High court decision hits home

June 26--The U.S. Supreme Court ruled Thursday the tax subsidies of the Affordable Care Act are legal, a decision allowing roughly 26,000 West Virginians to afford health insurance.

Despite two justices appointed by Republican presidents joining the majority decision, the state's GOP roundly condemned the ruling.

The 6-3 decision marked the second time in three years the court has upheld the Affordable Care Act.

Penning the majority opinion, Chief Justice John Roberts wrote, "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them."

In King v. Burwell the court decided seven words -- "through an exchange established by the state" -- buried in nearly 1,000 pages did not prohibit the federal government from providing tax subsidies to employed individuals.

If the Supreme Court had ruled against the tax credits, tens of thousands of West Virginians would have suddenly found themselves uninsured. Depending on who is asked, the number of West Virginians covered by the ACA is between 30,000 to 49,000.

The ACA tax subsidy saves the 26,000 West Virginians tens of millions annually, said Terri Giles, executive director of West Virginians for Affordable Health Care.

Nationwide, Thursday's decision affects working people in 34 states who receive subsidized insurance coverage under the act. The latest figures show nearly 11.7 million people signed up for the ACA. Of those, 6.4 million rely on the subsidy, according to data from the Center on Medicare and Medicaid Services.

"We have the most ineffective health care system in the world. It's time for us to be a leader on this issue of health care, which is so fundamental to people's lives," said Terri Giles, executive director of West Virginians for Affordable Health Care.

West Virginians rank No. 1 for a number of health issues, she said, including diabetes, obesity, heart health and drug addiction.

Perry Bryant, founder of the organization, said the decision gives West Virginians "peace of mind" that they can still afford health care

Christopher Plein, with West Virginia University's John D. Rockefeller School of Public Policy, said the 21-page ruling looked at the broader wording of the law, not just the seven words on which the lawsuit was based.

"The court looked at the meaning of the law," he said of the ruling. Plein pointed out the tax subsidy is only a part of the ACA, which has been in effect for five years. The law also includes a guarantee that children can stay on their parents' insurance policy until 26, people can no longer be denied coverage because of pre-existing conditions or charged higher premiums. Vital preventive services, such as immunization and certain cancer screenings, are available at no extra cost.

If the court overturned the ACA's tax subsidies, there "would be a great deal of disturbance" of the law's effectiveness, he said.

This is the second time the Court has ruled to uphold the ACA. In 2012 the court ruled on the constitutionality of the act, while Thursday they ruled on a statutory interpretation.

In a blistering dissent read from the high court's bench, Justice Antonin Scalia said the court "really should start calling this law Scotus-care," a reference to the Supreme Court of the United States acronym.

Plein said the ACA most likely will always be a politically sensitive issue. "Health care is one of these hot button issues in American society," he said, anticipating more possible legal challenges.

The decision decided the legality of the subsidies, but now it returns to the political arena. Republicans tried to eliminate the ACA more than 50 times. A new New York Times/CBS News poll shows more Americans favor the ACA than not.

State politicians released a number of statements, from the GOP vowing to continue the fight for its elimination to more tepid tones by Democrats.

The state's top lawyer, Attorney General Patrick Morrisey, disagreed with Thursday's decision, but said it was a welcome sign the high court intends to more closely scrutinize attempts by unelected bureaucrats to seize power, especially where their decisions have economic and political significance.

"As Justice Scalia explained in his dissent, the plain text of the Affordable Care Act says that subsidies are only available for health insurance purchased on an exchange established by a state. I support helping poor individuals obtain financial assistance to buy health insurance, as part of a system that protects consumers' choice and patients' rights.

"However, I strongly oppose the Supreme Court's decision to again rewrite the fatally flawed Affordable Care Act in order to give out millions of dollars of federal subsidies that Congress never authorized. The language is clear, and courts do not have license to themselves ignore clear laws or to permit agencies to do so through deference," Morrisey said.

Rep. Evan Jenkins, R-W.Va., said he will renew his efforts to fight the law, which he sees as broken.

"West Virginians are facing higher premiums and fewer choices through Obamacare. According to the National Conference for State Legislatures, premiums in West Virginia increased by 10 percent from 2014 to 2015. And West Virginians in the exchange, unlike every other state, have only one choice of insurer, reducing competition and the ability for families to shop for the plans that best suit them," he said in a statement.

Sen. Shelley Moore Capito's office said it is possible to protect insurance consumers and lower prices, but gave no details on how.

"It's not an either-or question. Nearly all of the administration's expectations for Obamacare have not been met -- people have lost coverage, patients have lost doctors and premiums have risen. We can protect those who receive subsidies in West Virginia and create a better health care system that is more workable and affordable," her office said in a statement.

The U.S. Department of Health and Human Services refuted Republican notions that the ACA is not working. In a press release Secretary Sylvia M. Burwell said millions of Americans depend on the ACA for insurance and officials are working to improve access, affordability and quality for them and their families.

"Millions more won't have to worry about an upward spiral in their premiums because of today's decision, even if they didn't buy their insurance through the Marketplace. And the law's financial assistance will be available in the next open enrollment so that others can benefit as well," said Burwell.

Democrats were more sanguine about the ruling. Sen. Joe Manchin, D-W.Va., never thought the ACA was a perfect piece of legislation, that it needed repaired, not repealed.

"After all, it is simply unacceptable to go back to the days when millions of Americans, including about 250,000 West Virginians, went without health insurance, or when we spent more than any other country in the world on health care but still ranked only 43rd in the world in health and wellness," said Manchin.

"The Affordable Care Act does some things well, including expanding access to preventative care, protecting those with pre-existing conditions and closing the Medicare Part D prescription drug doughnut hole, but the law has many flaws."

Manchin, who has told a number of publications his frustration with the amount of bickering in Washington, concluded his press release by stating, "Now that the Supreme Court has ruled to uphold the Affordable Care Act, my sincere hope is that we can put the political divisiveness behind us and start working on the necessary improvements to make this law work better for all Americans."

Gov. Earl Ray Tomblin, who has explained not starting a state exchange because the low number of people who are eligible to join it was not financially feasible, said the Supreme Court ruling is "appreciated."

"This will help West Virginians who count on the tax credits available through the Affordable Care Act to continue purchasing insurance through the private market," said his press secretary Shayna S. Varner.

-- E-mail: dtyson@

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