Published July 2, 2015
Now that the Supreme Court has affirmed nationwide tax credits for mandatory insurance coverage under the Affordable Care Act (ACA) — preserving access to affordable health insurance in all 50 states — Congress can get serious about fixing what needs to be improved in the law, UB health policy expert Nancy Nielsen says.
The ruling was a huge win for President Obama, says Nielsen, senior associate dean for health policy and clinical professor in the School of Medicine and Biomedical Sciences.
“This could be the end of serious legal attacks on Obamacare,” she says. “There will still be legal challenges and political moves to alter the law, but the structure will remain. Everything was riding on this. Now the country and Congress can get serious about fixing the things in the law that need improvement.”
Danielle Pelfrey Duryea, an instructor and clinical teaching fellow at the UB Law School who teaches the Health Justice Law and Policy Clinic, says that while in the short term an estimated 6.5 million people would have lost access to health insurance if the court had not upheld the tax credits, the longer-term implications of the ruling are just as striking.
A different decision could have “destabilized the whole architecture” of the ACA, with side effects that would have hit even states such as New York that have their own health insurance exchanges, she says.
“We know that low-income Americans suffer worse health outcomes, on average, than higher-income citizens. And we know that this outcomes gap derives, in part, from the historical gap between insured and uninsured that the ACA was designed to close,” she says.
“People without health insurance don’t receive preventive care, delay seeking treatment when they do become ill and must often rely on emergency medicine for primary care needs — all of which are ultimately far more expensive to the health care system than helping people afford to insure themselves.”
In affirming that the federal government may provide this assistance to citizens of any state, the Supreme Court brought significant new certainty and stability to a statute that has been under legal attack for years, Pelfrey Duryea says.
“We all deserve a chance to live healthy lives, no matter what state we happen to live in,” she says.
Nielsen adds that the country has seen the biggest decline in uninsured citizens in decades, and that is a result of important provisions of the ACA. The court’s 6-3 decision highlights the fact that subsidies are there for anyone who qualifies, regardless of where one lives.