Supreme Court upholds Obamacare exchange scheme

The U.S. Supreme Court has ruled that a key provision of the Affordable Care Act – popularly known as “Obamacare” – should remain intact, allowing hundreds of thousands of Louisianans to retain the health insurance they bought through a federal exchange program.

While noting that the controversial law “contains more than a few examples

of inartful drafting” Chief Justice John Roberts wrote for a 6-3 majority that the law was passed 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,” Roberts wrote in the King vs. Burwell decision . “(The law) can fairly be read consistent with what we see as Congress’s plan, and that is the reading we adopt.”

Some local health care providers expressed relief upon learning of the decision.

“I am elated and delighted,” said Dr. Gary Wiltz, CEO of the Franklin-based Teche Action Clinic, which provides medical care to low income people in Houma and Dulac, as well as other locations in Louisiana. “It would have been the cruelest cut of all to give to someone and then take it away. We have people now coming into our system that were previously undiagnosed with diabetes and hypertension that did not have a medical home. We have people with cancer treatments getting worked up that would have had insurance taken from them, and not been abl to maintain.”



Local members of Congress and other Louisiana officials quickly responded to the decision, acknowledging the high court’s reasoning but emphasizing their displeasure overall with the Affordable Care Act, which they and other lawmakers – primarily conservative Republicans – have vowed to dismantle, amend or replace. The ACA hs been a cornerstone of President Barack Obama’s administration.

At issue was whether a tax credit that makes insurance when bought through individual state health insurance exchanges was intended to apply in cases where the federal exchange was used instead. Louisiana is among states without an exchange, and so Louisianans buying insurance with the help of a subsidy or tax credit must use the federal exchange.

Supporters of the law had said that more than 143,000 people in Louisiana would have had crippling increases in health insurance rates had the court not kept the current system intact. More uninsured people, some health advocates have advanced, would mean higher rates overall in the insurance market for all people.



Some estimates suggested that elimination of the federal exchange from the subsidy program would cause rises in rates from less than $100 per month cash layout to more than $600 per month for some families.

“Today is a victory for hard working Americnas all across this country whose lives have become more secure in a changing economy because of this law,” Obama said in a statement delivered from the White House rose garden.

A major criticism of the law has been that for Americans who already had health insurance, privately or through employers, rates have gone up. Obamacare, they maintain has negatively altered the health insurance ecology.



U.S. Senator David Vitter, R-La. said the decision does not fix what he sees as chief deficiencies in the law.

“The problem with President Obama celebrating today is that millions of Americans are still being hurt because of Obamacare,” Vitter said. “In Louisiana, 93,000 folks have lost insurance they wanted to keep, and middle class families’ healthcare premiums and costs have skyrocketed.”

Sen. Bill Cassidy, R-La., who is a medical doctor, said the decision does not derail plans by himself and other representatives to replace the law.



“The Supreme Court’s decision does not repeal the problems with Obamacare,” Cassidy said. “The fight to repeal and replace Obamacare to give patients the power must continue. Health insurance premiums are increasing as much as 60 percent per year, Americans are paying more for less, and view government mandates, penalties, and IRS coercion as un-American.”

The ACA’s requirement that all people in the U.S. be covered by health insurance under pain of an IRS penalty is particularly oppressive.

Cassidy is proposing a replacement law that would change that.



“As a doctor who has treated uninsured and underinsured patients for 25 years, I have worked with colleagues to craft the Patient Freedom Act,” Cassidy said “This gives patients the power, not Obamacare bureaucrats and the IRS. I remain committed to repealing and replacing Obamacare with conservative, free market solutions that give you the power.”

Rep. Charles Boustany, R-Lafayette, also a medical doctor, said he had been working with other lawmakers for a solution to problems that might have been caused for people had the high court ruled differently. The alternative, he suggested, would have kept the medical care sky from falling had the ACA provision been eliminated.

“As a physician, I know firsthand ObamaCare is bad law, plain and simple. This decision doesn’t change that,” Boustany said. “It doesn’t change my resolve to continue protecting families from premium spikes and lost coverage, and it doesn’t change my desire to see the entire law repealed. This isn’t over. Today’s decision will cast the shortcomings of this law in an even harsher light, forcing the law to emerge from the shadow of litigation, stand on its own two feet, and be judged on its merits.”



The case was brought by four Virginia plaintiffs who maintained that the law’s wording forbids the federal government from providing subsidies in states that do not have their own exchanges, 36 in all. The distinction, they said, was intended to encourage the creation of state exchanges.

As framed by Roberts, the case concerned the plaintiffs disputing whether Section 36B of the ACA “authorizes tax credits for individuals who enroll in an insurance plan through a Federal Exchange. Petitioners argue that a federal exchange is not an exchange established by the state …”

The Obama administration argued that “an Exchange established by the State should be read to include Federal Exchanges.”



The Supreme Court, Roberts maintains in the decision, may, if a law is ambiguous, determine whether a federal agency’s own interpretation is reasonable.

The decision outlined clearly the potential effects of a finding that the federal exchange does not qualify for the subsidy through the tax credit.

“The combination of no tax credits and an ineffective coverage requirement could well push a State’s individual insurance market into a death spiral,” Roberts wrote. “One study predicts that premiums would increase by 47 percent and enrollment would decrease by 70 percent … It is implausible that Congress meant the Act to operate in this manner.”



Gov. Bobby Jindal, also a longtime critic of the ACA, said the law remains a failure because it does not contain health care costs. Jindal, a staunch Obama opponent who announced his candidacy for the presidency Wednesday, entering a crowded field of Republican contenders, said that today “the Supreme Court had its say; soon, the American people will have theirs.”

“President Obama would like this to be the end of the debate on Obamacare, but it isn’t,” Jindal said, adding a pitch for his candidacy.

“The debate will continue because the law has failed to accomplish its prime objective: Containing health care costs. Republicans must outline a clear and coherent vision for health care to win the trust of the American people to repeal Obamacare. And right now, I am the only candidate to put forward a comprehensive plan. Now that the Supreme Court has ruled, the debate will grow,” Jindal said. “Conservatives must be fearless in demanding that our leaders in Washington repeal and replace Obamacare with a plan that will lower health care costs and restore freedom.”



Jindal’s refusal to accept an expanded Medicaid program that is part of the act has drawn fire from many health care providers, who say the expansion would allow more people to receive medical care. Many see a potential for change once the term-limited presidential candidate leaves office. Dr. Wiltz and others say that battle is far from over and will be fought in Baton Rouge next year.

“We have got miles to go before we sleep,” Wiltz said. “There is a whole population that could have qualified for Medicaid but we did not do expansion. That issue did not go away and we are hoping the next administration will embrace it, because it will help 300,000 people. That is another battle to be fought.”