What they said
In praise of the ruling: "The ruling resolves important long-standing questions about the act and will allow attention to be turned to focus on increasing access, delivering quality care and improving patient health." - Rae Young Bond, director of the Chattanooga-Hamilton County Medical Society "The uncertainty surrounding tax credits and federal and state health insurance exchanges jeopardized patient care and was a potential disruptor to our health care system, especially for the nearly 156,000 Tennesseans who currently use federal subsidies to purchase health insurance on the federal exchange." - Dr. John W. Hale Jr., president of the Tennessee Medical Society "There are no more excuses for this legislature or its leadership to ignore the 300,000 working men and women waiting on health care. We have work to do. It is my hope that the Governor and our speakers will call legislators back to Nashville immediately to work on passing Insure Tennessee." - Tennessee House Democratic Leader Craig Fitzhugh "We can get busy now and start providing the avenues for people to have access to health care that they very much need. So I'm anxious to come back and work on that and get busy with it." - State Rep. JoAnne Favors, D-Chattanooga "The reason why millions of families now have health insurance is because of the subsidies that have finally made access to health care affordable. Yet, to this day, Nathan Deal continues to play politics with the issue, denying health care to hundreds of thousands of Georgians who fall through the coverage gap." - Democratic Party of Georgia Chair DuBose Porter Opposed to the ruling: "Today's ruling affirms that it is up to Congress to come together around a responsible solution that provides relief from the damaging effects of the president's health care law, including policies to provide far greater choice in the marketplace so affordable plans that meet the actual needs of Tennesseans can openly and effectively compete for their business." - Sen. Bob Corker, R-Tenn. "Today confirmed what we have said all along: Obamacare is a poorly written law that was not read by the members of Congress who passed it. Although this is a setback, it is by no means the end of our fight. I will continue to work to repeal Obamacare and replace it with true free market health care reform that benefits hardworking families and businesses in East Tennessee." - Rep. Chuck Fleischmann, R-Tenn. "I am terribly disappointed in the Supreme Court's ruling. As I have said from the beginning, this issue goes well beyond the Affordable Care Act and to the very heart of our constitutional separation of powers. The Supreme Court has further expanded executive power to the point where the White House now believes it has the ability to unilaterally change laws a power exclusively reserved for Congress." - Rep. Scott DesJarlais, R-Tenn. "I am very disappointed in the Supreme Court's decision to once again save Obamacare from itself. Although the Court has spoken, I will continue working to protect my constituents from the harmful effects of this law. My hope is that the next president will work with Congress to repeal the law and replace it with legislation that restores freedom, puts patients first and expands choice." - Rep. Tom Graves, R-Ga "While the Supreme Court decision will not result in millions losing their health coverage immediately, it is clear to everyone that deep and fundamental flaws in the law remain. I look forward to 2016 and electing a president who can appropriately assess the damage and chart a course away from Obamacare." - Senate Speaker Ron Ramsey, R-Blountville "Obamacare has been a failed law from the start, and it is unfortunate that it has survived another legal challenge. I am hopeful that our elected officials in Washington will take action to repeal this law and replace it with something that will be beneficial for all citizens." - State House Majority Leader Gerald McCormick, R-Chattanooga "I am deeply disappointed by today's Supreme Court ruling in the King v. Burwell case. By permitting President Obama to ignore and rewrite important provisions of the Affordable Care Act, the Supreme Court has threatened our constitutional structure, which has always been understood to give Congress-and only Congress-the power to enact and amend the laws of our nation. Today's Supreme Court ruling is a loss for everyone who cares about the Constitution and the rule of law." - Georgia Attorney General Sam Olens
Darlene Ables was glued to the living room TV in her Soddy-Daisy home Thursday morning, nervously waiting to see what the U.S. Supreme Court would decide about her health insurance.
Ables, 57, had stepped away from the screen for a few minutes when she got a call from a friend. The court had decided to uphold a key provision of the Affordable Care Act, the friend told her: Ables' insurance was safe.
"Oh, thank God," Ables recalls thinking. "I think I can finally breathe again for a while."
Health industry officials and Democratic leaders also are breathing sighs of relief after the Supreme Court's landmark 6-3 ruling in the case called King v. Burwell, which upheld the legality of subsidies people use to buy health insurance on the federal marketplace.
The decision means nearly 6.4 million Americans will keep the tax credits that help them afford coverage on the federal exchanges that opened in 2013. For Ables, a self-employed home health worker, the tax credit lowers her $415-a-month plan to just $23 a month.
A contrary decision from the court would have made subsidies unavailable in 34 states, upending the insurance market and dealing a staggering blow to President Barack Obama's signature health law.
Speaking from the White House after the announcement, Obama praised the court's decision and said, "The Affordable Care Act is here to stay."
Most Republicans, meanwhile, said they would now double down in their efforts to repeal a law they say is flawed and take it back to the drawing board.
"It's unfortunate that the Supreme Court didn't read the law the way that Congress wrote it," said U.S. Sen. Lamar Alexander, chairman of the Senate health committee.
"The 36 percent increase in some individual health care rates announced recently should remind Tennesseans that Obamacare was an historic mistake. It gave Americans higher health care costs while reducing our choices of health plans, doctors and hospitals. Republicans are ready to reduce the cost of health care so more people can afford it, put patients back in charge, and restore freedom and choice to the health care market."
