What’s next for Medicaid expansion?

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Saint Louis, Mo. — A group of healthcare advocates were attending an annual conference in Columbia, Missouri when the Supreme Court announced its decision on a legal challenge to the Affordable Care Act that conservatives said was the best legal chance at dismantling the law.

The Court rejected a challenge to the subsidies for health insurance that the law created for millions of low-income individuals and families. For supporters of the ACA and the Medicaid expansion it calls for, the win was nothing short of monumental.

“It’s here to stay,” Jen Bersdale, executive director of Missouri Health Care for All, told The Missouri Times. “The court was very clear, and the ruling could potentially give some momentum to [Medicaid] expansion.”

Bersdale was sitting in the back of the conference with one eye on the SCOTUS online blog when the ruling broke. While her fellow advocates sat in a budget presentation meant to show the fiscal positives of expanding Medicaid eligibility, Bersdale was watching the court uphold President Obama’s signature healthcare law.

Bersdale leapt to her feet and broke the news to the room, which broke out into applause and cheers. And while advocates were thrilled, Bersdale said it’s nothing compared to the relief of those watching the case wondering if the end of their subsidy and thus their vital treatment was coming.

A woman who was diagnosed with breast cancer not long after signing up for insurance said her subsidies were vital in paying for her treatments. Bersdale said the woman fell into her arms, crying, when word broke that the subsidies were here to stay.

The ruling in the King v. Burwell case settles the legality of much of the ACA for good, some legal scholars have said. And while plenty of conservatives scoffed at the court’s decision and issued statements against the case, the ruling ends the final significant legal challenge to the law.

Sen. Bob Onder, R-Lake St. Louis, said the ruling was likely to harden both supporters and opponents of the law, saying the majority went outside their judicial restraints to “rewrite” and “save” Obamacare.

“The Supreme Court again on Thursday re-wrote Obamacare to save Obamacare,” Onder said. “They did it with regard to the Medicaid expansion piece, they did it with regard to the individual mandate, and now they’ve done it for the subsidies as well.”

Onder filed a bill last year that essentially would have had the same force and effect as an anti-Obamacare ruling on Thursday. Onder’s bill stripped health insurance subsidies for any Missourian signed up through one of the ACA federal exchanges. With the Burwell ruling, Onder says little is “settled.”

In Missouri, Medicaid expansion advocates like Bersdale are hoping the ruling represents positive momentum toward expansion, a fight that has been a bitter uphill climb in Missouri. But next year advocates have an even taller order, when 2016 becomes the first year that the federal government does not reimburse states for 100 percent of new Medicaid enrollees.

“We’ve seen multiple studies say that we’re going to save more than we spend,” Bersdale said. “It is still a fantastic deal for the states. We’d like to see our legislators listen to data and statistics and facts instead of politics.”

Onder said that while he had no doubt the ruling will have energized supporters on the left, he believes rank-and-file Republicans will still line up to rail against the ACA.

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