The Affordable Care Act, which has helped millions of people get health care, is now fully woven into the nation’s social fabric. As President (Barack) Obama said Tuesday, there is something “deeply cynical about the ceaseless, endless, partisan attempts” to roll back the progress already made.

His remarks at a forum of the Catholic Health Association come only weeks before the Supreme Court is expected to issue a ruling that could, if the administration loses, eliminate federal tax subsidies in 34 states that have made it possible for millions of Americans to buy health insurance. Mr. Obama was right when he said on Monday that the court probably shouldn’t have even taken the case. Unfortunately it did, and no one can predict how the deeply divided court will rule.

The administration claims to have no contingency plan should the subsidies be invalidated. But some states, fearing the worst, are beginning to consider options, none of which look easy to carry out.

The Affordable Care Act provides subsidies in every state for low-income people who earn too much to qualify for Medicaid, the health program for the poor. Opponents of the act have seized on careless wording in the law to argue that subsidies should be available only in states that have established their own health insurance exchanges but not in states that chose to use HealthCare.gov, the federal government’s exchange. That defies common sense and the understanding of all those who passed the law in 2010. There was never any question that the A.C.A. subsidies would be available on exchanges in all the states.

There is an easy solution for the problem. Congress could pass a one-sentence law clarifying that subsidies will be available on all the exchanges. That’s what polls show Americans want. But congressional Republicans are not about to do anything realistic to help millions of people keep their health coverage, and are bent on destroying the law that made coverage possible.

As Mr. Obama noted, since he signed the law in March 2010, more than 16 million uninsured Americans have been covered, driving the uninsured rate to the lowest level ever recorded. Americans can no longer be denied coverage because of pre-existing conditions. Health care prices and employer premiums have been rising at very low rates. There are no more annual or lifetime limits on how much insurers have to pay for care. And as for the claim by Republicans that the program is a “job killer,” the nation has experienced 63 straight months of private-sector job growth, starting the month the act was passed.

It would be tragic at this point to reverse course and put millions of Americans at risk of disease and death from inadequate heath care or potential bankruptcy from inability to pay staggeringly high medical bills while disrupting insurance markets that depend on large enrollments to stabilize prices …

— New York Times,, June 10