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Maryland health advocates laud Supreme Court’s ACA decision

Justice Stephen Breyer, shown while attending a 2017 forum, wrote the opinion for the court's 7-2 majority. (AP Photo/Steven Senne, File)

Justice Stephen Breyer, shown while attending a 2017 forum, wrote the opinion for the court’s 7-2 majority. (AP Photo/Steven Senne, File)

Public health advocates in Maryland are celebrating the Supreme Court’s decision to dismiss a challenge to the Obama-era health care law, preserving insurance coverage for millions of Americans.

The justices, by a 7-2 vote, left the entire law intact Thursday in ruling that Texas, other Republican-led states and two individuals had no right to bring their lawsuit in federal court.

The law’s major provisions include protections for people with preexisting health conditions, a range of no-cost preventive services and the expansion of the Medicaid program that insures lower-income people, including those who work in jobs that don’t pay much or provide health insurance.

The Affordable Care Act has long been supported in Maryland, which was one of the first states to begin implementing it, creating the Maryland Benefit Exchange in 2011 and expanding Medicaid in 2014, said Vincent DeMarco, president of Maryland Citizens’ Health Initiative. The state has also passed a number of laws in recent years that build upon the ACA, such as Maryland Easy Enrollment Health Insurance Program.

“This decision, No. 1, protects the people that have health insurance now. (It also) give us opportunity to compound the ACA and help those people who don’t have health insurance,” DeMarco said. Maryland’s uninsured rate is now only 6%, declining from 13% in 2013 but still lagging behind other states like, Massachusetts, which has a rate of 3%, the lowest in the nation.

DeMarco also noted that Maryland passed bills in the 2000s that later informed provisions of the ACA, such as a bill that allowed individuals up to the age of 26 to continue using their parents’ health insurance.

The Supreme Court’s decision left in place the ACA’s now-toothless requirement that people have health insurance or pay a penalty. Congress rendered that provision irrelevant in 2017 when it reduced the penalty to zero.

The elimination of the penalty had become the hook that Texas and other Republican-led states, as well as the Trump administration, used to attack the entire law. They argued that without the mandate, a pillar of the law when it was passed in 2010, the rest of the law should fall, too.

And with a more conservative Supreme Court that includes three Trump appointees, opponents of “Obamacare” hoped a majority of the justices would finally kill off the law they have been challenging for more than a decade.

But the third major attack on the law at the Supreme Court ended the way the first two did, with a majority of the court rebuffing efforts to gut the law or get rid of it altogether.

Maryland had previously prepared for the possible repeal of Obamacare, establishing the Health Insurance Coverage Protection Commission soon after Trump was elected president in 2016. The General Assembly later passed a law that would have kept some provisions of the ACA in effect in Maryland even if the law were repealed. But, DeMarco said, it would have cost the state billions of dollars.

“I’m glad we passed it, but it would have been a disaster,” he said. “It would not have come anywhere near making up what would’ve been lost from the national law.”

Trump’s three appointees to the Supreme Court — Justices Amy Coney Barrett, Neil Gorsuch and Brett Kavanaugh — split their votes. Kavanaugh and Barrett joined the majority. Gorsuch was in dissent, signing on to an opinion from Justice Samuel Alito.

Justice Stephen Breyer wrote for the court that the states and people who filed a federal lawsuit “have failed to show that they have standing to attack as unconstitutional the Act’s minimum essential coverage provision.”

In dissent, Alito wrote, “Today’s decision is the third installment in our epic Affordable Care Act trilogy, and it follows the same pattern as installments one and two. In all three episodes, with the Affordable Care Act facing a serious threat, the Court has pulled off an improbable rescue.” Alito was a dissenter in the two earlier cases as well.

Republicans pressed their argument to invalidate the whole law even though congressional efforts to rip out the entire law have failed. The closest they came was in July 2017 when Arizona Sen. John McCain, who died the following year, delivered a dramatic thumbs-down vote to a repeal effort by fellow Republicans.

Chief Justice John Roberts said during arguments in November that it seemed the law’s foes were asking the court to do work best left to the political branches of government.

The court’s decision preserves benefits that became part of the fabric of the nation’s health care system even as Republicans repeatedly tried to rip out Obamacare — in Senate GOP Leader Mitch McConnell’s words — “root and branch.”

Michele Eberle, executive director of the Maryland Health Benefit Exchange, lauded the court’s decision in a statement, calling it, “great news for all Marylanders, including more than one million of our neighbors, friends and family covered through Maryland Health Connection. They will continue to have access to quality health insurance plans and financial help for those who qualify.”

Brian D. Pieninck, president and CEO of CareFirst BlueCross BlueShield, a health insurance company that serves Maryland, Washington D.C. and Northern Virginia, echoed Eberle’s sentiments. “CareFirst is pleased that the key provisions of the Affordable Care Act remain in effect and will continue to promote access to affordable health insurance for the individuals we serve and all Americans,” he said in a statement. “CareFirst looks forward to continuing our work with federal and state policymakers to maintain and improve access to healthcare throughout our region.”

Polls show that the 2010 health care law grew in popularity as it endured the heaviest assault. In December 2016, just before Obama left office and Trump swept in calling the ACA a “disaster,” 46% of Americans had an unfavorable view of the law, while 43% approved, according to the Kaiser Family Foundation tracking poll. Those ratings flipped and by February of this year 54% had a favorable view, while disapproval had fallen to 39% in the same ongoing poll.

The health law is now undergoing an expansion under President Joe Biden, who sees it as the foundation for moving the U.S. to coverage for all. His giant COVID-19 relief bill significantly increased subsidies for private health plans offered through the ACA’s insurance markets, while also dangling higher federal payments before the dozen states that have declined the law’s Medicaid expansion. About 1 million people have signed up with HealthCare.gov since Biden reopened enrollment amid high levels of COVID cases earlier this year.

The administration says an estimated 31 million people are covered because of the law, most through its combination of Medicaid expansion and marketplace plans. But its most popular benefit is protection for people with pre-existing medical conditions. They cannot be turned down for coverage on account of health problems, or charged a higher premium. While those covered under employer plans already had such protections, “Obamacare” guaranteed them for people buying individual policies.

Another hugely popular benefit allowed young adults to remain on their parents’ health insurance until they turn 26. Before the law, going without medical coverage was akin to a rite of passage for people in their 20s getting a start in the world.

Because of the ACA, most privately insured women receive birth control free of charge. It’s considered a preventive benefit covered at no additional cost to the patient. So are routine screenings for cancer and other conditions.

For Medicare recipients, “Obamacare” also improved preventive care, and more importantly, closed a prescription drug coverage gap of several thousand dollars that was known as the “doughnut hole.”

The Associated Press contributed to this story.

Editor’s note: A previous version of this article stated that Maryland expanded Medicare in 2014. It expanded Medicaid in 2014.


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