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What Supreme Court decision means for health insurance; Missouri politicians respond

Protesters holding sign in front of Supreme Court
LaDawna Howard | Flickr

In a 6-3 decision, the Supreme Court upheld a high-profile challenge to the Affordable Care Act that could have made health insurance unaffordable for more than 5 million people.

The case, King v. Burwell, addressed whether income-based tax subsidies should be available to consumers who purchased their insurance on the federal health-care exchange because their states did not set up their own exchange. The subsidies come from federal funds and are used to bring down the cost of insurance for people who cannot afford it.

For 61-year-old Lynn Nelson of Vinita Park the ruling brought an immense sense of relief. The former schoolteacher had been uninsured for three years before purchasing a plan on Healthcare.gov for $76 a month. Without the subsidy, the cost would have skyrocketed to more than $600 a month. 

“I was just trying to think of what would be my options. I’d been searching on Canadian and Mexican websites, trying to find my medication and how I would get it,” Nelson told St. Louis Public Radio. “I know that without that I’d have to make some life-altering decisions.” 

In the majority ruling,Chief Justice John Roberts wrote that the tax credits involve billions of dollars each year, and affect the price of health insurance for millions of people.

“Whether those credits are available on Federal Exchanges is thus a question of deep 'economic and political significance' that is central to this statutory scheme; had Congress wished to assign that question to an agency, it surely would have done so expressly,” wrote Chief Justice John Roberts in the majority ruling.

And with that, the tax credits were upheld. Consumers should see no changes to the cost of their insurance this year.

Nearly 220,000 Missourians are enrolled in health insurance plans purchased on the federal exchange at Healthcare.gov. Nine out of 10 people with those plans receive income-based federal tax credits to bring down their premium costs, at an average of $278 per enrollee.

Counted together, those subsides represent $54,950,314 a month.

Also at risk were tax subsidies offered on federal-state partnership exchanges like Illinois, where 232,000 people receive subsidies for the health insurance they purchased there.

Without the subsidies, average premiums for Illinoisans were set to rise 169 percent, according to an analysis from the Kaiser Family Foundation.

Washington University health economist Tim McBride, who predicted the ruling’s outcome on his blog, said he saw two reasons given by the court for upholding the subsidies:

“They give deference to laws passed by Congress, and they don’t want to legislate from the bench. The second reason appeals to the fact that they didn’t want to cause disruption to insurance markets,” McBride said. 

Justice Antonin Scalia, who issued the dissenting opinion, wrote that he believed “somersaults of statutory interpretation” were used to uphold the two previous challenges to the Affordable Care Act.

“The cases will publish forever the discouraging truth that the Supreme Court of the United States favors some laws over others, and is prepared to do whatever it takes to uphold and assist its favorites. I dissent,” he concluded.

Cynthia Bauer, a St. Louis-area flutist who lives in Missouri, said the ruling offered a measure of certainty for the cost of her health insurance.

“If it weren’t for the subsidy, I would be paying closer to $648 (a month) because rates went up that much in one year,” Bauer said.

Because she works multiple jobs, Bauer said her income-based subsidy changed dramatically between the first and second year of her coverage. When she had to do work on her house this year, she worried about dipping into her savings. But if she took on additional work, she worried that she would lose the subsidy for her health insurance.

“It’s so complex right now that I would have to spend weeks just reading the Affordable Care Act to fully comprehend how it’s going to affect everything,” Bauer said. “I’d like it to be simpler than it is and have a provision for people who have long term issues who need to be covered. Society could do so much more to be humane to everyone.”

No change expected in Missouri

Although Missouri supporters of the Affordable Care Act appear emboldened by Thursday’s Supreme Court ruling, little is expected to change in the state government’s approach to health care.

Missouri Attorney General Chris Koster, a Democrat running for governor in 2016, swiftly issued a statement Thursday calling for the General Assembly to reconsider its opposition to the expansion of Medicaid as recommended by the ACA.

So did Gov. Jay Nixon, a fellow Democrat. “There are no more excuses for continuing to send our tax dollars to other states and denying 300,000 working Missourians the opportunity to access affordable health care coverage through Medicaid expansion," Nixon said. "I look forward to working with the General Assembly next session to finally bring our tax dollars home and provide affordable health coverage to hundreds of thousands of hard-working Missourians through Medicaid expansion.”

But Republican legislative leaders appear to remain solidly against any expansion. They also are unlikely to revisit the idea of setting up a state health insurance exchange.

So far, few state Republican leaders — including the crowd of likely GOP candidates for governor — have not weighed in on the ruling. And they may not need to, since the court in effect backed the status quo and let state legislators off the hook. They will not have to debate the fate of the insurance subsidies that hundreds of thousands of Missourians now collect through the federal exchange. Those subsidies will remain intact.

One GOP candidate for governor — state Sen. Mike Parson, R-Bolivar — issued a statement late Thursday saying he will continue to fight against the ACA in the General Assembly. 
“...With this ruling, the U.S. Supreme Court has given the Obama administration a major victory that will enable them to continue forcing this policy upon states like Missouri.  However, the fight is not over, and I will keep working in support of efforts to challenge Obamacare and free our state from this burdensome law.  Healthcare reform should focus on free markets, not government mandates," Parson said.

However, abortion opponents appear ready to shift the fight to curbing coverage in the exchanges that they believe subsidize abortion and related services. Unless a federal law is passed, Missouri abortion opponents would need to press for a state exchange if they want such restrictions put in place.

Meanwhile, Affordable Care Act supporters planned to celebrate Thursday evening with a series of rallies to be held around the state at 5:30 p.m. In St. Louis, such a celebration is scheduled at the  Central Reform Congregation, 5020 Waterman Ave.

In Festus, a rally is to be held at the Disability Resource Association, 130 Brandon Wallace Way.

Congressional react along party lines

U.S. Rep. William Lacy Clay, D-University City, echoed the Democratic delight at the court’s decision. “The ACA is now the settled law of the land,” he said. “And the endless, politically motivated attempts to weaken or overturn it must end.”

Clay renewed his call for the General Assembly to expand Medicaid, claiming that the opposition “continues to throw away $5.4 million a day in federal funds” that would cover the expansion costs for the first three years.

As expected, Missouri’s Republican members of members of Congress lamented the court’s ruling.

U.S. Sen. Roy Blunt, R-Mo., has been outspoken for years against the ACA. On Thursday, he reaffirmed his opposition, and predicted that health insurance costs in Missouri will increase in 2016 because of the ACA’s provisions.

“While I’m disappointed that the court didn’t ultimately accept what the law actually said, I'll keep fighting to protect Missourians from the president’s flawed health care plan and replace it with a patient-centered system that lowers costs, increases choices, and provides greater access to quality care,” Blunt said.

U.S. Rep. Ann Wagner, R-Ballwin, offered a similar assessment, while doubling-down on the GOP’s arguments: “Today’s Supreme Court decision does not change the fact that Obamacare is a deeply flawed law that puts an undue burden on hardworking Americans,” Wagner said. “We will continue to focus on protecting the American people — and offering new choices for quality, affordable health care — not protecting this failed law …”

For more health and science news from St. Louis, follow Durrie on Twitter: @durrieB.

Inform our coverage

This report contains information gathered with the help of our Public Insight Network. To learn more about the network and how you can become a source, please click here.

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Jo Mannies is a freelance journalist and former political reporter at St. Louis Public Radio.