Supreme Court Obamacare ruling hailed as last major challenge

June 25--Retired teacher Pamela Taplin of Royal Palm Beach said she hopes with Obamacare again withstanding the scrutiny of the U.S. Supreme Court, lawmakers can turn to making the law work for people who rely on it for health insurance.

"I'm glad they didn't strike it down, but someone has to fix the problems," said Taplin, adding it took her 90 days and hours of phone calls to switch coverage for her husband, Roy, to keep his cardiologist. "During all of this political arguing, we could have been fixing the plan."

Taplin's sentiments were echoed by doctors, patients, lawyers and supporters, who said the high court's decision Thursday to uphold the Affordable Care Act should finally put to rest any legal challenges to Obamacare. Now it is up to Congress and the states, they said.

Ruling 6-3 in King v. Burwell, the Supreme Court upheld the nationwide tax subsidies in states that did not set up their own health care exchanges.

The high court rejected a challenge based on the semantics of an ambiguous text in the law that threatened the health insurance for 1.3 million Floridians who receive Obamacare through the federal exchange. It was the second time in three years that the Supreme Court preserved the President Barack Obama's signature legislative achievement.

"Things have to go through Congress, not the Supreme Court," said Dr. Alan Pillersdorf, president of the Florida Medical Association. "If they want to change the Affordable Care Act, that is the mechanism."

U.S. Rep. Ted Deutch, D-Boca Raton, tweeted: "It is time for Republicans to recognize that this law is here to stay."

Florida Democratic U.S. Sen. Bill Nelson said, "Hopefully, some of the extremists will now stop trying to dismantle the law and instead join us in trying to improve it where needed."

While Gov. Rick Scott issued no statement as of Thursday afternoon, Attorney General Pam Bondi lashed out.

"The Affordable Care Act continues to be the most heavy handed federal health care law in our nation's history, and today's decision in the King v. Burwell case does nothing to alleviate the harms the law will continue to cause."

Bill McCollum, who as Florida attorney general in 2010 spearheaded the legal challenge by two dozen states, said Thursday's ruling shows that any changes will not come through the courts.

"I don't anticipate any further litigation," said McCollum, now a partner in a Washington law firm. "But that doesn't mean the Affordable Care Act is not going to change. It's just going to depend on Congress and the results of the next presidential election."

No concession

There were plenty of Republicans not ready to concede ground. The front-runners for the GOP presidential nomination vowed to continue the fight to repeal the 900-page law.

"Obamacare is still a bad law that is having a negative impact on our country and on millions of Americans," said U.S. Sen. Marco Rubio, R-Fla. "I remain committed to repealing this bad law and replacing it with my consumer-centered plan that puts patients and families back in control of their health care decisions."

At issue in King v. Burwell is the interpretation of the statement in the Affordable Care Act: "exchange established by the State."

When states controlled by Republican lawmakers balked at creating Obamacare exchanges, their residents relied instead on an exchange set up by the federal government. Challengers said Congress had to specifically state the federal government could set up exchanges.

About 87 percent of individuals who enrolled through the federal website are receiving subsidies in 34 states whose legislatures have not set up their own exchanges. Advocates estimated about 6.4 million people could have lost their subsidies if the high court ruled in favor of King.

In Florida, a Palm Beach Post analysis of enrollment shows more than 127,000 people across Palm Beach County signed up for plans, including 399 people in the tony ZIP code of Palm Beach. The highest concentration of enrollees came in the Lake Park area.

READ: How many people signed up for health care coverage in each Palm Beach County ZIP code? Here is the breakdown.

'Death spiral'

Chief Justice John Roberts, who wrote the landmark opinion upholding the law in 2012, again spoke for the majority. He said limiting subsidies to individuals only in states with their own exchanges could well push insurance markets in the other states "into a death spiral" and said the question posed by the King case was of "economic and political significance."

Justice Antonin Scalia wrote an entertaining dissent, chastising the majority and giving a lesson on grammar, bemoaning how words no longer have meaning.

But the majority's opinion some experts said is designed to protect the law from future challenges, with Roberts writing "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them" and the "correct reading" of the law requires subsidies in all 50 states.

West Palm Beach attorney Jim Farrell, who co-chairs the health law practice at Shutts & Bowen, said he hopes it's the end of the challenges, but he said the law needs fixing.

"We are still dealing with unsustainable premium increases," he said. "The fact that you save the tax credit is irrelevant if no one can afford the exchange products."

Some pundits, such as those at The New York Times, suggested there was now even less impetus for states like Florida to set up an exchange.

If the Supreme Court ruled in favor of the plaintiffs, health insurance costs were expected to triple for 1.3 million Floridians, advocacy groups warned.

Through the exchange healthcare.gov, the average monthly premium in Florida is $82. Without the exchange, premiums skyrocket to $376, according to the advocacy group Families USA.

Dr. Ron Wiewora, the CEO of the Health Care District of Palm Beach County, called it "a good news day."

"We providers are all about people having access to care and Obamacare has been a way people have been able to get that access and to get that coverage," Wiewora said. "We are very please where it went today."

He said the district, which helps uninsured residents with health care coverage, was preparing to phase out its own subsidy program called Vita Health. If the ruling had gone differently, they might have been forced to reconsider. he said.

Coverage gap remains

He noted that the ruling hardly fixes the problems left by Florida refusing to accept federal Medicaid expansion money to set up its own exchange.

Significant problems geared to the Affordable Care Act are already here. The federal government assumed Obamacare would ease the burden on hospitals providing care to the indigent and plans to phase out the $1 billion low income pool, also known as LIP. This again was contingent on states setting up their own exchanges.

Since Florida didn't, Wiewora said the district expects to take a $3 million cut when LIP money expires and is looking at cost-cutting measures.

An estimated 800,000 Floridians remain in the health-care coverage gap -- unable to pay for insurance and unable to qualify for Obamacare -- because Florida refused to accept Medicaid expansion money to set up its own exchange.

Scott and the House leadership rejected a plan put forth by the Senate this year to extend health care coverage to those individuals.

House Minority Leader Mark Pafford of West Palm Beach said the Supreme Court's decision at least saved health care for 1.6 million Floridians because Scott has yet to show any impetus to close the coverage gap.

"We still have to deal with 800,000 people who are using the emergency rooms as a primary source of health care," he said. "That is the tragedy that needs to be resolved."

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