The U.S. Supreme Court today voted 6-3 to uphold the provision of the Affordable Care Act that allows people using the federal health insurance market to receive tax subsidies.
Wisconsin is one of 34 states that have adopted a federally run exchange as opposed to a state-run exchange. If the Supreme Court had ruled against the Obama administration in the King v. Burwell case, 184,000 people in Wisconsin and 6 million people nationwide could have lost their health insurance.
The Supreme Court’s decision was considered by many to have boiled down to four key words in the Affordable Care Act: “established by the state.” The plaintiffs in King v. Burwell claimed those words meant the tax subsidies were intended only for those in state-run exchanges. The Obama administration said “the state” refers to the government in general, whether state or federal.
Reaction to today’s ruling was mixed.
According to the Wisconsin Hospital Association, 33,469 Milwaukee County residents were enrolled in the exchange as of April.
“We are pleased with this decision,” said Wisconsin Hospital Association president and chief executive officer Eric Borgerding. “The loss of premium assistance would most certainly have triggered a large increase in the number of uninsured. The disruption to our health care system and broader insurance markets would have been substantial.”
Borgerding said thousands of people in Wisconsin who were previously uninsured, or who were made ineligible for Medicaid, connected with health insurance coverage on the federal exchange. The subsidies reduced the monthly cost of buying insurance on the exchange to an average of $125 per month in Wisconsin, he said.
Brett Healy, president of the John K. MacIver Institute for Public Policy, a Madison-based conservative advocacy organization, disagreed with the court’s interpretation. “It is disappointing that the Supreme Court failed to stand with taxpayers today,” he said. “The Affordable Care Act says in plain language that individuals who purchase insurance through Obamacare only qualify for subsidies ‘established by the state,’ and the Court’s decision today unfortunately endorses a flawed law that has driven up health care costs exponentially. Instead of interpreting the law for what it actually says, the Court interpreted it for what they wanted it to say. The Affordable Care Act is severely broken, and this activist result will only continue the negative impact the law has had on taxpayers in Wisconsin and the country.”
The impact of today’s ruling means that the Affordable Care Act in its present form is here to stay, according to Charlie Stevens, an employment attorney at Milwaukee-based Michael Best & Friedrich LLP. “The upshot is the Affordable Care Act will continue to be enforced, low-income individuals will continue to get subsidies, employers are still subject to the pay-or-play mandate, and the rules that are part of what Congress drafted and the rules and regulations the federal agencies came up with to enforce it will still be in effect and will be enforced,” Stevens said.
Stevens added that large employers will still be required to offer coverage to employees who average 30 or more hours a week. If they do not offer coverage to 70 percent of full-time employees, they will be subject to the pay-or-play penalty. Next year, he said the percentage of full-time employees who must be offered coverage will be 95 percent.
Besides Healy, others who were disappointed by today’s decision included Sen. Ron Johnson (R-Wis.). “That decision upholds legislation that was falsely marketed and forced through Congress in a completely partisan fashion and that has harmed millions of Americans,” Johnson said. “The court’s decision cements a system costing millions of Americans the health plans they chose and liked and access to doctors they knew and trusted. The Supreme Court is sustaining higher health care costs for patients and taxpayers, a law that makes it costlier for employers to hire and harder for workers to keep full-time jobs.”
Republican National Committee chairman Reince Priebus said, “Today’s ruling makes it clear that if we want to fix our broken healthcare system, then we will need to elect a Republican president with proven ideas and real solutions that will help American families.”
Wisconsin Gov. Scott Walker tweeted: “Today’s #SCOTUScare ruling means Republicans must redouble their efforts to repeal and replace this destructive & costly law.”
The decision, however, was also met with applause from many local and national leaders and organizations.
“It is my hope that this historic decision from America’s highest court will put an end to (Walker’s) support for repealing health care for Wisconsin families and that he will do the right thing and accept a federal investment in our BadgerCare program instead of clinging to his plan to cover fewer people at a higher cost to Wisconsin taxpayers. I also believe this Supreme Court decision should send a powerful message to Congressional Republicans,” said Sen. Tammy Baldwin (D-Wis).
John Arensmeyer, founder and chief executive officer of Small Business Majority, a national small business advocacy organization, said: “The Supreme Court’s decision protects the millions of small business owners, employees and self-employed freelance entrepreneurs from losing the valuable health insurance they have secured in the past 18 months. Moreover, eliminating the credits would have led to a return of ‘job lock,’ which shackled many would-be entrepreneurs to jobs working for others rather than starting their own businesses.”
Congresswoman Gwen Moore (D-Wis.) said, “This landmark legislation provides all Americans, regardless of where they live, with access to quality health care, and is an important lifeline for our working and middle class families. This Supreme Court decision is further confirmation that the ACA is here to stay. I call upon my Republican colleagues to end their efforts to undermine the ACA, and to work with Democrats to improve this vital law that continues to secure the health and well-being of all Americans.”
State Assembly Democratic Leader Peter Barca (D-Kenosha) said, “Today’s court decision is an especially important victory for Wisconsin families, especially the 183,000 Wisconsinites – including 11,000 children – who stood to lose their health care coverage. Just yesterday the Governor made it clear he would not take any affirmative steps to ensure those families would continue to be covered had the decision gone the other way.”
The National Association for the Self-Employed said, “At a time when affordable health care premiums continue to be a major concern for small business owners, today’s ruling comes as a relief to the millions of mom-and-pop business owners across the country who are complying with the individual mandate requirement, but happen to live in a state who declined to establish a state-based exchange.”
Sara Finger, executive director of the Wisconsin Alliance for Women’s Health, said, “This decision means that we won’t turn the clock back on the progress we’ve made. Our work is not finished. We will continue our advocacy to advance the goal of access to health care for all Wisconsinites by advocating for Medicaid expansion to ensure Wisconsinites who cannot afford private insurance have access to the health care they need to live long, healthy and productive lives.”