California officials and consumer groups cheered the Supreme Court's ruling Thursday to uphold Obamacare premium subsidies nationwide, and some health-law supporters chided justices for hearing the challenge in the first place.
"Now that the Supreme Court has upheld the Affordable Care Act once again, we hope we can stop debating a 5-year-old law and discuss additional ways to reduce health costs," said Anthony Wright, executive director of Health Access California, a consumer advocacy group.
A court ruling against the Obama administration in the King vs. Burwell case wouldn't have had any immediate effect on Covered California and its 1.2 million consumers receiving subsidies because it's a state-run marketplace.
Conservative activists in their unsuccessful challenge argued that a strict reading of the Affordable Care Act made subsidies available only in states such as California that established their own exchange.
However, California officials were concerned that a ruling against Obamacare would have opened the door to changes in Congress that could have harmed Californians and their ability to get federal help paying their premiums.
"This ridiculous challenge should have never been taken," Wright said, "since it was based on a hyper-literal willful misreading of four words of the Affordable Care Act."
Peter Lee, executive director of the Covered California exchange, praised Chief Justice John G. Roberts Jr. for his majority opinion in the landmark 6-3 decision.
“In many ways, Chief Justice Roberts demonstrated a deep understanding of what the Affordable Care Act is about,” Lee said in a conference call Thursday. “It’s making sure multiple pieces work together to reform the insurance system and make it available to everyone.”
Lee said a court ruling against the subsidies would have confused consumers in California and across the country.
“It would have cast a pall over implementation in this state and around the nation,” Lee said. “It would have led to uncertainty for people on whether the law would be applied. Now we can move on.”
Sen. Barbara Boxer (D-Calif.) said the court's ruling was a victory for millions of Americans -- many of whom obtained health coverage for the first time under the health law.
"It is long past time for Republicans to end their efforts to undermine the Affordable Care Act and join us in fulfilling the promise of quality, affordable healthcare for all," Boxer said.
Many health-law supporters said considerable work remains to be done to fulfill the goals of the Affordable Care Act in terms of increasing enrollment and tackling stubbornly high healthcare costs.
"It’s time to stop fighting this law and start enrolling more Americans," said Dr. Robert Ross, chief executive of the California Endowment and a former board member of Covered California.
People can qualify for premium subsidies if they make less than four times the federal poverty level, which is about $47,000 annually for a single adult and $97,000 for a family of four.
Nearly 1.4 million Californians are enrolled in the state exchange and nearly 90% receive some level of federal subsidy. About 120,000 enrollees pay less than $10 per month after accounting for that assistance.
Overall, Californians received $3.2 billion in premium subsidies during the rollout of the insurance overhaul last year. The average monthly subsidy was $436 per household, according to the state.
Health-policy analysts say Covered California and other exchanges are facing a tougher road ahead signing up the uninsured and holding down premiums.
"While this is a major victory for exchange markets, critical challenges remain for future years,” said Caroline Pearson, senior vice president at Avalere Health, a national consulting firm. “Exchanges need to focus on increasing enrollment and attracting younger, healthier individuals in order to ensure a variety of affordable health plan options participate in the market.”