By Sun Sentinel Editorial Board
On Thursday, the U.S. Supreme Court didn't just save health insurance for nearly 1.5 million Floridians. The court saved opponents of the Affordable Care Act from having to offer their own alternative.
Had the court invalidated subsidies in states such as Florida where the federal government operates the health insurance exchange, Republicans in Congress had no plan for how to help 6.4 million Americans in those states retain their coverage. Gov. Rick Scott and Republicans in the Legislature had no plan for the 1.3 million Floridians who have obtained coverage using the subsidies.
For now, however, all those critics of the health care law have caught a break. Writing for the court's 6-3 majority, Chief Justice John Roberts stated the obvious: Congress intended that subsidies be available not just in states that run their own exchanges but in states where the federal government runs the exchange. Practically speaking, as Roberts put it, the federal exchange and the state exchanges are "identical."
Roberts called the language of the law "ambiguous" and "inartful." Another description would be "sloppy." Section 36B states that subsidies shall be available on an exchange "established by the state." Right-wing critics searching for a way to undermine the law seized on this phrase. They found four plaintiffs from Virginia — which didn't create an exchange — to claim that subsidies are illegal in the 34 states where the U.S. Department of Health and Human Services runs the exchanges.
As Roberts noted, however, where there is ambiguity in legislation the courts must look to intent. Studies showed that if the court ruled the subsidies illegal, enrollment would have plummeted and premiums would have spiked, creating what insurers call a "death spiral."
Roberts wrote: "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret (the law) in a way that is consistent with the former, and avoids the latter." Striking down the subsidies, which average $300 per month, would have produced a "calamitous result."
The result would have been especially calamitous in South Florida and for Republicans. No region nationwide had more sign-ups through the exchange. According to Families USA, an advocacy group for the Affordable Care Act, roughly a quarter million of those newly insured live in the districts of GOP Reps. Mario Diaz-Balart, Ileana Ros-Lehtinen and Carlos Curbelo. Another 362,000 live in the districts of Democrats Frederica Wilson, Alcee Hastings, Debbie Wasserman Schultz, Lois Frankel and Ted Deutch.
With Republicans controlling Congress and the Legislature, however, the GOP would have been responsible for helping those who have benefited from a law that Republicans have tried to kill. Before the ruling, Diaz-Balart and Ros-Lehtinen said they have been seeking to keep the subsidies during a transition to ... something. "This is not the best possible health care option available to Americans," Diaz-Balart and Ros-Lehtinen said, "and we intend on working with our colleagues fix it."
Yet subsidized coverage under the Affordable Care Act is the only option available to their constituents. For the last five years, Republicans have tried to repeal the law without offering a credible replacement. Jeb Bush was still calling for repeal Thursday, saying that he wants to put "patients in charge." Of course, he offered no specifics. Mike Huckabee called the ruling "judicial tyranny," even though Roberts pointed out what so many others have pointed out: The exchange mirrors health reform in Massachusetts that happened under the well-known Republican Mitt Romney.
After Thursday's ruling, the GOP should move from "repeal and replace" to "reform." Even if a Republican succeeds Barack Obama, ripping out the health care law in 2017 would disrupt the industry. Indeed, the Rand Corporation concluded that a ruling against the subsidies could have roiled all health insurance markets. Further, providers have changed policies to deal with the law's tougher standards for payment reimbursement. Parents like being able to cover their children until age 26.
The debate over whether the law can reduce insurance premiums goes on. The debate over the need for more Americans to have insurance, however, should be over. A new study by the Brookings Institution found that every uninsured patient costs hospitals $900 per year. Even with the law, millions of Americans lack coverage.
As Obama acknowledged Thursday, there's more to do. On Florida's to-do list should be expansion of Medicaid, which Gov. Scott continues to oppose. It would cover nearly 1 million more Floridians, and further lower the state's rate of uninsured. Scott has never offered his own idea to help the more than 2 million Floridians who have subsidized coverage or could get coverage through an expanded Medicaid program.
Ranting for the minority, Justice Antonin Scalia spoke for sore losers everywhere when he called Thursday's ruling "quite absurd" and claimed that Roberts has a political agenda in keeping the law alive. Actually, the law is about keeping people alive and healthier. All we want to hear now from the critics are ways to help do that.