Ruling upholds subsidies for controversial Obamacare

When most Republican legislative leaders balked at Gov. Bill Haslam’s health insurance plan for the working poor, several said they would wait for the U.S. Supreme Court’s ruling on the Affordable Care Act’s premium subsidies before acting.

If the court struck down federal subsidies in Tennessee and other states without state-run health insurance exchanges, the entire ACA might collapse, they reasoned.

But the high court’s decision June 25 upholding the subsidies surprised state GOP leaders, and Haslam said it eliminated one of the big reasons lawmakers cited for refusing to act on his plan, Insure Tennessee.

As reaction to the ruling flowed in, it was clear that Republican legislators were not swayed enough to act soon on the governor’s plan to extend health coverage to up to 300,000 low-income working Tennesseans who lack access to insurance on their jobs or can’t afford it.

“I think there were some folks who thought this was going to totally disable the ACA and change the whole game and lead to a total redesign of the system,” Haslam said. “For those folks who said that was one of their big issues and that we should wait and see, we now have an answer.

“Will that move the argument in a decisive way? I honestly don’t know. We’ll see.”

But Senate Speaker Ron Ramsey, R-Blountville, continued his stance that the state can wait until a new president is elected before considering a new health insurance program. He posted his reaction to the court ruling on Facebook, along with a picture of President Barack Obama and the words “Lying to America.”

“The Supreme Court today provided more shortterm relief to a long-term problem,” Ramsey wrote. “While the decision will not result in millions losing their health coverage immediately, it is clear to everyone that deep and fundamental flaws in the law remain. I look forward to 2016 and electing a president who can appropriately assess the damage and chart a course away from Obamacare.”

Senate Majority Leader Mark Norris, R-Collierville, declined to sponsor the governor’s plan during the 2015 legislative session, despite that being a traditional role for a floor leader of the governor’s party. In a statement, he declined to speculate on what impact the ruling will have on Insure Tennessee’s fate.

“The Supreme Court’s opinion may be a judicial sleight of hand, but it’s the law of the land. It clears the air in that we now know many Tennesseans will keep their subsidized coverage. Next, we must focus on how best to control the costs of TennCare going forward so thousands of others won’t lose theirs,” Norris said.

Republicans hold heavy majorities in the legislature. The top three House GOP leaders also seemed disinclined to act soon on Insure Tennessee, which would be funded through the ACA’s Medicaid expansion provisions.

House GOP Caucus Chairman Glen Casada of Franklin, who opposed the governor’s plan, suggested continued resistance.

“Now, more than ever, it is time for us to stand firm and tell Congress that it needs to clean up its own mess,” he said.

Chief Justice John Roberts again voted with his liberal colleagues in support of the health care 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 June 25.

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

Limiting the subsidies only to individuals in states with their own exchanges could well push insurance markets in the other 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.

Health care advocates in Tennessee applauded the decision and suggested it should pave the way for Gov. Bill Haslam’s alternative Medicaid expansion proposal.

“Today’s ruling is good news for millions of ordinary Tennesseans,” said Michele Johnson, executive director of the Tennessee Justice Center, a nonprofit public-interest law firm that occasionally sues the state over issues affecting health care for low-income residents. “It reaffirms the reality that the Affordable Care Act is the law of the land.”

In Nashville, Haslam said he was surprised by the ruling and, in a way, disappointed because a reversal would have created an opportunity to “fix” problems with the health care law. Still, Haslam said he was pleased for Tennesseans who can continue receiving federal subsidies to help pay for health insurance.

In Washington, U.S. Rep. Steve Cohen, D-Memphis, and other supporters insisted that Obamacare is working and helping make health coverage affordable for millions of Americans.

“I hope that this ruling will help the nation to see that the Affordable Care Act is a federal law that is helping Americans stay healthy and alive, and that it is here to stay,” Cohen said.

But opponents who had hoped a ruling against the subsidies would bring about the downfall of Obamacare were exasperated that the justices once again upheld the 5-yearold law.

Regardless, they pledged to continue their push to repeal the reforms and replace them with more of a market-driven health care system.

The ruling “does not change the fact that Obamacare is still harmful to many Americans,” said U.S. Rep. Stephen Fincher, R-Frog Jump. “Millions have been faced with higher premiums, lost coverage, reduced paychecks and many other damaging side effects. My Republican colleagues and I remain committed to repealing this unworkable law and giving the American people what they asked for all along — real solutions that increase people’s access to quality and affordable health care.”

U.S. Sen. Lamar Alexander, who chairs the Senate committee with jurisdiction over health care issues, called it “unfortunate” the Supreme Court “didn’t read the law the way that Congress wrote it.”

The 36 percent increase in some individual health care rates announced recently “should remind Tennesseans that Obamacare was an historic mistake,” said Alexander, RMaryville.

U.S. Sen. Bob Corker, R-Chattanooga, said the ruling affirms that it’s up to Congress “to come together around a responsible solution that provides relief from the damaging effects of the president’s health care law.”