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After Thursday’s Supreme Court ruling upholding subsides on the federally-facilitated marketplace, the industry was quick to react. The Justices’ majority and minority opinions and those of advisers, lawyers and even the president reveal what it means for the Affordable Care Act, exchanges and employer-sponsored health care.

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ACA not built to destroy markets

In his opinion for the majority, Chief Justice John Roberts wrote, “the combination of no tax credits and an ineffective coverage requirement could well push a state’s individual insurance market into a death spiral. ... It is implausible that Congress meant the act to operate in this manner.”
“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”

— Chief Justice John Roberts, United States Supreme Court

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SCOTUSCare

In writing the for the dissent, Justice Antonin Scalia wrote, “the act that Congress passed makes tax credits available only on an ‘exchange established by the State.’ This Court, however, concludes that this limitation would prevent the rest of the act from working as well as hoped. So it rewrites the law to make tax credits available everywhere. We should start calling this law SCOTUScare.”

— Justice Antonin Scalia, United States Supreme Court

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POTUS on employer sponsored insurance

“The law has helped hold the price of health care to its slowest growth in 50 years. If your family gets insurance through your job — so you’re not using the Affordable Care Act — you’re still paying about $1,800 less per year on average than you would be if we hadn’t done anything. By one leading measure, what business owners pay out in wages and salaries is now finally growing faster than what they spend on health insurance. That hasn’t happened in 17 years — and that’s good for workers and it’s good for the economy.”

— President Barack Obama

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Four words

"Many observers noted prior to the decision that the case would hinge on just ‘four words’ — actually four words repeated seven times in one section — 'established by the state.' It turns out, the case hinged on one word: 'such.' The Chief Justice and five colleagues found that the phrase directing the federal government to establish 'such' exchange after identifying exchanges as being 'established by the state' was enough proof for them that Congress intended subsidies to be available on both federal and state exchanges.”’

— Mark Rust, managing partner, Barnes & Thornburg, Chicago office

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No fundamental change

“For employers and brokers/advisers, the decision does not fundamentally modify any plans they were moving out on and should not change any plans they were considering implementing as it relates to their compliance activities and their employee benefit programs.”

— Perry Braun, executive director, Benefit Advisors Network

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Less challenges

“I think we'll see less challenges to the law now, at least through the court system. It was a stretch to think that the original drafting of the law only meant to have subsidies for states that formed exchanges. The writers of this law view the world through Washington goggles; that every state would rush forward to establish exchanges in unbridled glee. The truth about the American people runs much deeper in that we don't like to be told we have to do something if D.C. says we do.”

— Kevin Roberts, principal, KR Benefits Insurance Services

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Status quo

“This is really more of a status quo decision. Employers weren’t doing anything differently during this whole litigation — they had to implement the employer mandate, they had to look at whether they were offering coverage to the right number of employees, they had to do their testing for affordability and for minimum value. All those things were going on, and employers aren’t going to do anything differently after this [decision]. But it really does remove the last major judicial hurdle to full implementation of the Affordable Care Act.”

— J.D. Piro, senior vice president, Aon, and leader of Aon’s health law group

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Sigh of relief for Republicans

"There are likely some Republican Governors who are quietly breathing a sigh of relief, having both argued against Obamacare and dodged this bullet. This is the Republicans’ last hope at a judicial fix to Obamacare. The real question is whether the Republicans hang on to Obamacare as a key issue in the upcoming elections or begin to quietly work on changes to key provisions like the tax on high-cost plans or the medical device tax. Hanging on to the political issue is more likely and not necessarily good for employers, insurers, providers and hospitals who are struggling with a great deal of uncertainty. It would be difficult if not impossible to repeal Obamacare in a few years but it’s very possible to continue to use it as a political football.”

— Bob Seng, partner, Dorsey & Whitney; former assistant general counsel for pay and benefits at Target Corp.

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Total cost of care

"While there are many things that need fixing inside the ACA world, it is refreshing that the court used common sense versus legal semantics as the basis for their decision. All of us involved in the health reform journey need to remain focused on ‘total cost of care’ within the system. Having people covered by a plan enables those efforts."

— Joseph Berardo, Jr., CEO, MagnaCare

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Daunting challenges ahead

“This decision does not change the way millions of Americans receive and pay for health coverage, yet the world of employee benefits remains in constant flux. For example, many employers still face potentially daunting challenges, including required government reporting and the impact of the upcoming Cadillac Tax. Employers should use this opportunity to consult with their benefits advisers about how to protect their businesses — and employees — to strategically position their benefits for the future.”

— Adam Bruckman, president and CEO, Digital Insurance / Digital Benefit Advisors

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