The U.S. Supreme Court ruled Thursday in favor of the Affordable Care Act, preserving thousands of subsidies for people in the Augusta area who used them to purchase health insurance.
The Court ruled 6-3 in favor of allowing the subsidies to be provided in the 34 states, including Georgia and South Carolina, that had refused to set up their own state exchanges and instead enrolled people through the federal marketplace. That would have affected 412,000 people in Georgia who had received subsidies, some quite substantial, to help them afford their monthly premiums.
An estimated 25,000 in the 12th Congressional District – which includes Augusta – would have been affected.
Navigator Terri Gant at Medical Associates Plus @ Belle Terrace has put that number at closer to 33,000 who got enrolled in the area.
Nearly everyone that she helped enroll needed the subsidy and for many it was the first time they had insurance or the ability to see a doctor on a regular basis.
“They never had the money to afford health care,” Gant said. “They’ve used the ER for medical care. They’ve used other people’s medicine, they know they shouldn’t be doing that. All types of things I feel are unhealthy. My concerns were we were going to go backward instead of moving forward.”
To take that away after giving it to them for a short time would have been especially cruel, she said.
“For me to tell them now they can access health care and they can afford it and then to go back a year or two later and say, ‘Look, it might not be there,’ would have been disappointing to me.”
U.S. Rep. Rick Allen, R-Georgia, whose district includes Augusta, has been a vocal opponent of the law and he said the ruling does not mean the fight is over.
“While the Supreme Court’s ruling upholds the law’s subsidies, it does not affirm ObamaCare as the right health care solution for the American people,” he said in a statement issued shortly after the ruling.
“Health care solutions should empower patients and families – not Washington – and give them the freedom to choose a plan that meets their needs. I will continue to fight at every opportunity for better health care solutions by repealing and replacing ObamaCare with patient-centered reforms,” Allen said.
At Christ Community Health Services, co-founder Robert Campbell said he is glad the court ruled the way it did because it will mean less disruption with people’s coverage.
“If well-intentioned people have better ideas about ways to structure health care funding, I think we always have an opportunity to change the law, to revise it, to remove it,” he said. “But I am relieved that this wasn’t the way it was going to happen.”
In upholding the law and its subsidies, the court rejected the plaintiffs’ assertion that one section of the law that refers to subsidies through a state-based exchange should invalidate subsidies provided through the federal exchange established for those states that refused to create one.
Noting that some of the language about subsidies is “ambiguous,” the court must then look at “the broader structure of the Act” and whether interpreting it so narrowly “produces a substantive effect that is compatible with the rest of the law,” Chief Justice John Roberts wrote. The majority found that the plaintiffs’ argument to reject those subsidies “would destabilize the individual insurance markets in any State with a Federal Exchange and likely create the very ‘death spirals’ that Congress designed the Act to avoid.”
In a sharply worded dissent, Justice Antonin Scalia notes that it is not an accident that the relevant section refers to subsidies in “an Exchange established by the State” because it occurs seven times throughout the act, which he interprets as deliberately limiting on the part of lawmakers and prohibiting the substitution of an exchange established by the federal government.
“Words no longer have meaning if an Exchange that is not established by a State is ‘established by the State,’” he wrote.
“Under all the usual rules of interpretation, in short, the Government should lose this case. But normal rules of interpretation seem always to yield to the overriding principle of the present Court: The Affordable Care Act must be saved.”
In fact, Scalia contends, because the court’s action is essentially rewriting the law to make the subsidies available, “We should start calling this law SCOTUScare,” instead of Obamacare.
But at the end of its opinion, the majority relied in part on the Marbury v. Madison decision from 1803 that defined the proper roles of the branches of government in ruling in favor of the Administration that the law intended for people to receive the subsidies regardless of whether they got them through a state exchange or not.
“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Roberts wrote. “If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”
Secretary of Health and Human Services Sylvia Burwell, the defendant in the case, said “it is time to move forward” and focus on improving the now-spared system.
“I hope that this week’s Supreme Court decision will push us to do what I believe Americans want, which is come together to focus on the substance and begin working to build an even better health care system,” she said. “Building on the tools of the ACA, we have the opportunity to transform our health care system in unprecedented ways, by delivering better care, spending our health care dollars in a smarter way, and putting patients at the center of their care.”