Last year, it was estimated that the law would save $210 billion through 2021. But it absorbed a major financial blow last fall, when the Obama administration announced that it would not proceed with an initiative to provide Americans with insurance for long-term care. That program was expected to generate more in revenue in the early years than it paid out in benefits. Its demise could sharply increase the expected costs.
The nonpartisan Congressional Budget Office said Thursday that it will take some time to calculate the budgetary effect of the ruling.
The White House still faces a number of legal challenges from religious groups objecting to a requirement that most employers provide access to contraception for employees. Catholic bishops have called the mandate a major violation of religious liberty and have begun one of their biggest campaigns in a generation against it.
Then there is the political threat to the law: Republicans said Thursday that they will continue a push to repeal it outright.
“What the court did not do on its last day in session, I will do on my first day as president,” said Mitt Romney, the presumptive GOP nominee. If elected, Romney couldn’t repeal the law on his own. He would need help from Congress, including a Senate that is now in Democratic hands.
On Thursday, to show their resolve, the House’s GOP leaders announced that they will hold a vote on July 11 to repeal the law.
“The court makes a decision about whether this law is constitutional. Doesn’t mean that the law is wise. It doesn’t mean that the law is good for the country,” House Speaker John A. Boehner (Ohio) said in a news conference Thursday.
In the world of political theater, this would be something like a remake. The House previously voted to repeal the legislation in January 2011, just days after Republicans took over. But it died in the Senate, by a vote of 51 to 47.
On Thursday, many Democrats in Congress still felt safe to celebrate. House Minority Leader Nancy Pelosi (Calif.) called the widow of former senator Edward M. Kennedy (D-Mass.), a longtime advocate of health-care reform.
“Now Teddy can rest,” Pelosi told her, according to a Pelosi aide.
On Thursday, it wasn’t just activists and politicians asking themselves what happens next. Near Baltimore, Lashonda Edwards, 29, who has sickle-cell anemia, said her insurance does not cover visits to a specialist.
If the health-care law is fully implemented, she said, she may be able to find better insurance — or to be covered under and the expansion of Medicaid.
“I’m really excited,” she said. “It’s going to open up doors.”
Michelle Boorstein, Ed O’Keefe, Rosalind S. Helderman, Lori Montgomery and Sarah Kliff contributed to this report.