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The Supreme Court’s affirmation of federal health care reform means 6.4 million low- and middle-income Americans, including 228,000 in Michigan, will continue getting annual subsidies to help them pay for coverage. But it doesn’t end partisan bickering on the issue that has become the hallmark of Barack Obama’s presidency.

The ruling makes it all but impossible for Republicans to undo the act before Obama leaves office in 2017. Still, several Republicans with eyes on succeeding Obama, as well as House Speaker John Boehner of Ohio, vowed to continue the fight — despite the 6-3 High Court ruling that for the second time in three years upheld a major aspect of the Affordable Care Act.

Obama greeted news of the health care decision by declaring the law is no longer about politics but the benefits millions of people are receiving. “This is no longer about a law,” he said in the White House Rose Garden. “This is health care in America.”

The court was asked to decide whether subsidies to lower monthly premiums should benefit only those states that build their own insurance exchanges — not to the 34, including Michigan, where the federal government operates the marketplaces. Subsidies average $272.

In an opinion written by Chief Justice John Roberts, the court said no.

“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.”

Obama declared that the health care law “is here to stay.”

“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,” he said. “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.”

Nationally, 10.2 million people have signed up for insurance under Obama’s health care overhaul. That includes the 8.7 million people who are receiving a subsidy to help pay their 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.

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 signaled their fight would go on.

Boehner vowed that 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.” Sen. Ted Cruz, R-Texas, a presidential candidate, called the court majority “lawless.”

Majority rejects challenge

In announcing the court’s decision from the bench, Roberts said the statute “clearly contemplates” that individuals would qualify for the tax credits in all the exchanges, whether established by a state or federal government. He acknowledged the petitioners’ argument was “strong,” but the statute as a whole “compels” the justices to reject it.

He noted that Congress crafted key elements of the health care law 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.

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

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

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

The case decided Thursday, as well as a previous ruling on the health care law, “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.

“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,” Sedler said.

With the conclusion of the case, no broad legal challenges to the statute remain, 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.

Obama scores 2nd big win

The outcome was 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 the health care law 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.”

Terry Burke, a vice president at Blue Cross Blue Shield of Michigan, said in a statement Thursday that the decision “allows thousands of Michigan consumers to stay covered, and gives those who remain uninsured the opportunity to explore their options knowing financial assistance will be available now and into the future, giving those who need help a sense of security when buying health insurance.”

Dr. William Conway, executive vice president of Henry Ford Health System and CEO of Henry Ford Medical Group, said 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.”

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. She urged Republicans to “stop playing games and get to work making sure the law works for every American family.”

With the case settled, Gov. Rick Snyder said he will focus on Michigan health care and expansion of Medicaid.

“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,” he said.

His fellow Republican, state Attorney General Bill Schuette, 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,” Schuette said.

U.S. Rep. Fred Upton, R-St. Joseph, said the health care law is “deeply unpopular” and 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,” he 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.”

Staff writer Jim Lynch and Associated Press contributed.

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