In N.J., a collective sigh of relief

June 26--For the 172,000 New Jersey consumers who were able to buy health insurance this year because of federal subsidies from President Obama's Affordable Care Act, Thursday's Supreme Court decision upholding a key provision of the law meant they wouldn't lose their coverage.

For the five insurance companies that sold plans in New Jersey through HealthCare.gov, the federal marketplace set up by the law, the ruling averted the threat of thousands of customers exiting the market and the price spike that would inevitably follow.

And for hospitals around the state, it meant chaos avoided -- no sudden influx of uninsured patients in their emergency rooms, with its drag on the bottom line.

Relief was palpable throughout New Jersey on Thursday as patients, health care providers, and insurers -- the people and institutions that have benefited most from Obamacare -- assessed the consequences of the long-awaited resolution of King v. Burwell. Hospitals and insurance companies, especially, said that the decision allowed them to refocus efforts on controlling the escalating costs of health care.

Amid the applause, however, came a strong dissenting voice that echoed the chorus of outrage from ardent opponents of the Affordable Care Act nationwide, including many Republican Party leaders.

"This decision turns common language on its head," Governor Christie wrote in posts on his political -- rather than governor's -- Twitter account minutes after the court's 6-3 ruling late Thursday morning. "Now leaders must turn our attention to making the case that Obamacare must be replaced."

Christie's reaction came about the same time as reports surfaced that he planned to formally announce his candidacy for the Republican presidential nomination. Christie himself would not confirm those sourced reports on Thursday night.

Had the decision been different, Christie and the Democratic-controlled state Legislature would have been under pressure to cobble together a solution to the imminent loss of insurance by nearly 200,000 low- and middle-income people. As the governor increasingly has sought to appeal to the more conservative bloc of the Republican Party, there was concern that he would be against any such effort.

One-two punch

Nationally, 6.4 million Americans in 34 states, including New Jersey, would have lost their subsidies if the decision had gone the other way.

"Thank God," said Jacqueline Clay, a Montclair resident who turned 61 on Tuesday and said her life had been saved by the Affordable Care Act. Clay had lost her job as a human-resources executive -- and her insurance -- a few months before her breast-cancer diagnosis in 2013.

But she was able to afford health coverage, she said, because the tax credits lowered her monthly premium by more than $500. She watched Obama's Rose Garden speech -- in which he declared that Obamacare was here to stay -- while recovering from surgery to remove a cancerous tumor from her colon, with complications that required a long hospital stay. Last year, she completed chemotherapy and radiation for breast cancer.

"Without the ACA, I don't know where I would be," she said. "After 40 years of working, I was put in a situation where you don't know how you're going to live. You can't work. I needed chemotherapy and radiation every day."

For all those who did not qualify for tax credits -- employees who receive coverage through their jobs, senior citizens on Medicare, parents who have kept adult children on their plans to age 26, and Medicaid beneficiaries -- nothing changed.

Planned for contingencies

In the long lead-up to the decision, insurers had struggled with uncertainty and tried to plan for various contingencies, said Ward Sanders, president of the New Jersey Association of Health Plans.

"There was an enormous amount of consternation and work behind the scenes," he said. With the decision, "It does free up a lot of time for folks to figure out the other challenges in health care, rather than focus on what we're going to do if subsidies are taken away."

The greatest of those challenges, he added, is affordability. New Jersey's insurance premiums, and the subsidies to buy them, are among the highest in the country.

Nine health plans -- of about 50 offered in the state -- would see premium increases of more than 10 percent for 2016, under rate filings this year that have yet to be approved by the state Department of Banking and Insurance, records show.

The chairman and CEO of the state's largest health insurer, Horizon Blue Cross Blue Shield of New Jersey, also said work could now turn to the cost of care.

"There are a number of other health care issues to focus on in New Jersey," Robert A. Marino said in a statement, "including working to protect health care consumers from surprise medical bills and price gouging by enacting out-of-network reform legislation."

AmeriHealth New Jersey, the second-largest company in New Jersey's marketplace, with 73,000 beneficiaries, noted its efforts to try to hold down premiums through partnerships with physicians and hospitals.

"We are very pleased that our members will not be affected by today's ruling," said Judith L. Roman, the company's president and CEO. "The health care reform law has increased access for many, [but] there is still work to be done to make health care more affordable."

For Health Republic Insurance of New Jersey, a new consumer-operated health plan created by the Affordable Care Act, an adverse ruling might have been disastrous. Of its 44,000 customers, 38,000 purchased coverage on the federal marketplace.

"The ruling clears the way for health reform to continue to grow," said Cynthia Jay, Health Republic's chief marketing officer. "It's a victory that affirms the benefits of the ACA." The law has allowed "innovative" alternative companies, such as Health Republic, to compete with long-established insurers, she said.

'We were very worried'

Hospital executives, too, said they were glad that the ruling had not caused a drastic increase in the numbers of uninsured people who would turn to hospital ERs as a last resort.

"We were very worried, honestly," said Betsy Ryan, CEO and president of the New Jersey Hospital Association. It would have been doubly damaging to see an influx of charity-care patients at the same time that the coming state budget had trimmed nearly $150 million in payments to hospitals for their care, she said.

As a result of the health law, consumers now have much greater access to care that they need, she said. "To have backtracked on that progress would have been devastating for those individuals," and also would have been "a big blow to the hospitals and other health care providers that take care of those patients regardless of their ability to pay," she said.

The ruling "stabilizes the health care delivery system," said Robert C. Garrett, president and CEO of Hackensack University Health Network, with four hospitals in northern New Jersey. "In this environment of ballooning health care costs, keeping people healthy is our number one priority, and we believe that subsidies are a key asset in achieving that goal."

Physicians, too, welcomed the ruling, and are "pleased that patients who do not qualify for Medicare or Medicaid will not need to scramble to pay their health insurance premium, and will be able to receive the affordable, quality care they deserve," said Larry Downs, CEO of the Medical Society of New Jersey.

The Record (Hackensack N.J.)

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