The long-awaited decision is in.
The U.S. Supreme Court ruled the Obama administration can continue to subsidize health-insurance purchases by lower-income Americans across the country, a decision that preserves a centerpiece of the Affordable Care Act. The ruling marks the second time President Barack Obama’s signature domestic policy achievement has survived a near-death experience in the courts, and leaves the law on a firmer footing for the remainder of his time in office. The court ruled contested language in the 2010 health-care law allows the administration to offer subsidies in the form of tax credits to people in all states, including those who buy health coverage on the federal insurance site HealthCare.gov.
The Supreme Court ruled on Thursday that President Obama’s health care law may provide nationwide tax subsidies to help poor and middle-class people buy health insurance. Chief Justice John G. Roberts Jr. wrote the majority opinion in the 6-to-3 decision. The court’s three most conservative members — Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. — dissented.
The U.S. Supreme Court upheld the nationwide tax subsidies that are a core component of President Barack Obama’s health-care law, rejecting a challenge that had threatened to gut the measure and undercut his legacy. The 6-3 ruling is the high court’s second in three years to preserve Obamacare in the face of Republican-backed legal attacks. It averts a collapse in state insurance markets and lets millions of Americans keep using federal tax credits designed to make policies affordable. Chief Justice John Roberts and Justice Anthony Kennedy joined the court’s four Democratic appointees in the majority. They said the 2010 Affordable Care Act allows tax credits in all 50 states, not just the 16 that have authorized their own online insurance exchanges.
The Supreme Court cemented President Barack Obama’s signature achievement on Thursday by affirming that the Affordable Care Act intended to help all Americans who need help paying for their insurance. In their 6-3 majority in King v. Burwell, the justices ruled that Americans are eligible for subsidies regardless of whether their state set up its own exchange. The result preserves premium assistance for 6.4 million customers in the 34 states that rely on the federal marketplace. On a practical level, it also preserves the mandate, at the center of the law and of its controversy, that every American buy health insurance.
If you were going to boil the decision down to two sentences, it would be this one from Roberts, writing for the majority: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.” And this one from Antonin Scalia: “We should start calling this law SCOTUScare.”
Looks like opponents won’t win in court, so they will have to win at the ballot box if they continue to seek total repeal or substantive change. But the odds of that happening just dropped. As Philip Klein wrote for Bloomberg:
The U.S. Supreme Court is expected to decide by late June whether millions of Americans in three dozen states are benefiting from illegal health insurance subsidies. If the justices invalidate those subsidies, Republicans must have a free-market alternative waiting in the wings. Otherwise, there will be tremendous pressure on Congress to pass a “fix” allowing existing benefits to continue. Obamacare will be entrenched before Republicans even get a chance to retake the White House.
The entrenching continues apace. But reform seems a more likely outcome and fruitful path forward and should be considered. One promising venue was highlighted on Twitter, moments after the ruling, by my pal Derek Khanna: “Since SCOTUS has upheld Obamacare again, GOP should respond w/: “How to use tech & innovation for cheaper, faster & better healthcare.”
But innovation can also improve Obamacare itself. Let me again refer to “Seize the ACA: The Innovator’s Guide to the Affordable Care Act“ by Ben Wanamaker and Devin Bean of the Clayton Christensen Institute as possible blueprint for reform: ” … where provisions of the ACA discourage disruptive innovation—namely, Insurance Exchanges, Essential Health Benefits, Cost-Sharing Requirements, Medical Loss Ratio, and Medicaid Expansion—we appeal to policymakers to focus their efforts on making the legislation more innovation-friendly.”
But there are other reform ideas out there that assume Obamacare will continue to exist in more or less its basic structure. Center-right policymakers must actively pursue and develop them. As Peter Suderman writes in Politico, “Obamacare, in other words, was ClintonCare’s second act—the culmination of more than 15 years of work and consensus building. To put it another way: Republicans never started working on health policy; Democrats never stopped.”
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