The Supreme Court’s decision Thursday to uphold a pillar of Obamacare is a “loss for everyone who cares about the Constitution,” as one leading Georgia Republican put it. Or it is a sign that the Affordable Care Act is settled law that “has now been woven into the fabric of America,” as President Obama said.
In a 6-3 ruling, the court said the tax credits that make Obamacare affordable to millions of Americans, including more than 400,000 in Georgia, are central to the health law.
“That’s good news for us. That’s great,” said Baburam Sharma of Marietta as he absorbed the news. “Wow.”
Without the tax credits, Sharma, his wife and their two kids would be uninsured, he said. Without his insurance, his son’s broken arm would have cost the family $9,000, instead of $1,000.
“I was without insurance for years,” said Sharma, who works in the salvage business. “I know the pain.”
Experts say a ruling the other way would have stripped Sharma and 6.4 million Americans of their tax credits and forced most to drop the newly gained coverage they could no longer afford. The resulting chain reaction would have crippled the online marketplaces, also called exchanges, where people buy Obamacare plans. And key parts of the law would be essentially gutted — an outcome for which Republicans had hoped.
Georgia Attorney General Sam Olens said Thursday that the “Supreme Court ruling is a loss for everyone who cares about the Constitution and the rule of law.”
Other Georgia leaders vowed to continue trying to repeal a law they say unfairly forces millions of people to buy insurance, costs taxpayers billions and harms businesses.
“Today the Supreme Court failed to recognize how terribly flawed President Obama’s health care law is for millions of Georgians suffering under the law’s health insurance premium spikes and intrusive mandates,” U.S. Sen. Johnny Isakson, R-Georgia, said in a statement. “I will continue to work with my Senate colleagues to repeal and replace Obamacare.”
‘Affordable Care Act is here to stay’
The argument in the Supreme Court case, King v. Burwell, hinged on four words in the more than 900-page Affordable Care Act: “established by the state.”
Those words, according to the plaintiffs in the case, meant that the tax credits were illegal for anyone who bought Obamacare plans on the federal website, rather than one run by the state. Thirty-four states, including Georgia, chose the federal site instead of operating their own, so the plaintiffs sought to nullify tax breaks awarded in all those states. The Obama administration, however, argued the intent of the health care law is clear: Americans in every state should have access to the credits.
Six of the nine court justices agreed with Obama.
Writing for the majority, Chief Justice John Roberts said, “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the act in a way that is consistent with the former, and avoids the latter.”
The court’s three most conservative justices — Samuel Alito, Antonin Scalia and Clarence Thomas — dissented. Scalia derided the majority’s opinion, calling it “quite absurd" and "pure applesauce" and arguing that the “overriding principle of the current court (is) the Affordable Care Act must be saved.”
As a result, Scalia said, “We really should start calling this law SCOTUScare.”
Speaking from the Rose Garden Thursday morning, President Obama said, “After multiple challenges to this law before the Supreme Court, the Affordable Care Act is here to stay. What we’re not going to do is unravel what has now been woven into the fabric of America.”
Indeed, experts say the ruling further solidifies the legitimacy of the law and its health insurance marketplaces.
King v. Burwell gave those who want to repeal the law an opening, but that door is now closed and there will be less impetus for such efforts, said Christine Eibner, a senior economist with RAND Corp., a nonprofit that focuses on research and analysis of health care and other issues.
“Now that this has been upheld, I think the law is in a much more stable place,” she said.
The next question: Medicaid expansion?
Despite the White House’s most recent victory, the battle over Obamacare seems far from over.
While Republicans could get a repeal of the law through Congress, Obama would veto it. But conservatives have set their sights on 2016 and the potential election of a Republican president as their best hope to slay Obamacare.
Democrats say it’s long past time to stop treating Obamacare as a political football and move forward.
U.S. Rep. John Lewis, D-Atlanta, called Thursday’s ruling “a turning point” in securing the law. “Passing the Affordable Care Act was the right thing to do. Now let the leaders of this nation turn their attention to the other pressing problems before us.”
For many Georgia lawmakers, consumer advocates, health care providers and others, that pressing problem is the state’s continued opposition to expanding Medicaid under the Affordable Care Act.
Gov. Nathan Deal and conservative lawmakers have long argued that growing the state’s Medicaid program would be too expensive, even though the federal government would pick up at least 90 percent of the cost. Georgia is one of 19 states that have not adopted expansion, though a growing number of red states are exploring it as an option.
Georgia Medicaid provides health coverage to roughly 1.8 million mostly poor children, pregnant women, seniors and people with disabilities. Expansion would add about 600,000 people to the Medicaid rolls, mostly low-income adults without children.
'A federal ruling on a federal law'
Meanwhile, an estimated 300,000 people fall into a so-called “coverage gap” in which they make too much money to qualify for Medicaid but not enough to qualify for federal tax credits to buy on the Affordable Care Act marketplace.
“It is time for Georgia’s leadership to focus new attention on closing the coverage gap to help working adults across the state,” said Tim Sweeney, a health policy analyst at the left-leaning Georgia Budget and Policy Institute.
Deal’s office has continued to rule out significant changes to Georgia’s approach toward the Affordable Care Act.
“This is a federal ruling on a federal law,” said Jen Talaber, Deal’s spokeswoman. “And any serious efforts to change the law would require a federal solution.”
Still, states that haven’t yet expanded Medicaid will face increasing pressure, said Bill Custer, a health care policy expert at Georgia State University. Expansion would create 56,000 new jobs and bring in $35 billion in new federal funding to Georgia over a decade, Custer estimates.
“The longer Georgia goes without expanding Medicaid, the more that pressure will build,” he said. “Other states in the region are going to find ways to expand Medicaid and bring those federal dollars to their states.”
The Obamacare decision is the first of two blockbuster rulings expected from the court before its term ends this month. The other ruling, still to come, concerns the constitutionality of gay marriage.