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Supreme Court Rules Obamacare Subsidies Are Legal

Supreme Court Rules Obamacare Subsidies Are Legal
Supreme Court Rules Obamacare Subsidies Are Legal
Supreme Court Rules Obamacare Subsidies Are Legal GUESTS:Glenn Smith, constitutional law professor, California Western School of Law Gary Rotto, director of health policy and strategic communications, Council of Community Clinics

Our top story, today's US support decision upholding the affordable care act is mostly an academic exercise for Californians. Throughout the debate before the court will told because we are among the handful of states that have set up their own health exchanges, it didn't matter how the court will. Eventually healthcare experts warn we would feel it. The court struck down the act and other state insurance systems collapsed the cost would rise, markets would destabilize and if you had to move to a state without an exchange, you may have to kiss your health insurance goodbye. Today's ruling is important even to Californians. Joining me are Glenn Smith, constitutional law professor at Calpurnia Western school of Law Gary Roto is director of health policy for the Council of committee clinics in San Diego. Thank you. What is your reaction to this 63 decision upholding Obama care. I'm very surprised at how decisive it was. I was predicting it was more likely than not then one or the other of the justices might provide a 5 to 4 margin but 6 to 3 in an opinion that cuts across the board is a big win for Obama care, for the initiation. Also for the idea that statutes should be looked at in their totality and given a reasonable and practical interpretation and that the court ought to think along and hard before it interferes with the basic nature a compass meant of a compass. The swing votes you're talking about our Justices Kennedy and Chief Justice Roberts. Guess because How important you think the decision is? While it didn't to directly affect California, it did affect so many states across country. It affected the movement of committee health centers and committee clinics. Certain as we have seen in California, the number of people who have enrolled in the Medi-Cal expansion and covered California and how many of those people are coming into the clinics, that is mirrored across the country. This whole controversy, before the court as you said it was statutory deal. It is centered around a few words in the law which said the exchange had to be established by the state. Why was that a pivotal issue in this? Because the challengers were claiming and several circuit judges had agreed, because 36 exchanges weren't established by the statement as a fallback were done by the federal government that Williams of dollars of subsidies necessary to make health care affordable for upwards of 8 million people, and were not available. You have the prospect that in one Supreme Court opinion, millions of people would be disinterested in healthcare. If they didn't get the federal subsidies they would be up to afford the healthcare tax Yes. They also would be required to have healthcare so what you would have is a huge wave going against the overall approach of the act which was to have as much universal coverage as we could have and have more people to participate in the system to make it affordable. It would subvert the mandate that this court upheld in its last decision? Right. That's what was said. You have to understand the subsidies for one of three key facets to the law. If you undercut that in 34 states there an overly technical reading of these four words out of the contracts, you do basic damage to the acts and so what you had, although the issue three years ago was whether the individual mandate was constitutional, is a nice symmetry to both decisions. Both written by Justice Roberts and both taking language which on its face looks like it goes contrary to the government and looking at it in its overall context and straining to uphold it in light of the overall purpose of Congress. As you mentioned, Chief Justice Roberts wrote the decision on the mandate he also wrote this decision. How significant is that? I think whenever the chief justice a science of the opinion to himself, he's trying to land a greater gravity to it. What is significant is you have someone who most people paint with a large brush as happens as conservative, showing you there's more at stake in these cases. As a whole question about the practical impact but there's also a legitimacy question about the courts purporting to but in and stand in the way of the other elected branches of the federal government and what they want to do. I think Roberts has shown in this case he is very conscious of that as a cheese as he should be. This law should be called Scotus care. What's his argument? He is basically up to his usual Scalia clever rhetoric. He is saying that started with that opinion three years ago and in this opinion, the Supreme Court has overstepped the line of not interpreting what Congress did. Becoming congresses copartner in changing the law and order to make it work. That's not the appropriate role of the court. Put broadly, that's true. Also broadly, the Chief Justice is right is inappropriate for courts to stand in the way for mechanistic interpretation of commerce is real intent. Boat sides are right in principle but the question in this case is what principle wins out in this particular set of facts? We saw a decisive goal when for practicality and for a more modest role of the courts. Staying with practicality, what have been the real-world effects of the affordable healthcare act here in California? We certainly hear the establishment of the ACA, a great uptick in the number of people who have been eligible for Medi-Cal because of Medi-Cal expansion. We've gone for around 350,000 people in San Diego County to over 650,000 people. It shows there's a need acceptance it shows through quality care is needed to be provided for our community clinics. We're also seeing the cover California subscribers here in San Diego have also been somewhere around 150,000 which is not an insignificant number. Overall, who you have people who have coverage, kept a more comfortable in seeking care, looking for that access to care. And also bringing the number of uninsured down significantly over just these past few years. Are the statistics already if more people are seeking healthcare cuts of this? We see that in the clinics. We know people who had previously come to us as uninsured, they come to us once, they feel more comfortable in saying I'm going to get only what I need for right now, I want to state well, I want to get prevention, have better understanding. I need to come in more often because of my asthma, diabetes etc. or because I have the potential to develop those chronic diseases, and more willing to do it because I know I have coverage here that will buttress with my provider says I need to do for the best care for me. Critics of the law contend the polling still indicates almost half of all Americans still don't support Obama care. What you think accounts for that? Anytime you have a law that is 2000 pages long, trying to understand that, when you go back and take a look and you asked people should there be an exception for pretesting conditions? Should you not be able to get insurance? They said no of course. Anybody should be covered. Should people have greater access, absolutely. Would ask about the individual programs that have been set up under the ACA, the polling shows people are supportive. Civilian talk to people in the community, they are supportive of what we are doing, they are supportive and glad to see their more people coming in to stay healthy and ill to healthy committee. With the polling numbers may show is very different than what people are acting on in the field. Gary touched on an issue, when this law was being about it on. The act that it was such a big law. 70 pages to this law, a lot of lawmakers said they didn't get a chance to read it. I'm wondering, is the way the affordable care act crafted, does that open itself to these challenges that have come up. Was that whatever the reason that has been challenged so much. There are so many assumptions that statutory interpreters make Congress consistent got a document, it's difficult to sustain that over multi-hundred page law. You see that here. This particular issue, nobody noticed the obscure language until three years after the law. I suspect our people now coming to the lot looking for the next daunting at the challenge to try to deal with this. Adjusting me and a few had Justice Robert citing the poor getting as a law for the reason for the court to look beyond the specific language. If anybody -- on the one hand the court majority say they differed to Congress in the grand scheme but they had a few negative things to say about the job of getting that was done. In fact it became one of the reasons they ruled in favor of Congress ironically. If they depict anything about the law, there be no law. If you like sausage, and your claws, don't watch how they are made. I know in hectic political environment, to expect perfection or consistency is not reasonable. I think that's an underlying theme of this court opinion. If this decision had gone the other way, would California have felt the impact? They would have an tricky. I think his dissenting opinion Justice Scalia said if we say the subsidies are not legal, commerce will just come back and not disappoint as people in total, they will do something. If they did something that means Congress would have made an appropriation and set up a program that would have excluded California. Right now, I really do the subsidies that go to subscribers it in exchange, you have other programs that Congress has set up with as part of the essay of outside the ACA that our critics in San Diego Southwest Riverside County to be very well on a national level to go we know there is still areas that are underserved that do -- people don't have access to primary care because Becca extended service, many of our clinics have been receiving hundreds of thousands of dollars in grants because they have proven what needs to be done, they have proven the need in specific areas, you can beat it very well in those grants opportunities. We were concerned we may have seen those go away in a short-term to try to buttress what is going on in other states because Becca --. You would have added to confusion in the entire country. There are more rulings expected from the supreme court in the last few days in June. A major ruling on same sex marriage. Another that may have indications in the lethal injection form of execution is that right? This case formally and directly only affects or states and not California California in a related lawsuit has agreed to go to a different lethal injection method. What this case will do is said that indication about who bears the burden, the death penalty defendant or the state in showing the method of execution is safe or at least acceptable to go It will have an indirect impact on that. Why doesn't the court wait until the very end in order to release these decisions? If they are trying to create drama, it's a byproduct. These are relative -- argued late in the town because Becca they have to circulate the opinions and agree, it's not surprising it waits till the last part. It's like all of us on our way to vacation put off the difficult stuff until the end. Is it possible these decisions might come down tomorrow. They're going to announce decisions tomorrow and Monday. They could always extend it to Tuesday. It's possible the same sex marriage could come down. I'm expecting that on Monday. The lethal injection opinion could come down. Another case is the legislative district in case because they were used as a citizen session process and if as people are expecting based on the oral argument, the court invalidates that system, we may be back today in California where we don't have the districts strong by citizen commission. Therefore we have more polarized districts. There's always something to watch. I want to thank you both, Glenn Smith and Gary Rado, thank you both very much. You're welcome.

