Now that the Supreme Court has upheld the Affordable Care Act, what's next?

June 25, 2015

By Michael Doonan

Michael Doonan teaching in class

Michael Doonan is director of the Master of Public Policy program and the executive director of the Massachusetts Health Policy Forum.

The Supreme Court’s decision in King v. Burwell supports the Obama administration, solidifying the Affordable Care Act (ACA) and the President’s legacy on his key domestic policy achievement. The court ruled that health care subsidies could still be provided in the 34 states where the federal government runs the state’s health care marketplace.

If the court had decided against the government it might not have been the death of Obamacare, but it would have put in on life support. King argued that ambiguous language in the law prevented health insurance subsidies from being provided in federally-run, state-based marketplaces or exchanges. This is a big deal. 34 states decided to have the federal government run their marketplace and subsidies are currently provided to over 6 million people in those states. Without subsidies the majority of these people could not afford coverage and would return to the ranks of the uninsured.

A decision against the administration would have thrown a monkey wrench into the Affordable Care Act and would have been another opportunity for opponents who control Congress to repeal or significantly weaken the law. Instead the decision further roots the ACA into the fabric of the American health care system, making it even harder to repeal. It makes sense. In five years no one is going to be clamoring for “the good old days” when over 47 million Americans were uninsured.

The law will be further protected not only because covering the uninsured is the right thing to do, but because hospitals and providers are seeing fewer uninsured patients and they like it. These healthcare providers and the insurance companies--which have seen increased enrollment--are powerful, and will defend their new revenue source.

Not only is the Obama administration breathing a huge sigh of relief, but secretly I think a lot of Republican governors are happy too. Take Texas, for example--there is no stronger opponent of “Obamacare” than Governor Rick Perry, who describes Obamacare as socialist, job killing and evil incarnate. Yet, over a million people in Texas have health insurance coverage through the federally-run exchange. Over 900,000 of them are receiving subsidies, and were in jeopardy of losing coverage. Governor Perry even spoke of some step-down measures to help in the event the court ruled against the ACA. Now Perry can continue to rail against the plan while more Texans are covered and more hospitals are getting paid for their services.   

Obamacare is patchwork on top of a non-system health care system, but it is far better than what we had before. Lives have been saved and millions can sleep better at night knowing that if they or their children get sick, they don’t have to go without care or mortgage their future. Still, the ACA is far from completely implemented and the Supreme Court made a huge mistake when it allowed states to opt out of expanding Medicaid coverage to the most vulnerable.

But now the focus can be on expanding awareness and expanding coverage. This is a huge win for the president and for the newly insured and millions of others who will benefit from this program.

More on the Affordable Care Act: Heller's Stuart Altman, chair of the Massachusetts Health Policy Commission, recently sat down with fellow Heller faculty member Rajesh Sampath to discuss the landmark legislation. Listen to their conversation.