The Supreme Court cemented President Barack Obama’s signature domestic achievement on Thursday by affirming that the legislation that created Obamacare and required Americans to buy health insurance intended to help all who need help paying for it.

In their 6-3 majority in King v. Burwell, the justices handed Obama one of the biggest victories of his presidency, preserving premium subsidies for 6.4 million Americans in the 34 states that rely on the federal marketplace for health insurance. It also preserves the mandate, the tenet at the center of the law and of its controversy, that every American buy health coverage.


Chief Justice John Roberts’ decision, which was joined by the swing Justice Anthony Kennedy and the court’s four liberals, offered special vindication to Obama because it also affirmed that the whole point of his law was to improve the healthcare system.

“After multiple challenges to this law before the Supreme Court, the Affordable Care Act is here to stay,” Obama said in the Rose Garden. “Five years in, this is no longer about a law, this is no longer about the Affordable Care Act as legislation or Obamacare as a political football,” he said. “This is healthcare in America.”

He noted that the reforms implemented as part of the law have become so ingrained into the health care system at this point that many Americans don’t realize their insurance plan is part of it.

“Unlike Social Security and Medicare, people don’t really understand what Obamacare is…There’s no card that says `Obamacare’ when you enroll,” he said. “This reform remains what it’s always been: a set of fairer rules and tougher protections that have made healthcare in America more affordable, more attainable, and more about you, the American people.”

After so many other presidents tried and failed to revamp the health care system, Obamacare has become the crowning domestic initiative of his tenure, and he can already point to concrete results, including reducing the uninsured rate to the lowest level since measurement of that figure began.

“This president recognized the historic moment, and he seized it, and for whatever is said anywhere about his presidency, no one can deny that it took his signature leadership to put this over the top and really set in motion a transformation of our healthcare system,” said former Rep. Patrick Kennedy, who praised Obama for taking on the decades-long charge of his father, Sen. Ted Kennedy.

“It’s obviously been a roller coaster, and it’s been marked by all kinds of ups and downs,” Kennedy said. But the court’s decision shows that “the world has changed in this, and we’re not going to fight the old battles of whether people ought to get care. We’re going fight the new battles of what that care should look like.”

Obama’s success in revamping the health care system contrasts to other top ambitions that have failed — immigration reform, gun control — or remain incomplete, like the economic recovery and disengagement in Iraq. And unlike vast environmental reforms imposed through executive action, arguably Obama’s other biggest footprint, the ACA remains his most consequential collaboration with Congress, albeit along party lines in the end.

The partisan stigma of Obamacare — combined with an earlier setback in the Supreme Court — has left another pillar of the ACA only partially constructed: 21 states, most led by Republican governors, have refused to expand Medicaid after the high court made that part of the law optional. Now that the King decision keeps subsidies for the middle class in place, Obama vowed to “work as hard as I can” to convince governors and state legislatures to “put politics aside” and adopt his plan for covering millions of uninsured people whose incomes are just slightly above the poverty line.

The ruling also keeps alive a searing symbol of government dysfunction: Healthcare.gov, which hosts the federal exchange. Its cataclysmic meltdown during the first open enrollment period in October 2013 – a failure of the administration’s own doing after fending off so many other threats — still prompts PTSD flashbacks in the White House. While not directly related to the health policy reforms in the law, the site’s crash undermined the public’s confidence that the government could actually deliver on its promises.

The resulting surge of tech talent resulted in a vastly improved second year, but there were still big mistakes, like the more than 800,000 people who got erroneous IRS forms related to their insurance subsidies. But the first-year failure prompted a behind-the-scenes overhaul in how tech is handled across the administration and if it’s successful, then functional, user-friendly federal websites could emerge as part of Obama’s legacy in the years to come.

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The White House and its allies say the ruling means it’s time to put the political debate in the past.

“We’ll be able to concentrate on reforming the system rather than arguing about this and that,” said Zeke Emanuel, oncologist, bioethicist, former Obama adviser and brother to his former chief of staff, Rahm.

But Republicans aren’t ready to cede the argument, and polls show likely GOP primary voters still hate the law as much as ever. While it won’t necessarily be a top issue, the candidates vying for their votes in the 2016 primary are likely to hew to a “repeal and replace” line.

Thursday’s ruling means Republicans will face more pressure to offer a replacement in addition to a repeal, since the court declined to take on the politically untenable task of rescinding benefits from people who are currently receiving them. But Congressional Republicans are plotting ways to fundamentally change the law if they have an ally in the White House come January 2017. So supporters of the health law cannot truly breathe easy unless a Democrat succeeds Obama.

That said, the ruling does make it more difficult for a future president to take swipes at the law. In rejecting one line of argument by the plaintiffs, the court deemed the legality of subsidies on the federal exchange to be an inherent part of the ACA as written, as opposed to merely a permissible interpretation of the statute by the administration. Therefore, Obama’s successors cannot decide to simply change their interpretation — they’d have to get Congress to change the law.

Obamacare squeaked through Congress on a pure party-line vote, and the reason King so imperiled the law is that there wasn’t enough support in Congress to even pass a straightforward fix to the ambiguous language — “exchange established by the state” — at the center of the lawsuit.

And there are other drafting errors in the law that undermine its goal of offering affordable coverage. The so-called “family glitch” fails to include children in some affordability calculations, meaning that while insurance might be in reach for a parent, there’s no subsidy for the kids. But Obamacare remains so toxic in the Republican-led Congress that a vote to fix the problem is inconceivable.

The Supreme Court allowed Obama to keep his mantle as the president who reformed health care in America. But it may be his successor, with room to make improvements in a cooler political environment, who’ll get to coax Americans into actually liking it.

“In 10 years, 20, 25, the law is going have such a profound impact on the health care system,” Emanuel said, predicting near-universal coverage, higher quality care and lower costs. “We’re going look back and say wow, did the law actually do all that?”

No, not all of that, he allowed. “But it catalyzed it.”

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