State officials planned for a decision against Obamacare but praised the high court’s ruling Thursday preserving federal tax subsidies for consumers purchasing coverage via healthcare.gov.
Hawaii is planning to use the federal marketplace to sign residents up for health insurance coverage in 2016.
Thursday’s U.S. Supreme Court ruling ensures that people who sign up for health care through the federal government will still get tax credits.
State officials said they had planned for a ruling against Obamacare by keeping customer service and outreach in Hawaii to maintain the state’s status as a state-based marketplace.
“We’re pleased that the Affordable Care Act remains the settled law of the land because it will help Hawaii maintain its leadership role as it provides more affordable coverage to more of its residents than any other state since the passage of the Hawaii Prepaid Health Care Act of 1974,” said Jeff Kissel, the Hawaii Health Connector’s executive director, in a statement.
U.S. Senator Brian Schatz (D-Hawaii) called the Supreme Court’s decision a “victory for all Americans.”
“Because of the Affordable Care Act, more people have access to quality health care, the number of uninsured is falling, and health care costs are growing at the slowest rate in a generation,” Schatz said in a statement.
Gov. David Ige was traveling Thursday and unavailable for comment.
The Ige administration decided to abandon Hawaii’s troubled Health Connector website, which has struggled since its launch in October 2013 to meet enrollment targets, provide satisfactory service and raise enough money to be self-sustaining.
The Connector has burned through $130 million of $204 million in federal money granted to the state to build the exchange.
Ige acknowledged last month that Hawaii is out of compliance with the ACA and is at risk of losing $1 billion in Medicaid funds if Washington does not accept the state’s plan to remedy the ailing Health Connector.
Thursday’s 6-3 Supreme Court ruling upheld financial aid to millions of low- and middle-income Americans to help pay for insurance premiums regardless of where they live.
A handful of words in the Affordable Care Act suggested the subsidies were to go only to consumers using exchanges operated by the states.
With the ruling, more states may follow Hawaii and turn their Obamacare programs over to the federal healthcare.gov website.
When the Affordable Care Act passed in 2010, most people expected that each state would want to run its own health insurance marketplace. That never really happened, as many states opted to let the federal system, HealthCare.gov, do the work for them. Many of those states that did try running their own marketplaces are starting to think twice.
In the first year of operation, three state exchanges — Nevada, New Mexico and Oregon — had technology failures so profound that they handed the bulk of their operations to the federal government.
Even some exchanges that have performed relatively well — including Washington and Minnesota — are experiencing substantial information technology problems. And the expense of managing an exchange is also climbing in many places as federal startup funding diminishes. The Washington Post reported in May that nearly half of the states are suffering from financial difficulties.
“There is no new money now to build new infrastructure, and there are no grants available to fix these systems if they’re struggling,” said Heather Howard, the director of the State Health Reform Assistance Network at Princeton University, which was set up to advise states on exchange building. “So the only path forward may be to use HealthCare.gov.”
Nationally, 10.2 million people have signed up for health insurance under the law. That includes 8.7 million who are receiving an average subsidy of $272 a month to help pay their premiums. Of those receiving subsidies, 6.4 million were at risk of losing that aid because they live in states that did not set up their own insurance exchanges.
The health insurance industry breathed a sigh of relief, and a national organization representing state regulators from both political parties said the court’s decision will mean stable markets for consumers.
Obama greeted news of the health care decision by declaring the law is no longer about politics but the benefits millions of people are receiving. "This is no longer about a law," he said in the White House Rose Garden. "This is health care in America."
Declining to concede, House Speaker John Boehner of Ohio said Republicans, who have voted more than 50 times to undo the law, will "continue our efforts to repeal the law and replace it with patient-centered solutions that meet the needs of seniors, small business owners, and middle-class families." However, he declined to commit to a vote this year.
Several Republican presidential candidates said they would continue the fight, ensuring it will be an issue in the campaign.
Other legal challenges are working their way through the courts, but they appear to pose lesser threats to the law, which passed Congress without a single Republican vote in 2010 and has now withstood two stern challenges at the Supreme Court.
At the court, Chief Justice John Roberts again wrote the opinion in support of the law, just as he did in 2012. His four liberal colleagues were with him three years ago and again on Thursday. Justice Anthony Kennedy, a dissenter in 2012, was part of the majority this time.
Roberts said that to read the law the way challengers wanted — limiting tax credits to people who live in states that set up their own health insurance marketplaces — would lead to a "calamitous result" that Congress could not have intended.
"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Roberts declared in the majority opinion.
Justice Antonin Scalia, in a dissent he summarized from the bench, strongly disagreed. "We should start calling this law SCOTUScare," he said, using an acronym for the Supreme Court and suggesting his colleagues’ ownership of the law by virtue of their twice stepping in to save it from what he considered worthy challenges.
The New York Times and the Associated Press contributed to this story.