Updated at 1 p.m. ET

The Supreme Court today handed the Obama administration a major victory on health care, ruling 6-3 that nationwide subsidies called for in the Affordable Care Act are legal.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," the court's majority said in the opinion, which was written by Chief Justice John Roberts. But they acknowledged that "petitioners' arguments about the plain meaning ... are strong."

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The majority opinion cited the law's "more than a few examples of inartful drafting," but added, "the context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase."

Roberts was joined by the court's liberal justices, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan, as well as Anthony Kennedy.

As NPR's Nina Totenberg reported in March, opponents of the law contended "that the text of the law does not authorize subsidies to make mandated insurance affordable in 34 states."

At issue were six words in one section of the law. As Nina pointed out: "Those words stipulate that for people who cannot afford health coverage, subsidies are available through 'an exchange established by the state.'" She added:

"The government [contended] that those words refer to any exchange, whether it is set up by the state itself or an exchange run for the state by the federal government in accordance with individual state insurance laws and regulations. The challengers [said] the statute means what it says and no more."

The court agreed today with the government's position.

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The decision comes three years after a bitterly divided high court upheld the Affordable Care Act as constitutional by a 5-to-4 vote.

President Obama made a statement on the ruling late Thursday morning, saying the Affordable Care Act "is here to stay."

The case was King v. Burwell.

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