Julia Lounsbury said she was “elated” by news Thursday the U.S. Supreme Court had upheld a core component of the Affordable Care Act that provides tax subsidies for millions of Americans to buy insurance.

The 63-year-old Augusta woman bought a policy through the health insurance marketplace in 2014, and it was the first time in her life that she could remember being covered. She went decades without worrying about her health until her husband, Mike, had a heart attack and had to undergo heart bypass surgery.

After that experience, she decided to get covered, and the first thing she did was get a physical, her first check-up in at least 30 years. When she heard that the tax subsidies she relied on to pay for her insurance could be at risk, Lounsbury was concerned.

“That’s the only thing that makes it possible,” she said. “If it wasn’t for that, I’d still be out there without insurance.”

The Supreme Court justices said in a 6-3 ruling that the subsidies that 8.7 million people now receive to make insurance affordable don’t depend on where they live. The outcome is a major victory for President Barack Obama in a high-profile, politically charged test of what has been his most significant policy achievement.

Nationally, 10.2 million people have signed up for health insurance under the 2010 Affordable Care Act, including 8.7 million people who are receiving an average subsidy of $272 a month to help pay insurance premiums. Of those, 6.4 million people — including more than 60,000 Mainers — were at risk of losing aid for their health plans because they live in states that didn’t set up their own health insurance exchanges.

Nearly 90 percent of the 74,792 Mainers who have bought health insurance during the two enrollment periods since the law went into effect receive some kind of subsidy. According to a national analysis by the Urban Institute, 80 percent of the adults who would have lost subsidies are working, 46.5 percent full time and 33.7 percent part time. The institute estimated that 73 percent of part-time workers would have become uninsured.

The same analysis estimated that 62,000 people in Maine would have lost an average of $4,150 in tax credits and cost-sharing reductions if the court had ruled in favor of the plaintiffs. An estimated 50,000 Mainers would have become uninsured.

Legislators in Maine, one of 37 states that didn’t create their own state-run health exchanges, supported a bill in the Insurance and Financial Services Committee that would have created a state-based insurance exchange, had the Supreme Court ruled against the ACA. The bill would have allowed Mainers buying individual insurance to continue to do so through the federal website healthcare.gov, while meeting the legal definition of having a state-run exchange. The bill, which received unanimous support in committee as well as from insurance companies and Maine business interests, was held pending the court’s decision.

“This is a tremendous victory for all of us,” said Emily Brostek, the executive director of Consumers for Affordable Healthcare, an Augusta-based advocacy agency and a strong supporter of the Affordable Care Act.

“Tens of thousands of hardworking Mainers will be helped by this decision. Without the subsidies, monthly insurance premiums are just too expensive for people.”
Although the court’s ruling was a major step forward in cementing the health law, Brostek said more legal challenges were expected and her organization and others intended to keep pushing the state to accept federal funds to cover low-income Mainers through MaineCare.

“Even as we celebrate this victory, we will continue to advocate for universal health care so that everyone in Maine can have the affordable health coverage and care they need to live long, healthy lives,” Brostek said.

Will Chapman, of Greenwood, said he still would have been able to pay his insurance premiums if he lost his ACA subsidy, but he’s relieved he doesn’t have to worry about it. The 24-year-old first bought insurance through the ACA marketplace for 2014. With subsidies, he now pays $180 a month, but that likely would have jumped to $240 per month if he had lost the subsidy.

“That would have still been affordable for me, but not as affordable,” said Chapman, who receives a reimbursement from his employer, Bethel Historical Society, for part of the cost.

Chapman said he is “very relieved” for all of the people who wouldn’t have been able to afford their insurance if the subsidies were lost. He also wonders about the effect a different ruling would have had on the health care system.

“I would have questioned if the whole system would have fallen apart without the subsidies,” he said.

Maine’s congressional delegation had mixed reactions to the ruling.

Sen. Susan Collins, a Republican, said in a statement it is now “crucial for Congress to work together to fix some of the flaws in the law that have been hurting many low- and middle-income workers, as well as employees of many small businesses.”

She said, “These flaws include harsh penalties under Obamacare for middle-income workers who earn extra money or get a raise in a given year and the disincentives for small businesses to hire additional employees. These provisions need to be corrected. They discourage struggling workers from trying to earn more money and discourage small businesses from creating jobs.”

U.S. Rep Bruce Poliquin, who represents Maine’s 2nd Congressional District, also criticized the ruling, saying the ACA had forced families to purchase insurance with higher premiums and deductibles and was bad for businesses.

“Today’s Supreme Court ruling assures that healthcare in America will continue to be rationed and taxes will continue to rise to pay for the government-run system,” he said in the statement. “I fear that more jobs will be lost as the expensive government mandates prevent businesses from being able to hire more workers.”

Sen. Angus King, an independent, applauded the decision and said it’s time to “finally put discussions about dismantling the law behind us.”

“Today, more than 60,000 Mainers and millions more across the country can breathe a sigh of relief that they still have access to the high-quality affordable health insurance plans provided through the Affordable Care Act,” he said in a statement.

U.S. Rep. Chellie Pingree, a Democrat who represents Maine’s 1st Congressional District, praised the Supreme Court for making “the right decision.”

“When the ACA was being written and passed, everybody — Republicans, Democrats and the Congressional Budget Office alike — agreed that the subsidies would be available in all states. Only later did opponents change their minds,” she said in a statement.

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