Washington — The U.S. Supreme Court on Thursday ruled 6-3 that subsidies to people in states that didn’t set up their own health care marketplaces under a sweeping health care reform law are constitutional — a major win for the Obama administration.

The opinion makes it all but impossible Republicans will be able to undo the sweeping health care reform before President Barack Obama leaves office in 2017.

It also heads off a major battle that was expected this summer as the Republican-led Congress faced pressure to find a new way to extend subsidies for millions of Americans getting health insurance.

The court, in an opinion written by Chief Justice John Roberts, rejected a challenge to the Affordable Care Act that argued the subsidies to lower monthly premiums should benefit only those enrollees in states that built their own insurance exchanges, and not to the 34 states where the federal government operates the marketplaces.

As a result of the ruling, an estimated 6.4 million Americans, including more than 228,000 in Michigan, get to keep those subsidies, which are in the form of tax credits.

“We must respect the role of the legislature and take care not to undo what it has done,” Roberts wrote. “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”

Five years after a lengthy battle to reshape America’s $2 trillion health care market, Obama in a Rose Garden victory lap cast the ruling Thursday as a historic and emphatic declaration that the law has now been “woven into the fabric of America.”

“The Affordable Care Act is here to stay,” Obama said.

“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 backwards. And that’s not what we do.”

Obama called the court’s ruling a victory for hard-working Americans, ticking off specific benefits to parents, seniors, women, businesses, workers and more, then drawing an over-arching conclusion: “All of America has protections it didn’t have before,” he said.

But Republicans denounced the decision and the act, with Sen. Ted Cruz, R-Texas, a presidential candidate, calling the majority on the court “lawless.”

Dr. William Conway, executive vice president of Henry Ford Health System and CEO of Henry Ford Medical Group, said in an interview that if the court had ruled the opposite way it would have been “chaos.”

Hundreds of thousands of people in Michigan would “have lost insurance. It would have been a terrible mess,” Conway said. “We’re relieved. ... This was a technicality — and they were not going to create a lot of chaos over a technicality.”

In announcing the court’s decision from the bench, Roberts said the statute “clearly contemplates” that there would be individuals qualifying for the tax credits in all the exchanges, whether established by a state or federal government.

Roberts acknowledged the petitioners’ argument was “strong,” but the statute as a whole “compels us” to reject it.

He noted that Congress crafted key elements of the ACA behind closed doors and passed it using a complicated procedural maneuver that allowed for limited amendments and debate. Thus, the law does not reflect the type of “care and deliberation that one might expect of such significant legislation,” he said.

He joked about a cartoon once referenced by former Chief Justice Felix Frankfurter describing a senator who tells his colleagues “I admit this new bill is too complicated to understand. We’ll just have to pass it to find out what it means.”

Still, Roberts stressed the court’s obligation to respect the role of the legislature in a democracy, noting the justices are not popularly elected.

The administration had maintained that the intent was always for the tax credits to be available in all 50 states. The 4th U.S. Circuit Court of Appeals agreed, finding the subsidies are “essential” to fulfilling the primary goals of the 2010 law.

Justice Antonin Scalia, in a dissent he summarized from the bench, said the court’s opinion tries to “palm off” as a drafting error the phrase in the law, “established by the state.”

“But this court has no free-floating power to rescue Congress from its drafting mistakes,” Scalia said, noting that the phrase “by the state” appears in seven provisions of the Affordable Care Act that mentions tax credits.

“What are the odds, do you think, that the same slip of the pen occurred in seven separate places?”

He accused the court of rewriting the Affordable Care Act, saying, “we really should start calling the law SCOTUScare,” Scalia said, using the acronym for Supreme Court of the United States.

“The interpretive somersaults they have formed will remain as astounding precedent, cited by lawyers to confuse our jurisprudence,” he said.

“And these two cases will publish forever the discouraging truth that the Supreme Court of the United States favors some laws over others, and that it is prepared to sacrifice all the usual interpretive principles … to uphold and assist its favorites.”

Justices Clarence Thomas and Samuel Alito joined Scalia’s dissent.

Robert Sedler, a constitutional law scholar at Wayne State University Law School, disagreed with Scalia’s contention that the majority upended the usual rules of statutory interpretation.

“The court applied the fundamental principle of statutory construction that the words of a statute must be read in their context and with a view toward their place in the overall statutory scheme,” Sedler said.

“Since the text is ambiguous, the court must look to the broader structure of the Act to determine whether one of the permissible meanings — that the law includes federal exchanges — produces a substantive effect that is compatible with the rest of the law.”