The meaning of 'exchange'
The case hinged on wording in the law that says exchanges should be "established by the state." Thirty-four states, including Tennessee, Georgia and Alabama, did not set up their own exchanges and instead rely on HealthCare.gov, the federal marketplace site.
Challengers said the phrase was proof subsidies were only legal on state, not federal exchanges. Government attorneys argued the law was misphrased, and that Congress always intended for subsidies to be available to all. The majority of the court ultimately agreed.
"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Chief Justice John Roberts wrote in the majority opinion for the court. Doing away with the subsidies "could well push a State's insurance market into a death spiral. It is implausible that Congress meant the Act to operate in this manner."
Roberts was joined by justices Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan. Justices Antonin Scalia, Clarence Thomas and Samuel Alito dissented.
"Today's interpretation is not merely unnatural; it is unheard of," Scalia wrote in his dissent. "Who would ever have dreamt that 'Exchange established by the State' means 'Exchange established by the State or the Federal Government'?"
The majority's "interpretive distortions" to save the health law have gone so far that "we should start calling this law SCOTUScare," he added.
POLITICAL REACTION
Locally and nationally, reaction to the ruling split along party lines and indicated the attacks on the 5-year-old law are far from over.
Sen. Bob Corker, R-Tenn., said the ruling "affirms that it is up to Congress to come together around a responsible solution that provides relief from the damaging effects of the president's health care law."
State Rep. Craig Fitzhugh, Democratic caucus leader, said that "regardless of your feelings about the Affordable Care Act, one of the most conservative courts in the history of this country has ruled - again - that it is the law of the land."
Tennessee Democrats praised the decision and said it should bolster efforts to pass Republican Gov. Bill Haslam's Insure Tennessee proposal to expand Medicaid to an estimated 280,000 low-income residents.
"I am so happy for that ruling," said Rep. JoAnne Favors, R-Chattanooga, a registered nurse and former health care executive. "I was hoping that would happen because in Tennessee we have some of the sickest and poorest citizens. Being in the health care industry for 50 years, I know how critical this is."
Haslam himself told reporters Thursday he was "surprised" and has mixed feelings over the decision. Haslam had said the state didn't have a backup plan if the subsidies were ruled illegal.
"While personally, philosophically, I didn't agree with the ruling, in terms of the smoothness of the market and people retaining coverage in a predictable way, I think that's a good thing," Haslam said.
Haslam said he's still talking with lawmakers about Insure Tennessee, twice rejected by fellow Republicans in the Senate earlier this year, though he chuckled at Democrats' suggestions he call a second special legislative session this year to try to pass the bill again.
The governor said he thinks "some people's fundamental issue was we're taking more federal money at a time when the federal government doesn't have more money to give out."
House Speaker Beth Harwell, R-Nashville, also called the decision "both surprising and disappointing," but added that "there will be no interruption for Tennesseans who have insurance through the federal exchange and no major disruption to the state's insurance marketplace."
She said she hopes the Republican-controlled Congress will make changes to the law. Noting that the state's existing TennCare version of Medicaid is up for renewal next year by U.S. Health and Human Services officials, Harwell said she hopes "officials will be in a different posture to consider additional flexibility for our state Medicaid program and will consider block grants."
CHEERS FROM THE MEDICAL COMMUNITY
In the Chattanooga area, health industry leaders, doctors and health advocates cheered the decision.
Roy Vaughn, vice president of communications for BlueCross BlueShield of Tennessee, said the decision ensures the nonprofit "can continue to provide the security and stability of health insurance to the people of our community, no matter who they are or how they purchase coverage."
BlueCross has captured the majority of the exchange market, with 150,000 members from the marketplace. Eighty percent of those are subsidized, with the average subsidy around $295.
The CEO of American Exchange, a Chattanooga-based company that helps people buy from the exchanges, said the ruling "should be the final political shot at the Affordable Care Act."
"I hope that our country can start to see the good in the bill," said CEO Bobby Huffaker. "We have thousands of clients who were never able to obtain coverage and were completely dependent on their employer to purchase health insurance pre-ACA."
Hospital officials also praised the decision.
"In an era of significant reimbursement cuts and financial challenges, widespread insurance coverage is a critical issue for hospitals," said Craig Becker, president of the Tennessee Hospital Association. "As a result, the Supreme Court's ruling is especially good news for our industry."
"We are very pleased with the court's ruling," said Patty Montgomery, spokeswoman for HCA-owned Parkridge Health System. "As we have said before, we support efforts that improve access by providing affordable coverage for the uninsured."
Others said the ruling only cleared the way for more debate on Insure Tennessee.
"This is a good decision for Tennesseans and for health care. But we still have to address the issue of people who are uninsured or underinsured," said Erlanger Health System CEO Kevin Spiegel.
Michelle Johnson, director of the Nashville-based advocacy group the Tennessee Justice Center, said the ruling "makes us all the more aware that nearly 300,000 other Tennesseans still live with the dangers and fears that go with being uninsured, simply because our legislature has not yet approved Governor Haslam's plan."
In Soddy-Daisy, all Ables could say was, "I was so glad that it went through."
"I don't know what I would have done without the insurance."
The Associated Press contributed to this report.
Contact staff writer Kate Belz at kbelz@times freepress.com or 423-757-6673. Contact staff writer Andy Sher at asher@timesfreepress.com or 615-255-0550.