By William E. Gibson
A Supreme Court decision upholding subsidies for health insurance under the Affordable Care Act brought relief to more than a million Floridians who depend on them to save up to thousands of dollars on their policies each year.
Florida has the largest number of people with subsidized health insurance through the federal marketplace — 1.32 million. The state had the most to lose if the high court had struck down subsidies in 34 states that use the marketplace for buying insurance.
The decision affects about 622,000 patients from West Palm Beach to Key West, who have subsidized policies through the new health care system known as Obamacare. In the Orlando area, including Winter Haven and Kissimmee, 107,000 have subsidies.
South Florida had the most at stake mostly because the region had one of the highest uninsured rates before the new law was enacted. About one in five residents lacked health insurance, and many residents took advantage of subsidies provided by Uncle Sam, based on their income.
The average subsidized policy in Florida costs consumers $82 a month, according to a compilation of government figures by Families USA, an independent group that supports the new law. If subsidies were removed, the average policy would cost $376 a month.
Because the high court upheld the subisides, consumers will not face immediate increases in their premiums, nor will they need to adjust their policies.
Florida Republican leaders, who have resisted the new law, had no plan to replace the subsidies if they were struck down.
Democratic supporters of the new law declared victory.
"This ruling should also mark the end of Republicans' never-ending quest to gut the Affordable Care Act," U.S. Rep. Debbie Wasserman Schultz, D-Weston, said after the ruling was released. "Twice our nation's highest court has given its stamp of approval to the ACA; it is unquestionably the law of the land. Instead of constant political games, Congress must work together to continue improving the ACA, and states should work with the federal government to provide coverage for all of their citizens."
Rep. Patrick Murphy of Jupiter, a Democratic candidate for the U.S. Senate, said: "Today, millions of Floridians can rest easy knowing that the critical funding they need for their health care coverage will remain in place. More Floridians are benefiting from the health care law than anywhere in the country, and while we can continue to work to strengthen the law, it shouldn't be used as a political football that jeopardizes critical assistance for millions of Americans."
But Republicans showed no signs of backing down from attempts to repeal and replace the law.
"I disagree with the court's ruling and believe they have once again erred in trying to correct the mistakes made by President Obama and Congress in forcing Obamacare on the American people," said U.S. Sen. Marco Rubio, R-Fla.
"Despite the Court's decision, Obamacare is still a bad law that is having a negative impact on our country and on millions of Americans," added Rubio, a presidential candidate. "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. We need Consumer Care, not Obamacare."
Former Gov. Jeb Bush, another Republican presidential candidate from Florida, tweeted: "I am disappointed in the Burwell decision, but this is not the end of the fight against Obamacare." He promised in a statement to "work with Congress to repeal and replace this flawed law with conservative reforms that empower consumers with more choices and control over their health care decisions."
The ruling upholds an essential part of the Affordable Care Act but did not end other significant controversies.
A previous court ruling forbids the federal government from requiring states to expand Medicaid to cover millions nationwide and about 800,000 in Florida who do not qualify for subsidies but cannot afford the full price of insurance. Florida and other Republican-run states, while resisting the law when possible, have refused to expand Medicaid, creating a coverage gap.
Florida has tried to fill that gap by using money from a federal program that pays hospitals and other health-care providers to treat those who don't have insurance. The Low-Income Pool money for Florida has been cut from $2.2 billion to $1 billion for the fiscal year beginning July 1. The Florida Legislature this month added $400 million of state money.
Health-care advocates say the Low-Income Pool is no substitute for Medicaid, partly because it's designed to pay for emergency needs — not regular, ongoing preventive care.
The question before the high court — in King v. Burwell — was whether residents of states like Florida that use the federal marketplace were eligible for subsidies. It centered on four words in the voluminous law, which authorizes subsidies for those who enroll through an exchange "established by the State."
Critics of the law said that means the federal government could only offer subsidies to those who get their insurance through a state-run exchange. Defenders say that's just a technicality.
The high court majority, in a 6 to 3 decision, ruled that the phrase appears ambigous but the meaning was clear: Congress intended to provide subsidies through all exchanges.
"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Chief Justice John Roberts wrote in the majority opinion.
According to the Centers for Medicare and Medicaid Services, 1,324,516 Floridians would have lost an average of $3,528 in tax credits if the Supreme Court had ruled against the subisidies. Insurance premiums in the state would have increased by 350 percent.
As of March, 93.5 percent of Floridians enrolled in the federal marketplace received financial assistance to help lower the cost of their health coverage.
"My district has the third-highest number of people in the nation who benefit from the subsidy," said U.S. Rep. Frederica Wilson, a Democrat who represents parts of Broward and Miami-Dade counties. "It is a relief that those constituents, mostly immigrants, can now rest assured that their health care needs can be met.
"They will not have to forgo seeking treatment because they lack the financial resources or be forced to rely on emergency room services to meet their health care needs, which is bad for patients and bad for the economy because it drives up the cost of insurance and medical services for other consumers."
Florida congressional districts with largest number of people receiving subsidies
…….………………………Residents with subsidies………Counties
Dist. 25, Rep. Mario Diaz-Balart…………….91,000………Broward/Miami-Dade
Dist. 27, Rep. Ileana Ros-Lehtinen…............86,000……..Miami-Dade
Dist. 24, Rep. Frederica Wilson……………..84,000………Broward/Miami-Dade
Dist. 26, Rep. Carlos Curbelo……………..…83,000………Miami-Dade/Monroe
Dist. 20, Rep. Alcee Hastings………………..75,000………Palm Beach/Broward
Dist. 23, Rep. Debbie Wasserman Schultz...72,000………Broward/Mimai Dade
Dist. 22, Rep. Lois Frankel…………………..68,000……….Palm Beach/Broward
Dist. 9, Rep. Alan Grayson…………………..63,000……….Orange/Osceola/Polk
Dist. 21, Rep. Ted Deutch……………………63,000……….Palm Beach/Broward
Dist. 18, Rep. Patrick Murphy………………..47,000……….Palm Beach/Martin/St. Lucie