The U.S. Supreme Court ruled Thursday by a 6-3 vote that more than 6 million Americans, including 1.3 million Floridians, can continue to receive subsidies under the Affordable Care Act to buy health insurance through the federally run exchange at HealthCare.gov.
Ruling in the case of King v. Burwell, the Supreme Court upheld the Obama administration’s interpretation of the health law that allows billions of dollars in health insurance subsidies — including an estimated $389 million a month for Florida residents — to be distributed in the 34 states where the federal government operates the insurance exchange because the state decided against it.
Writing for the majority, Chief Justice John Roberts acknowledged that the challengers' "arguments about the plain meaning . . . are strong."
But, he noted: "Congress passed the Affordable Care Act to improve health insurance markets, not to estroy them."
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From the majority opinion: "In this instance, the context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase."
Dissenting were Justices Antonin Scalia, who read his opinion from the bench, according to a report from SCOTUSblog.com, Clarence Thomas and Samuel Alito. Scalia was critical of the health law in his reading from the bench.
From Scalia's dissent: "We should start calling this law SCOTUScare."
Outside the Supreme Court in Washington, D.C., crowds of supporters of the health law known as Obamacare hoisted signs and led chants cheering the decision.
But the law remains controversial in Florida, as the rest of the nation. While advocates trumpeted the decision as a victory, opponents slammed the court’s ruling.
“Today’s Supreme Court decision will allow millions of patients to continue accessing the health care they need and deserve,’’ said Steven J. Stack, a physician and president of the American Medical Association, the largest physician’s group in the country, in a written statement.
U.S. Senator Marco Rubio, a Florida Republican campaigning to be president, made it clear he disagreed with the court’s decision.
“I disagree with the Court’s ruling and believe they have once again erred in trying to correct the mistakes made by President Obama and Congress in forcing Obamacare on the American people,'' Rubio said in a written statement.
“Despite the Court’s decision, ObamaCare is still a bad law that is having a negative impact on our country and on millions of Americans. I remain committed to repealing this bad law and replacing it with my consumer-centered plan that puts patients and families back in control of their health care decisions.”
Healthcare policy analysts say the challenges from Congress remain as a viable threat to the law.
“Congress may still pursue strategies to alter the Affordable Care Act, and the debate over reform is likely to reignite as part of the 2016 presidential race,” said Elizabeth Carpenter, director of Avalere, a healthcare consultant. “Congress is still likely to consider repeal of the medical device tax and the Independent Payment Advisory Board, as well as changes to the employer mandate and the Cadillac Tax.”
The plaintiffs in King v. Burwell had challenged the government’s authority to provide those subsidies to individuals who buy health insurance on the federal exchange. They argued that a literal interpretation of the health law meant subsidies could only be given to consumers who bought plans on an insurance exchange established by a state.
Florida is one of 34 states that has not established an insurance exchange under the health law and instead relies on the federally-run marketplace at HealthCare.gov. However, two of those states, Delaware and Pennsylvania, have received conditional approval to operate state-based exchanges in 2016.
Washington, D.C., and 16 states have established insurance exchanges. Residents of those states would not have been affected by a Supreme Court ruling for the challengers.
Subsidies are provided to low- and middle-income Americans to help them afford insurance. The health law mandates that most people have health insurance.
Leah Heinz, CEO of Florida Chain, a statewide health advocacy organization, said the decision "safeguarded health care access for more than six million Americans and more than a million Floridians." She added that the ACA "is working as intended, and today’s decision should finally put an end to efforts to hijack or derail this historic and law that is saving lives. Now it is time for state leaders to roll up their sleeves and get to work closing Florida’s disgraceful coverage gap."
As of March 31, more than 1.4 million Floridians were enrolled in a health plan through the federally-run exchange, with about 1.3 million of them receiving financial help from the government to make their insurance more affordable, according to the U.S. Department of Health and Human Services.
Eligible Floridians can receive two types of financial aid under the health law: one to help pay monthly premiums through the use of tax credits, and another to help pay out-of-pocket costs, such as deductibles and co-insurance, called a “cost-sharing reduction.”
In Florida, about 1.3 million residents receive a premium tax credit, and nearly 1 million receive the cost-sharing reduction, according to government data.
On average, those Floridians received a premium tax credit of $294 per person in March, reducing their monthly payment for health insurance to an average of $82, according to government data.
South Florida, in particular, was an enrollment powerhouse. Combined, sign-ups in Miami-Dade, Broward, Monroe and Palm Beach counties topped those in 47 entire states. Miami-Dade County alone enrolled more people than 43 states: about 400,000 as of Feb.22.
The country’s top enrollment ZIP codes were also in South Florida. Hialeah claimed the No.1 ZIP code in the country — 33012 — along with three others in the top 10.