the federal exchange. He rejected the challengers' arguments that Congress intended to give the states an incentive to create their own exchanges.

He said the challengers' interpretation would produce results Congress didn't intend, creating insurance "death spirals" as all but the sickest consumers dropped their policies.

"It would destabilize the individual insurance market in any state with a federal exchange, and likely create the very 'death spirals' that Congress designed the act to avoid," Roberts wrote. "It is implausible that Congress meant the act to operate in this manner."

Roberts said the challengers' arguments about the law's language "are strong" and that the measure was laden with "inartful drafting."

"But in every case we must respect the role of the legislature and take care not to undo what it has done," he wrote. "A fair reading of legislation demands a fair understanding of the legislative plan."

Justices Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan joined Roberts' opinion in the case, King v. Burwell.

Justices Antonin Scalia, Samuel Alito and Clarence Thomas dissented, saying the law was susceptible to only one interpretation. Scalia called the majority opinion "pure applesauce" and "interpretive jiggery-pokery," reading a summary of his dissent from the bench to give it added emphasis.

Scalia said Roberts had performed "somersaults of statutory interpretation" to preserve the act. "We should start calling this law 'SCOTUScare,'" he wrote.

The ruling sends the message 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," he said.

The ruling is the high court's second in three years to preserve the health care law in the face of Republican-backed legal attacks.

In a clash three years ago, the justices upheld another of the law's core provisions, its requirement that people either acquire insurance or pay a penalty. Roberts joined the court's four Democratic appointees in the majority in that case, with Kennedy in dissent.

That ruling also gave states more freedom to opt out of the law's expansion of the Medicaid program for the poor. Twenty-two states have refused to expand Medicaid, reducing the number of people eligible for subsidized insurance by almost 4 million, according to the Kaiser Family Foundation.

The Affordable Care Act "is here to stay," Obama said Thursday at the White House.

"What we're not going to do is unravel what has now been woven into the fabric of America," the president said. "I can work with Republicans and Democrats to move forward. Let's join together. Make health care in America even better."

The challenge to the law was spearheaded by the Competitive Enterprise Institute, a Washington-based advocacy group. Its general counsel, Sam Kazman, called the ruling a "a tragedy for the rule of law in our country."

But groups representing hospitals and doctors praised the ruling. Steven Stack, the president of the American Medical Association, said his group is "relieved."

The American Hospital Association said the decision was a "significant victory for protecting access to care for many of those who need it."

According to a report by the Menlo Park, Calif., based Kaiser Family Foundation, about 48,100 in Arkansans were receiving tax-credit subsidies as of March 31.

In addition to allowing the subsidies to continue, the ruling removed a potential obstacle to the creation of Arkansas-based health insurance exchanges.

A law passed by the Legislature this year would have prohibited the Arkansas Health Insurance Marketplace, a state-created nonprofit organization, from moving forward with creating state-based exchanges if the Supreme Court had ruled in favor of the plaintiffs.

Gov. Asa Hutchinson on Thursday called the ruling "disappointing" and said the state should "proceed with caution" as it considers the "potential of a state exchange."

Using money from a $99.9 million federal grant, the marketplace plans to establish an Arkansas-based exchange for small businesses for coverage that will start as early as Dec. 1 and an exchange for individual consumers for coverage starting in 2017.

Further challenges

Litigation seeking to upend the Affordable Care Act remains, and more will likely be filed, experts said Thursday.

"We have a long, complicated statute that implicates a significant portion of the economy," said Jonathan Adler, a law professor at Case Western University in Cleveland. "The law was poorly written and enacted in a rush."

"We're going to see ACA suits forever," Adler said, adding that while major challenges may be past, "there will continue to be significant cases about the way the law is implemented."

One such battle is already before a federal judge in Washington. House Republicans contend that U.S. reimbursements to insurance companies, expected to tally about $175 billion over a decade, weren't approved by Congress, and that Obama unlawfully delayed by a year a requirement that most employers offer insurance to their workers.

Obama administration attorneys on May 28 asked U.S. District Judge Rosemary Collyer to dismiss the suit, arguing the issues are political and should be resolved in Congress. She has yet to rule.

Timothy Jost, a law professor at Washington & Lee University in Lexington, Va., said a decision to strike down those reimbursements wouldn't extinguish the law but may force insurance carriers to raise rates.

Indiana and dozens of its school districts sued in 2013 over an aspect of the law's employer-coverage mandate. At issue is a requirement that companies provide coverage to any employee who works more than 30 hours a week or pay a penalty, as well as the tax subsidy that was at issue in Thursday's Supreme Court ruling, claiming these violate state sovereign rights.

An Indianapolis federal judge who heard the arguments put his ruling on hold pending the outcome of the high court case.

Others said Thursday that no current lawsuit is seen by supporters or opponents as an existential threat.

"The real threats to the Affordable Care Act are largely behind us," said Ron Pollack, executive director of Families USA, a health-care advocacy group. David Rivkin, a Washington lawyer who represented opponents of the law, agreed, saying there aren't any "fundamental challenges" left.

On the horizon, however, is the possibility that Republicans, who have opposed the law from the start, capture the White House and retain control of Congress. Then the law may again be at risk.

The 2010 Patient Protection and Affordable Care Act has weathered more than 50 votes for delay or repeal in the Republican-led U.S. House of Representatives.

Democrats said the ruling should send a signal to Republicans.

"Stop wasting the time of the American people by trying to repeal a law," said Senate Minority Leader Harry Reid of Nevada. "Enough's enough. Let's move on."

But Senate Majority Leader Mitch McConnell, R-Ky., urged Democrats on Thursday to work with his party to alter the law.

"The politicians who forced Obamacare on the American people now have a choice: crow about Obamacare's latest wobble towards the edge, or work with us to address the ongoing negative impact of a 2,000-page law," McConnell said in a speech on the Senate floor shortly after the ruling was issued.

Jost said that even if Republicans capture the White House next year, the prospect of outright repeal is unlikely. He said the legislation is now so interwoven with the U.S. health care industry that "it would be like repealing the interstate highway system."

Jost's sentiments were supported by health care stocks, which jumped as much as 8 percent on the Supreme Court ruling.

Still, the law could be significantly amended to limit its effectiveness and reach, Jost said.

Information for this article was contributed by Greg Stohr, David McLaughlin, Mark Drajem, Billy House, Kathleen Hunter, Zachary Tracer and Andrew Harris of Bloomberg News; by Robert Barnes of The Washington Post; and by Andy Davis of the Arkansas Democrat-Gazette.

A Section on 06/26/2015

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