Obamacare patients and advocates expressed feelings of deep relief, hope and cynicism Thursday after the Supreme Court upheld the health care law against a challenge by Texas and 17 other Republican-led states.
The court, by a 7-2 vote, rejected the states' claim that Obamacare, or the Affordable Care Act, was unconstitutional and that therefore the entire law should be scrapped. It's the third Supreme Court challenge the law has survived since President Barack Obama signed it in 2010.
Patients who depend on Obamacare and activists who fought to defend it said that they hoped this would be an opportunity to pivot the country's focus to building upon the law and expanding health care access and that they want to believe this would be the final existential battle for the Affordable Care Act.
NBC News spoke to six ACA patients and four Obamacare advocates about their feelings after the Supreme Court's decision.
"It hasn't sunk in for me yet," said Elena Hung, who racked up millions of dollars in medical bills to treat her daughter's rare breathing disorder and became an advocate promoting the ACA as a result. "Every Monday and Thursday for the past several weeks, I've clicked refresh every morning to see if they'd made a decision. Today there's some relief, but I'm also just reflecting on the last several years of the toll, the stress."
Health and Human Services Secretary Xavier Becerra told NBC News that he "wouldn't be surprised if reaching affordable, universal coverage for all Americans will continue to face challenges."
But the Supreme Court decision cemented Obamacare as "the law of the land and that’s from where you build," he added, with affordable, universal coverage being the ultimate goal.
"I think it's the close of one chapter — the defense of this landmark health care law — and it's now the beginning of the next chapter of making it better," said Becerra, who led other Democratic states in defense of the law when he served as California attorney general.
Still, many ACA patients also expressed deep feelings of bitterness over the long partisan battle waged in the past decade: numerous legal challenges, the piecemeal expansion of Medicaid in conservative states and the Trump administration's offensive against the law.
"I'm relieved that they threw out this lawsuit, but they certainly could bring up this or something else again, and I would expect that they would," said Laura Packard, a Denver-based Obamacare advocate who survived stage 4 lymphoma with the help of her ACA coverage. "This has become a crusade for certain Republicans."
The threat has left Obamacare patients on the edges of their seats for years.
Lauren Ashley Carter, 41, a small-business owner in Atlanta, can remember how her health care experience changed when she lost her job and her health insurance in 2009 during the Great Recession. She was in the middle of breast cancer treatment and couldn't afford the $1,500 a month for COBRA coverage, so she had to go on Medicaid, under which she received more limited care.
The next year, Carter signed up for Obamacare shortly after it became law. She said that the program saved her life but that the challenges made health care coverage a constant stress.
"You deal with your health care issues and all of the physical aspects of it, but for the past decade, there is an additional emotional and psychic trauma that you actually go through because you don't know whether or not you're actually going to have the insurance to afford the care that you need," she said.
Other ACA patients echoed that feeling.
Amy Raslevich said Obamacare helped cover her surgical treatment for breast cancer. It has also protected her two children, who have pre-existing conditions.
"The way they've made health care political is just scary, and it's really disappointing, because it shouldn't be," she said. "Nobody in this country should go bankrupt for medical care. Nobody should have to forgo their pills or not get that surgery they need or go to their follow-up."
Raslevich said she feels "a huge relief" and is hopeful that the ruling will remain and that there won't be additional challenges. "Maybe they'll finally give up, and we can build on it, make it stronger and expand and improve it," she said.
While the law has come under numerous challenges, it was also strengthened with the passage of the American Rescue Plan this year. The $1.9 trillion Covid-19 relief bill included subsidies to bring down Obamacare premiums.
Amber Lee, who runs a small communications firm in Anchorage, Alaska, said the subsidies decreased the cost of her plan from $750 a month, with a $6,000 deductible, to $40 a month, with a $1,500 deductible.
Lee said that because of a genetic disease that causes tumors and increases her chance of kidney cancer, health care is a constant concern for her and her family. She said the Affordable Care Act has meant she hasn't had to decide between her finances and her family.
"Sometimes you think, 'Just keeping myself alive could bankrupt my family.'"
"Sometimes you think, 'Just keeping myself alive could bankrupt my family,' and you're making decisions about whether or not you want to go in debt or, you know, live," she said. "It's a ridiculous decision to have to make."
With the court challenge in the rearview mirror, Obamacare patients and advocates for the law said they hope attention can turn to expanding its role.
Leslie Dach, who was a senior counselor at the Department of Health and Human Services during the Obama administration, founded the liberal group Protect Our Care to defend the law's public image and fight the many legal challenges against it.
He said that the group will continue the efforts but that it is refocusing its energies to push to make the American Rescue Plan subsidies permanent, create a federal solution to expand Medicaid in resistant states and lower the price of drugs.
"We've been arguing for this agenda, as have others, because we have this once-in-a-decade opportunity to move forward," Dach said, "but this now clears the path and hopefully puts the wind in the back of those sails."