In a broad decision that left little room for future legal challenges, the U.S. Supreme Court voted 6-3 on Thursday to preserve the health insurance subsidies available under President Barack Obama's signature health law.
"The Affordable Care Act is here to stay," the president declared from the Rose Garden.
Prominent Republicans, including presidential candidates Jeb Bush and Marco Rubio, vowed to continue fighting the law politically, foreshadowing its potential role in the 2016 election.
But few health insurance consumers were thinking that far ahead. In Florida alone, 1.3 million people would have lost their financial aid for health insurance had the ruling gone the other way.
Lizzie Jimenez, a 22-year-old nursing student at St. Petersburg College who receives $150 a month from the government to offset the cost of coverage, shrieked with excitement when she learned the subsidies had not been invalidated by the court.
"I was scared, not just for myself, but for all of the other people," Jimenez said. "They rely on that money."
The Affordable Care Act has faced an array of legal challenges since being signed into law in 2010. The latest, a case known as King vs. Burwell, targeted the tax credits that help low- and moderate-income people to cover the cost of health insurance.
The case was built around four words in the health law allowing subsidies for consumers who buy insurance on exchanges "established by the state." The plaintiffs, four Virginia residents, said the law only authorized the subsidies for consumers in states that established their own insurance exchanges — and tried to have the assistance discontinued in the 34 states using federally run marketplaces, including Florida.
The government pushed for a more comprehensive read of the 900-page law. Federal attorneys said other provisions in the Affordable Care Act made it clear the financial aid was intended for all.
In the majority opinion, Chief Justice John Roberts conceded that the plaintiffs had a "strong" case. But he also said the tax credits were "necessary for the federal exchanges to function like their state exchange counterparts, and to avoid the type of calamitous result that Congress plainly meant to avoid."
He wrote: "In this instance, the context and structure of the Act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase."
The dissent from Justice Antonin Scalia offered a sharp rebuke of the majority opinion.
"The Act that Congress passed makes tax credits available only on an 'exchange established by the state,' " wrote Scalia, considered one of the court's most conservative jurists. "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."
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Scalia accused the court of performing "somersaults of statutory interpretation."
"The cases will publish forever the discouraging truth that the Supreme Court of the United States favors some laws over others, and is prepared to do whatever it takes to uphold and assist its favorites," he wrote.
He was joined by Justices Samuel Alito and Clarence Thomas.
The decision was welcome news to insurance companies, which feared millions of Americans would drop their coverage if the court ruled against the subsidies, driving the market into chaos.
Hospitals favored the ruling as well. Many were bracing for a spike in uninsured patients.
Florida Senate Budget Chairman Tom Lee, R-Brandon, said state lawmakers had also "dodged a bullet."
"There would have been an enormous amount of pressure on the Legislature to find a state-based solution to this problem," Lee said. "We still have hundreds of thousands of Floridians who are uninsured. We are trying to figure out how to deal with that, and (a ruling against the subsidies) would have magnified the problem exponentially."
Some other Obamacare-related lawsuits are still working their way through the courts, including a case alleging that provisions on birth control violate religious rights. But Michael Allen, a law professor at Stetson University, said Thursday's ruling would likely be the last major legal hurdle for the health law.
"People may file (other) challenges, but I think the chances of them being successful will be exceedingly small," Allen said. "The court adopted a view here of statutory interpretation that's not unheard of, and that's looking at the law in its entirety."
Jay Wolfson, a professor of public health and medicine at the University of South Florida, expects the battle to shift to political ground. "The Republicans are going to continue to rattle their sabers because this is a battle cry," he said.
But Wolfson said even those efforts might be diminished because the "conservative, business-minded" Roberts authored the majority opinion.
Obama, for his part, urged lawmakers to put politics aside and come together to improve health outcomes.
"This is not about the Affordable Care Act as legislation or Obamacare as a political football," he said. "This is health care in America."
Michael Grimes watched the president's speech on TV from his Indian Rocks Beach home with his wife, Marilyn.
"It almost brought me to tears," the 64-year-old said. "I didn't realize I felt that strongly about it."
Grimes makes too much money from his family's antiques trade show business to qualify for financial aid. But he had feared a Supreme Court ruling against the subsidies would cause his premiums to spike.
"I anticipated payments over $2,000 or $3,000 to keep the level of coverage I have," he said, pointing out that he paid that much before Obamacare because of a pre-existing condition. "I couldn't have afforded it."
Nicole Peterson, a single mother from Kenneth City who worried about losing her $150 monthly subsidy, was also relieved.
She found out about the decision in a text message Thursday.
"I can take a nice, deep breath," she said later that morning. "That's one less thing to worry about."
Information from the Associated Press was used in this report. Contact Kathleen McGrory at firstname.lastname@example.org or (727) 893-8330. Follow @kmcgrory.