The Carolinas dodged a health care crisis Thursday when the U.S. Supreme Court preserved insurance subsidies for more than 6 million Americans, including almost 459,000 in North Carolina.
But even as the Carolinians who get federal help buying private policies exhaled in relief, the battle over health reform raged anew. Republicans, who would have been under pressure to come up with a quick alternative if the court had overturned the subsidies, renewed their criticism of the Affordable Care Act.
“While the Court may have ruled on the issue of subsidies in the federal exchanges, this fundamentally flawed law continues to speak for itself in the form of broken promises, government mandates, and double-digit premium increases,” said U.S. Sen. Richard Burr, R-N.C.
Supporters of the act rejoiced at the 6-3 ruling in the King v. Burwell case, but called for improvements such as expansion of Medicaid to cover the impoverished residents who don’t qualify for subsidies.
“State leaders should now present a plan to extend the benefit of affordable health insurance to the 500,000 individuals and families left in the Medicaid gap,” said Adam Linker, health policy analyst for the N.C. Justice Center.
A ruling to overturn subsidies, while viewed as unlikely, would have created financial shock waves and political turmoil.
Only two states, Florida and Texas, had more residents at risk than North Carolina. King v. Burwell challenged the legality of subsidies in 34 states that refused to set up their own insurance exchanges. South Carolina is among them, with about 154,000 using the federal marketplace to get federal aid.
The subsidies go to low- and moderate-income people who don’t get workplace insurance. If that aid had been overturned, average monthly premiums for North Carolina and South Carolina recipients would have more than quadrupled, according to recent federal data. Federal and state officials would have been under pressure to extend or replace the program, for fear that massive loss of health insurance would send rates skyrocketing for everyone.
Kimberly Tonyan of Cornelius, who was treated for cancer soon after getting subsidized coverage in 2014, watched the case closely. She credits the insurance she got through the federal exchange with saving her life and paying for her ongoing treatment. Harvard Law School told her story in a King v. Burwell brief supporting the government.
“I’m very thankful that we won,” said Tonyan, a registered Republican who became an advocate for the ACA. She has a rare genetic syndrome that puts her at high risk for other forms of cancer, and is working part time at Home Depot. Without the aid, she said, she couldn’t pay for coverage.
Beverly Groom, a Charlotte Democrat who just got subsidized coverage, also voiced relief. She works as a caregiver for the elderly and recently lost Medicaid eligibility when her son aged out of the program.
“It would be a struggle if I couldn’t get it,” said Groom, who has high blood pressure and high cholesterol. “I need my medicine to keep me healthy.”
The plaintiffs contended that the law only allowed the subsidies in exchanges “established by the state.” The court ruled 6-3 in favor of the administration, which argued that the act clearly intended to allow the federal marketplace to provide subsidies in states that didn’t set up their own exchanges.
Chief Justice John Roberts wrote the opinion for the court, joined by frequent swing vote Anthony Kennedy and the liberal justices Ruth Bader Ginsburg, Stephen Breyer, Sonya Sotomayor and Elena Kagan.
“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” wrote Roberts. “The combination of no tax credits and an ineffective coverage requirement could well push a State’s individual insurance market into a death spiral. It is implausible that Congress meant the Act to operate in this manner.”
Justice Antonin Scalia wrote the dissenting opinion. “Today’s interpretation is not merely unnatural; it is unheard of,” Scalia wrote. “Who would ever have dreamt that ‘Exchange established by the State’ means ‘Exchange established by the State or the Federal Government’?”
The ruling essentially preserves the status quo. The ACA has made insurance affordable to millions more people and forced companies to offer coverage regardless of pre-existing conditions. But plenty of challenges remain.
Because North Carolina and South Carolina declined to expand Medicaid to cover the states’ poorest residents, more than 500,000 earn too little to get subsidies for private insurance and aren’t eligible for the government plan. Meanwhile, North Carolina’s 2016 rates for ACA policies are expected to rise sharply, and people who get insurance through their employer continue to experience rising out-of-pocket costs.
With the 2016 elections looming, Republicans continue to push for repealing the act.
“The President’s health care law has been fundamentally flawed from the beginning, causing premiums to skyrocket and forcing millions of hardworking Americans to lose the very same health insurance plans they were promised they could keep,” said U.S. Sen. Thom Tillis, R-N.C. “Regardless of the Supreme Court’s ruling today, the President’s health care law is beyond repair and I remain committed to finding and implementing a solution.”
Staff writer Tim Funk and Jay Hancock of Kaiser Health News contributed.
Helms: 704-358-5033; Twitter: @anndosshelms.
This article is done in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.
What’s at stake?
Here’s the scope of Affordable Care Act subsidies sustained in King v. Burwell.
6.4 million people in 34 states using the federal exchange
$272 a month
$316 a month
$281 a month
Average premium increase if subsidies are eliminated
What they’re saying
“With the Supreme Court’s decision in King v. Burwell ... comes tremendous relief for nearly 460,000 North Carolinians and millions of Americans who rely on subsidies to purchase health insurance.”
Lee Dixon project director of N.C. Get Covered
“Notwithstanding the legality of Obamacare, President Obama’s health care law has been a disaster for the American people.”
U.S. Rep. Robert Pittenger, Republican representing North Carolina’s 9th district
“In North Carolina more than 400,000 people receive much needed financial help to make health insurance more affordable and the decision today means consumers will maintain access to these tax credits.”
Adam Linker, health policy analyst for the N.C. Justice Center