Supreme Court Thwarts Efforts To Put Obamacare On Life Support : It's All Politics Thursday's court ruling upheld subsidies nationwide under the Affordable Care Act. And unlike the court's previous Obamacare ruling, the majority was unified and the tone was broad.
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Supreme Court Thwarts Efforts To Put Obamacare On Life Support

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Supreme Court Thwarts Efforts To Put Obamacare On Life Support

Supreme Court Thwarts Efforts To Put Obamacare On Life Support

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The Supreme Court handed the Obama administration a huge victory today when it upheld all of the subsidies crucial to the president's health care law. It ruled that Congress did intend for all major provisions of the law to work in tandem and to apply to all states. NPR legal affairs correspondent, Nina Totenberg, reports.

NINA TOTENBERG, BYLINE: Today's ruling was the court's second upholding provisions of the law. Three years ago, it upheld it as constitutional, today, it upheld the critical subsidies. Chief Justice John Roberts once again wrote the opinion for the court, but this time there were six justices in the majority, not five, and there were no separate opinions, no evidence of disagreement among the six in the majority. At the White House, President Obama was elated.

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BARACK OBAMA: So we've got more work to do, but what we're not going to do is unravel what has now been woven into the fabric of America.

TOTENBERG: At the heart of the case are the exchanges where people go online to shop for individual insurance. That's also where low and middle-income people get tax subsidies that make insurance affordable. But those challenging the law maintained that by the explicit terms of the statute, subsidies could only be paid on exchanges, quote, "established by the state." And 34 states, mainly Republican-run states, have refused to establish these exchanges, leaving the federal government to establish them instead. The challenges contended that those federal exchanges are not authorized to pay out subsidies. Had they prevailed, estimates were that between six million and nine million people would lose their insurance. The Supreme Court however firmly rejected the challenger's argument, ruling that the overall purpose of the statute was to create a nationwide system of insurance for those who are not insured through work.

Chief Justice Roberts said that Congress established a system of interlocking reforms that could not be separated. Lose the subsidies, he said, and history shows that mainly the sick will sign up for insurance, costs will skyrocket making insurance unaffordable, and insurance plans will be pushed into what he called a death spiral. Said the chief justice, it is simply implausible that Congress intended such a result. Our duty, he said, is to construe statutes not isolated provisions. Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.

And he suggested, if Congress wants to change the law, it can do that.

Health care experts agree that the law is secure for the foreseeable future. Larry Levitt is vice president of the Kaiser Family Foundation.

LARRY LEVITT: Well, I think there's little doubt at this point that the health law is here to stay, but it's equally certain that the divisiveness over it will continue through the election and probably beyond.

TOTENBERG: As if to prove the point, Republicans on Capitol Hill took the occasion to lash out at Obamacare again. Senate Republican Leader Mitch McConnell.

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MITCH MCCONNELL: Today's ruling won't change Obamacare's multitude of broken promises. Today's ruling won't change Obamacare's spectacular flops.

TOTENBERG: In the House, Speaker John Boehner echoed that theme.

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JOHN BOEHNER: The problem with Obamacare is still fundamentally the same. The law's broken.

TOTENBERG: Louisiana Republican, John Fleming.

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JOHN FLEMING: It's more unpopular today than it ever has been.

TOTENBERG: But recent polls show Obamacare rebounding to its highest approval rating ever. A CBS New York Times poll this month showed a 47 percent approval rating, up 12 points since last month. And many critics as well as proponents of the law see it as becoming increasingly entrenched. Michael Cannon of the Cato Institute has been called Obamacare's most relentless antagonist, and he was infuriated today by what he saw as the Supreme Court's unprincipled decision.

MICHAEL CANNON: Does this ruling help to further entrench the ACA? Yes. Or at least, the ACA has amended by the Supreme Court three times.

TOTENBERG: Cannon notes that under the court's ruling, a Republican administration could not simply change the subsidy rules because the high court upheld them as a matter of law, not agency interpretation. Former Health and Human Services Secretary Kathleen Sebelius goes further, noting that there will be two more enrollment periods by January 2017.

KATHLEEN SEBELIUS: I see repeal as almost impossible at this point.

TOTENBERG: Indiana University professor Kosali Simon, a health policy expert, agrees.

KOSALI SIMON: I think that the longer that people who have gotten insurance understand the benefits of it, it becomes harder to take it away.

TOTENBERG: Descending from today's decision were the court's most conservative members - Antonin Scalia, Clarence Thomas and Samuel Alito. In a rare oral dissent from the bench, Scalia accused the majority of manipulating the usual rules of constitutional and statutory interpretation not once, but twice, to save the law - first three years ago and again today.

We really should start calling the law SCOTUS care, Scalia said, referring to the acronym for Supreme Court of the United States.

Chief Justice Roberts, the author of the opinion, was appointed by George W. Bush. He was joined by Reagan appointee Anthony Kennedy and four more liberal Democratic appointees, Justices Ruth Bader Ginsburg and Stephen Breyer appointed by President Clinton, and Justices Sonia Sotomayor and Elena Kagan appointed by President Obama. Yale Law professor Abbe Gluck.

ABBE GLUCK: I think what today's decision does is that it sends a strong signal that the Supreme Court doesn't want to be in the middle of this political battle.

TOTENBERG: With Obamacare now remaining in place as is for now, the court still has other business to take care of, most prominently, its decision on same-sex marriage, so stay tuned. Nina Totenberg, NPR News, Washington.

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