What today’s Affordable Care Act Supreme Court decision means for our region

The Supreme Court on Thursday upheld the nationwide tax subsidies under President Barack Obama’s health care overhaul.  The ruling preserves health insurance for millions of Americans, of which over 500,000 live in Delaware, New Jersey and Pennsylvania.

The Supreme Court on Thursday upheld the nationwide tax subsidies under President Barack Obama’s health care overhaul. The ruling preserves health insurance for millions of Americans, including a half million people in the tri-state region.

The justices said in a 6-3 ruling that the subsidies that 8.7 million people currently receive to make insurance affordable do not depend on where they live, under the 2010 health care law. The average person receiving a subsidy receives $272 a month to help make their insurance premiums more affordable. 

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.

Over 500,000 of those people live in Delaware, New Jersey and Pennsylvania. 

Nationally, 10.2 million people have signed up for health insurance under the Obama health overhaul.

In Delaware, Pennsylvania and New Jersey — none of which currently have state-run health insurance exchanges — the impact of the decision is being felt around the region. 

Delaware Department of Health and Social Services Secretary Rita Landgraf said she is grateful that the 19,128 Delawareans who qualify for subsidies on Delaware’s marketplace will continue to receive monthly tax credits that average $265.

The decision came as a huge relief for 63-year-old Tom Shea of Marlton, New Jersey. Last year, Shea helped hundreds of people enroll in subsidized coverage as a certified counselor. He qualified, too, for a plan that costs him about $50 a month. Without the discounts, he says it would be over $700 and  he wouldn’t be able afford it.

“It’s very important for me, I’m a cancer survivor,” he said, adding that insurance covers of majority of the costly $4,000 monthly injections he needs. 

University of Pennsylvania law professor Ted Ruger said the decision from the Supreme Court will prevent some political angst for governors in Pennsylvania, New Jersey and Delaware.

“A contrary ruling really would have put it on the front door of the governors and the statehouses in those states to come up with an insurance solution to small business owners and middle class individuals who would have then been deprived of the subsidies,” he said.

Ruger added that justices decided that the “intent” of the health law was most important, even if some of the legislative language was unclear.

Fifty-two-year-old Adrien Martinez was born and raised in Camden, New Jersey. And after years of being uninsured, he enrolled in health coverage through the affordable care act. He said that was thanks to a discount he qualified for that brought his monthly premium down to just under 200 dollars a month.

“It means the world to me,” he said.

Martinez added he wouldn’t be able to afford the coverage without those discounts. It’s helped him get back on his feet. No more postponing care, going to the ER or getting charity care.

Many groups say the justices got it wrong.

“The Court decision is a disappointment for the rule of law and for the states that have fought to keep Obamacare’s flawed policies out of their states,” said Heritage Foundation’s director of the Center for Health Policy Studies Nina Owcharenko.

Opponents say the health law still has big problems and has increased the cost of insurance for many Americans.

“The ball’s now back in Congress’s court, I don’t think there’s anyone who thinks efforts to repeal the law, or significantly reform the law are going to end anytime soon,” said Elizabeth Stelle, director of policy analysis for the Commonwealth Foundation, a free market think tank in Harrisburg.

Stelle says ironically her group’s main concern with the Affordable Care Act is affordability.

“We’re seeing insurance continue to increase in cost, even on the exchange,” Stelle said.

In Pennsylvania the 2016 rate increase requests were “quite high,” she said.

“Highmark asked for rate increases between 23 and 39 percent,” she said. “Geisinger between 40 and 58 percent, so, we are moving in the wrong direction.”

Stelle said the battles ahead will include a push to loosen some of the ACA’s regulations, including how much insurance companies have to spend on health services and benefit mandates. Those determine what benefits have to be covered in order for a plan to qualify as adequate insurance.

Before today’s ruling Pennsylvania and Delaware said they would be pursuing state-based exchanges. 

Shortly after the decision came through Pennsylvania Governor Tom Wolf said the state would no longer be taking such actions. 

Wolf released the following statement in response to the ruling.

“I am extremely pleased with the Supreme Court’s ruling in King v. Burwell. As a result of this decision, roughly 382,000 Pennsylvanians will keep their much-needed assistance to help them afford health care.

I took steps to protect Pennsylvania’s consumers by putting in place a contingency in the event the Supreme Court ruled people are not eligible for subsidies, but I am pleased to say that we will no longer need to rely on this plan.

My administration will be notifying the federal government that we will be withdrawing our plan to set up a state based health insurance marketplace in Pennsylvania.”

Antoinette Kraus, director of the Pennsylvania Health Access Networks, said she hopes the state does not abandon its efforts to set up a state-run exchange.

“We are relieved Pennsylvania doesn’t have to rush and set up a marketplace as a result of an adverse ruling, but we definitely think it’s worth exploring,” she said.

U.S. Representative Mike Fitzpatrick was disappointed in the decision. 

“American families deserve bipartisan healthcare reforms that transition us from a top-down, federal approach to a patient-centered plan that increases freedom, flexibility and empowers states and consumers. That is the objective I will continue to work toward despite today’s Supreme Court ruling,” he said. 

In New Jersey, Governor Chris Christie has vetoed two bills passed by the state’s Democratic legislature to set up a state-based exchange and has said that if the court were to strike down the subsidies, Congress should fix the situation.

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

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Roberts said in the majority opinion.

Limiting the subsidies only to individuals in states with their own exchanges could push insurance markets in the remaining states “into a death spiral,” Roberts wrote.

Justice Antonin Scalia, in a dissent he summarized from the bench, strongly disagreed.

“We should start calling this law SCOTUScare,” he said, using an acronym for the Supreme Court and suggesting his colleagues’ ownership by virtue of their twice stepping in to save the law from what he considered worthy challenges.

Obama greeted news of the decision by declaring the health care law “is here to stay.” He added the law is no longer about politics, but the benefits millions of people are receiving.