With the conclusion of the case, no other broad legal challenges to the statute are outstanding, said MaryBeth Musumeci, an attorney and associate director of the Kaiser Commission on Medicaid and the Uninsured.

“This decision today is a pretty clear affirmation that the law is here to stay, unless Congress was to do something,” Musumeci said.

The outcome is the second major victory for Obama in politically charged Supreme Court tests of his most significant domestic achievement.

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

Kathe Koja of Berkley said she was “over-the-moon” elated with the ruling, which means she can continue to afford her health care premiums through the exchange with help of the tax credits.

“This is just a resounding victory for public health and common sense,” Koja said, adding she hoped this means the battle over Obamacare is over.

“The opposition has no other plan. They were basically against this without being for anything else. They have nothing to replace it, and the Supreme Court basically puts the stamp of approval on Obamacare.”

U.S. Sen. Debbie Stabenow, D-Lansing, who helped write the tax credit section of the law as a member of the Senate Finance panel, also hailed the decision.

“Today’s decision means millions of families will be able to keep their affordable health insurance for themselves and their children,” she said. “Once again, the Supreme Court has upheld the Affordable Care Act, and I urge Republicans to stop playing games and get to work making sure the law works for every American family.”

Meanwhile, Gov. Rick Snyder said he would focus on Michigan health care.

“Our focus can now center on securing the second waiver for our Healthy Michigan Plan, which has been an outstanding success ,” Snyder said, referring to the state expansion of Medicare. “Regardless of feelings on the Affordable Care Act, it’s vital to our state that we continue working to improve and reform health care, create more and better jobs.”

Michigan Attorney General Bill Schuette, however, blasted the ruling.

“The Affordable Care Act violated the very first principle of medicine: Do no harm. The court’s ruling today continues the harm inflicted by Obamacare,” he said.

Michigan wasn’t a party in the case, King v. Burwell, but in a separate suit before a federal appeals court in Washington, Schuette last year signed on to a brief with his counterparts in Kansas and Nebraska, arguing against the tax credits in states that opted not to set up an exchange.

House Speaker John Boehner, R-Ohio, said Republicans wouldn't give up efforts to repeal the health care law. Rep. Fred Upton, R-St Joseph, says the Affordable Care Act hasn't worked.

“What remains today is a law that is deeply unpopular, and that has broken all of its core promises. Over the past five years, millions of plans have been canceled, the cost of health care has skyrocketed, and access to care has been limited," Upton said.

“Folks in Michigan tell me that they are looking to Washington for real solutions that lower costs and improve access to quality care. That’s what we have done and will continue to do.”

Upton and House colleagues spent the past several months working with governors and state leaders across the country “to develop solutions so that more Americans are not victimized further by this law.”

Rep. John Moolenaar, R-Midland, said the court’s decision fails to protect Americans from Obamacare, and that he would continue to fight for “patient-centered” alternatives.

House Democrats, including Rep. Sander Levin, D-Royal Oak, argue the law is working.

“Today, the Supreme Court of the United States reaffirmed that the American people, no matter where they live in this country, still have the right to access quality, affordable health insurance,” Levin said in a joint statement with Reps. Bobby Scott, D-Virginia, and Frank Pallone Jr., D-New Jersey.

“Legal experts had always considered the case attacking the Affordable Care Act to be legally frivolous.”

The nonpartisan Kaiser Family Foundation this week analyzed insurance premium changes for 2016 for the most popular plans under the Affordable Care Act exchanges in 11 major cities by studying the rate filings by insurers with state regulators.

Kaiser found across the 11 cities that the second-lowest cost “silver” plan is increasing by an average 4.4 percent over 2015 and by 2.5 percent in Detroit. The lowest-cost “silver plan is increasing by an average 4.5 percent but decreasing by 4.2 percent in Detroit.

The report says the number of insurers offering coverage through the exchange in Michigan will drop from 13 to 12 in 2016 with the departure of Assurant. Insurer participation elsewhere was largely stable.

Sen. Gary Peters, D-Bloomfield Township, praised the ruling, adding that he hopes it encourages his Republican colleagues to stop trying to repeal the Affordable Care Act and to “start working across the aisle to improve access to quality, affordable health care for all Americans.”

Nationally, 10.2 million people have signed up for health insurance under the Obama healthcare 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 people were at risk of losing that aid because they live in states that did not set up their own health insurance exchanges.

Associated Press contributed.


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