Rev. Jill Henning, a cancer survivor who lives in Grayson who has turned into an ACA attorney, said if the court rejected the ACA, insurance companies would likely have discontinued their cancer coverage as a pre-existing condition and they were leaving you wondering if they would would lose her home to pay for the high-tech scans she takes every three months.

“It was a decade in which we just wondered and waited what would happen and what would mean for us in the long term,” said Henning.

Rev. Jill Henning of Grayson says the Affordable Care Act made sure she would get the checkups that discovered her cancer eight years ago and its recurrence four years later. Henning is the Bishop’s Assistant for Leadership and Administration at the Southeastern Synod Evangelical Lutheran Church in America. (Alyssa Pointer / Alyssa.Pointer@ajc.com)

Photo credit: Alyssa Pointer / Alyssa.Pointer@ajc.com

Photo credit: Alyssa Pointer / Alyssa.Pointer@ajc.com

The Court of Auditors has also abolished the lifetime limit on insurance coverage. No matter how much Hennings screenings and treatments cost in the course of her life – the cancer returned four years ago and was fought by chemotherapy – it will not hit a cap. “Today is a great day for me,” she said.

Attorney General Chris Carr, who joined Georgia in Texas efforts to overturn the law, said in a statement that he was disappointed but would respect the court’s decision.

“Our coalition firmly believed the Court of Auditors was unconstitutional,” said Carr. “I stand by my promise to make sure we have the world-class healthcare system that all Georgians and our nation truly deserve.”

The regulation

The law has fundamentally changed the way Americans have health care, well beyond those who buy insurance on the ACA exchange or who have pre-existing medical conditions. It forced insurance policies to accept policyholders ‘children up to the age of 26 on parents’ plans. It also closed a “donut hole” in Medicare drug coverage. Such provisions were popular, but they also made the law a target for conservatives who saw them as excessive.

Still, Thursday’s ruling came as a surprise to some, as three of the court’s nine judges have now been appointed by President Donald Trump, making for a solid Conservative majority.

In the ruling, the judges relied on the same conservative legal principles to dismiss the case, ruling that the court had an obligation to avoid Congress.

Those who attacked the Court of Auditors had argued that the provision that made this possible as federal law was the financial penalty people would have to pay for not insuring themselves. The court ruled in the first appeal in 2012 that Congress had the right to enact the law because it had the power to tax.

But Republicans in Congress had reduced the fine to $ 0 in 2017 to make the law toothless. The plaintiffs in the most recent lawsuit argued that since the penalty is now zero, it is practically non-existent and the whole law must collapse.

However, the judges ruled that they could not interfere or make theoretical statements as the plaintiffs were not harmed by the sentence and did not need any money back.

“The matter is not just technical,” wrote Judge Stephen Breyer for the majority. “Running here … would threaten to give unelected judges general authority to oversee decisions made by the elected branches of government.”

Georgia-born Judge Clarence Thomas agreed. Judges Neil Gorsuch and Samuel Alito opposed it.

What now

Both supporters and opponents of the ACA on Thursday quickly turned to the next steps. Proponents have argued for years that the law needs a revision in Congress, but say it was foiled by opponents who wanted to see it fail. Opponents said Congress must repeal and replace it, even though Republicans have never come up with a replacement proposal that could find support.

The loopholes in the law are largely agreed. Under the law, adults earning below the poverty line, or $ 12,880 annual income for a single person, are not necessarily insured unless a state elects to extend Medicaid to all of its poor. When they do this under the ACA, the federal government pays 90% of the Medicaid cost.

People who earn above the poverty line receive subsidies for their premiums, which, however, decrease as their income levels rise. There are no subsidies for those whose incomes are four times the poverty line or higher. This means that an individual earning $ 51,520 or more or a family of four earning $ 106,000 or more must pay the full price premiums plus deductibles, which can be up to several thousand dollars annually.

Chris Denson, director of policy and research at the libertarian Georgia Public Policy Foundation, said the verdict “pretty much means the ACA will stand.” But he said the ACA is failing to address rising health care costs.

Georgia Governor Brian Kemp has proposed two state-centered “waivers” to fill some of these loopholes. One would help policyholders in Georgia with higher incomes by helping to lower premium costs in general through extensive government subsidies. It would also block Georgians’ access to shopping on the ACA marketplace website healthcare.gov.

Another of Kemp’s waiver proposals met with hesitation in the Biden administration: it would be addressed to the uninsured poor adults with the aim of extending Medicaid to those who do a certain number of specific activities each month. Kemp’s office estimates that perhaps 50,000 Georgians would qualify, compared to more than 400,000 who would likely qualify for a full expansion of Medicaid.

Not everyone is convinced that the fundamental threats to the Court of Auditors are over.

John Hauptert, CEO of Grady Health System, said “thank goodness” that the lawsuit failed, but noted that the court left it open for other plaintiffs to find out how to sue. Grady has financial advisors to help people determine if they are eligible for coverage on the ACA marketplace.

Steven Ledbetter, of Athens, said Thursday he was glad he still has insurance to pay for his insulin and eye and foot exams as he has diabetes.

Ledbetter has a number of jobs, such as teaching music to disabled students for a nonprofit, to raise about $ 24,000 a year. With his subsidies from the ACA exchange, his insurance premium is $ 15 a month, a price he can afford.

“Peace of mind means a tremendous amount,” he said.