DAVID GREENE, HOST:
We're digging deeper this morning into yesterday's big Supreme Court decision. The justices could have handed down essentially a death sentence for the president's signature achievement. Instead, they preserved the Affordable Care Act and in many ways vindicated President Obama. By a 6-3 vote, the court rejected a conservative challenge to subsidies that are crucial to the health care law. This was the second time in three years that the court has upheld it. NPR legal affairs correspondent Nina Totenberg reports.
NINA TOTENBERG, BYLINE: There was a distinct difference this time versus three years ago. This time there were six justices in the majority, not five. This time the majority was unified, not splintered. This time the decision was broad, not halfhearted. At issue were the subsidies that make health insurance affordable for the vast majority of people who've bought insurance on health care exchanges. Thirty-four states - mainly Republican-run - have refused to set up these online insurance marketplaces, leaving the federal government to do it instead. The challengers pointed to language in the law that authorizes subsidies for exchanges, quote, "established by the state," and they contended that subsidies could not be paid out on the exchanges set up by the federal government.
Chief Justice John Roberts, writing for the court majority, firmly rejected that argument, saying that the challenger's reading of the law was implausible, out of context and would lead inexorably to the law's failure. True, Roberts acknowledged, some of the language used was inartful, but Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. Law professor Abbe Gluck directs the health law program at Yale Law School.
ABBE GLUCK: I think what today's decision does is that it sends a strong signal that the Supreme Court doesn't want to be in the middle of this political battle.
TOTENBERG: Gluck expects the battle to continue, but she and most experts see the health care law as secure for now. Former Health and Human Services Secretary Kathleen Sebelius notes that by 2017 when the next president takes office, there will have been two more enrollment periods, and millions more Americans will have signed up for Obamacare.
KATHLEEN SEBELIUS: I see repeal as almost impossible at this point.
TOTENBERG: Larry Levitt, senior vice president of the Kaiser Family Foundation, agrees.
LARRY LEVITT: There are so many millions of people covered by this law and it's, you know, truly now an integral part of the health system. So it would be enormously disruptive and very hard to take away this law at this point.
TOTENBERG: Still, he says, he would expect to see even big changes after the election - changes right or changes left, depending on who wins the presidency and control of Congress. Tom Daschle, a former Senate Democratic leader, says the law can certainly be improved. But if Republicans want to get rid of Obamacare, they'll have to come up with a viable alternative.
TOM DASCHLE: If they don't have an alternative, and if they're really telling millions of Americans that we're going to take away your insurance, I think that's a tough political climb.
TOTENBERG: The Cato Institute's Michael Cannon, who spearheaded the challenge to the law, was infuriated by yesterday's decision, but concedes the law is now more firmly rooted.
MICHAEL CANNON: Does this ruling help to further entrench the ACA? Yes - or at least the ACA as amended by the Supreme Court.
TOTENBERG: And he notes that under the court's ruling, a Republican president couldn't just change the subsidy rules administratively because the court upheld them as a matter of law, not agency interpretation. Nina Totenberg, NPR News, Washington. Transcript provided by NPR, Copyright NPR.