In Win For White House, Supreme Court Upholds Obamacare Subsidies Nationwide

Transcript

RENEE MONTAGNE, HOST:

News from the Supreme Court justices this morning. They have had a decision on the Affordable Care Act, often called Obamacare. The case was about who was allowed to get subsidies to buy health coverage. Effectively, though, the justices have upheld the law. Joining us now is NPR's national political correspondent, Mara Liasson, and NPR's Scott Horsley.

Good morning.

MARA LIASSON, BYLINE: Good morning, Renee.

SCOTT HORSLEY, BYLINE: Good morning.

MONTAGNE: Huge, huge case, huge decision. And I'm going to start with you, Scott Horsley. Remind us what the case is about because technically, it really - it was really about a single phrase in the law.

HORSLEY: That's right. You've got to remember that this was a law that was sort of hastily crafted and hastily passed. And there's not been the opportunity as there usually would be to go back and make fixes for some sloppy language. And because of that sloppy language, there was a challenge to whether people in states that didn't set up their own insurance exchange but instead relied on the federal insurance exchange were eligible for government subsidies. And that's about 6.5 million people who were receiving those subsidies and might've lost them had this ruling gone the other way. What's more - had those folks lost them, the whole insurance market would've been upset. And in fact, in the majority opinion written by Chief Justice Roberts - John Roberts - he said Congress passed the Affordable Care Act to improve health insurance markets, not destroy them. So the court has left the law as it was. Everyone who was getting an insurance subsidy can continue to get an insurance subsidy - a big sigh of relief for those 6.5 million people and certainly a big sigh of relief at the White House for President Obama, whose legacy issue was on the line here.

MONTAGNE: Well, right. Well, I'm going to get back to exactly some of the meaning of the decision. But before I get to that, let me turn to you, Mara, because the politics - this had a huge - this will have a huge political effect.

LIASSON: It certainly will. You know, Scott just mentioned the big sigh of relief at the White House. This leaves intact the president's most important legislative achievement. Otherwise, it would've unraveled Obamacare. But Republicans, I think many of them, are also heaving a sigh of relief today because if the court had said the subsidies would have to stop for those 6.5 million people, Republicans would be left - since they control Congress - with the unenviable task of figuring out what to do. And even though they oppose the ACA, they have never been able to come together and find consensus on a replacement for Obamacare. And they would've been like the dog that caught the car - what were they going to do with it? And they just didn't know. Some of them said, well, we could put a patch on and continue the subsidies until maybe we had a Republican president in the White House. Other ones said, I don't want to do anything that would perpetuate Obamacare. So it was a very tough issue for the Republicans, they hadn't come up with an answer. And I think this, politically, is a good outcome for them, too.

MONTAGNE: That's what I was just going to ask. In some strange way, there would be a sigh of relief among Republicans.

LIASSON: No doubt.

MONTAGNE: Well, back to the - again, the law itself and today's case. You talked about the millions of people who would be affected or - effectively will not lose their insurance. But in the larger picture, this was never just about, you know, millions of people getting insurance - or rather losing their subsidies. It also had to do with people who had subsidies because it was expected if it had gone against the Affordable Care Act that all states would've been affected.

HORSLEY: Well, that's right because if you take away the subsidies then you would've had a real problem with the only people who would've been continuing to stay in the market would've been the most costly, sickest patients, and the economics really would've fallen apart. And here's an interesting footnote - the states that didn't set up their own insurance exchanges - that is, the ones that are relying on the federal government's healthcare.gov exchange - were the states that - where the people needed the subsidies most. In states that actually did set up exchanges, about 80 percent of the folks in the exchange were getting government subsidies. In the states that were relying on the federal exchange, that figure was closer to 90 percent. So the states that didn't have their own exchanges and where the subsidies were at risk were the ones that are using the subsidies the most.

LIASSON: And guess what about all those states? Most of them are red states, the states where you have the poorest populations, generally in the South. They are red states. They have Republican governors. Many of them have Republican senators up for re-election next year. And that's the interesting thing about them. It was a political decision on the part of these state governors and legislatures not to establish their own exchange because that would've been somehow approving of Obamacare.

HORSLEY: Sure.

LIASSON: So they held fast. They didn't do it, but the law said that everyone can get a subsidy, so their - their populations were able to buy insurance on the federal exchange and get subsidies through the federal exchange, which the court has just affirmed. So the question - the political question was, if the court had gone the other way, most of the 6.4 million people would've been in these red states - would they have blamed their own governors and legislatures, or would they have been mad at the president because he promised they could keep their coverage? We didn't know that, but Republicans were sufficiently concerned about that, that many of them felt this outcome is probably the best, politically, for them.

HORSLEY: And everyone had argued that this was a complete accident of sloppy legislative crafting here. Nobody really meant there to be different treatment of people in states with their own exchanges versus federal exchanges. No one even really argued that that was the intent, but that was the clear language in this one sort of sloppy passage of the Affordable Care Act. The president argued all along that the context of the law made it clear what the intent was, that this was an easy case of statutory interpretation and that it really should never even gotten to the Supreme Court. It did, however. Four justices agreed to take up the case. But in the end, six of the justices - six of the nine justices came out and said, yes, the intent of the lawmakers was clear, and that's the way they're interpreting the law.

LIASSON: And, you know, what's interesting is that some of the language in this decision says the ACA contains more than a few examples of, quote, "inartful drafting." So this happens all the time. And as Scott said earlier, usually Congress goes back and fixes typos, but you can't fix anything in Obamacare because it's such a highly charged political issue.

MONTAGNE: Well, given what you've said, doesn't sound like they - first of all, is there any other avenue of challenge? But it doesn't sound like there's a will there, a political will.

LIASSON: Well, you could get - you could elect a Republican president. And if you had a Republican president and a Republican Congress, you could probably chip away at Obamacare and unravel it over time.

HORSLEY: But we've now had - the law has now survived two very serious challenges before the Supreme Court. Once again, the death-defying Barack Obama has walked the tightrope, given a lot of folks heart palpitations and come out victorious on the other end.

MONTAGNE: Well, thank you both very much.

LIASSON: Thank you.

HORSLEY: My pleasure.

MONTAGNE: That's NPR's Scott Horsley and NPR's Mara Liasson. Transcript provided by NPR, Copyright NPR.