The fate of President Obama’s signature legislation, the Patient Protection and Affordable Care Act (ACA), hung on just four words: “…established by the State.” The Supreme Court of the United States sided with the Obama administration in a 6-3 decision in King v. Burwell.
The plaintiffs argued that government subsidies would only be available to those buying insurance through a state-based insurance exchange and not the federal marketplace, Healthcare.gov. The defendant, Health and Human Services Secretary Sylvia Burwell, argued that specific clauses should be viewed in light of the whole legislation and that extending subsidies to all insured was a reasonable assumption.
Chief Justice John Roberts and Associate Justices Stephen Breyer, Ruth Bader Ginsburg, Anthony Kennedy, Elena Kagan and Sonia Sotomayor voted to uphold a lower court decision. Dissenting were Associate Justices Antonin Scalia, Samuel Alito and Clarence Thomas.
“This decision is a victory for women and families,” March of Dimes President Jennifer L. Howse said via a statement. “The tax credits provided under the Affordable Care Act are enabling millions of women and families to purchase affordable health insurance in Health Insurance Marketplaces. We’re gratified that the Supreme Court accepted the arguments put forth by the March of Dimes and our allies supporting the legality of the ACA tax subsidies.”
The American Cancer Society and its advocacy arm the Cancer Action Network (ACS-CAN), the American Diabetes Association, the American Heart Association and the National Multiple Sclerosis Society “responded enthusiastically” to the decision in a joint statement.
“We commend the Court for not halting premium tax credits in the federal marketplaces, enabling an estimated 6.4 million people in 34 states to keep the assistance that makes their health insurance affordable. As a result, these patients can continue to focus on their healing and recovery, instead of worrying about losing their coverage and care,” said Nancy Brown, CEO of the American Heart Association.
“Today’s decision ensures that more than 6 million low- and middle-income people nationwide will continue to receive the financial assistance they need to afford health coverage,” said Chris Hansen, president of ACS CAN. “It means that millions of people with serious health conditions such as cancer will continue to have access to essential treatment and care, and millions of others at risk for disease will be able to afford preventive screenings and tests that could save their lives.”
American Diabetes Association CEO Kevin Hagan said, “We cannot significantly improve access to quality, affordable health coverage unless federal financial assistance is available in federal and state marketplaces nationwide.”
Cyndi Zagieboylo, president and CEO of the National Multiple Sclerosis Society, laid out some of the challenges that uninsured patients face: more expensive care; greater risk of bankruptcy when faced with the costs of care; and, higher healthcare costs “systemwide.”
The organizations filed an amicus curiae brief in January that outlined more dangers of being uninsured and sick. The uninsured are at higher risk of developing certain types of cancers and are more likely to go without treatment. They have longer hospital stays, more neurological impairments and a higher risk of death when they suffer a stroke. They are twice as likely to develop complications from diabetes.
Those with access to health insurance get an earlier and more accurate MS diagnosis, “which is essential to reducing the frequency and severity of relapses and slowing the progression of the disease,” according to the statement’s authors.
The Parkinson’s Action Network, based in Washington, D.C., also lauded the decision. “The ACA has had a profound effect on health delivery in this country and it’s important that PAN and other patient advocacy groups continue to work with the government and insurers to make sure that the system is working,” Ted Thompson, CEO of PAN, said in a statement.
“The Affordable Care Act has proven to be an effective way of ensuring people with chronic diseases and disabilities have access to meaningful insurance coverage,” Marc Boutin, CEO of the National Health Council (NHC), said in statement. “The Supreme Court made the right decision – a decision that will enhance coverage and improve patient access to quality health care,” he said. “Now that this decision is behind us, let’s focus our thoughts and actions on strengthening and enhancing the exchanges to better serve the patient community.”
The National Association of Free & Charitable Clinics issued a statement calling the decision a victory but tempering enthusiasm because of the millions of people who don’t have access to affordable health care and health insurance. The Alexandria, Va.-based association estimates that 70 percent of its more than 1,200 clinics report patients are returning for help even after signing up for insurance because of issues with timely access to a doctor or access to affordable medication.
“Hopefully one day we will live in a country where no one feels alone and forgotten because they can not afford to see a doctor. Today’s ruling is another step in improving access to health care but unfortunately it does not answer this plea,” according to a statement released by the NAFCC.
It’s not just health- and medical-related nonprofits supporting the decision. Sandy Kennedy, president of the Retail Industry Leaders Association in Arlington, Va., said in a statement that, “The Supreme Court took clear action today to uphold the critical safety net that Exchange tax credits provide for millions of American families.” She called on Congress to take “bipartisan action to make much-needed, and long-awaited, structural changes.”