Illinois health care advocates, organized labor, and Democratic politicians cheered the U.S. Supreme Court's 5-4 ruling announced this morning that all major provisions of the landmark Affordable Care Act that President Barack Obama signed into law in 2010 are constitutional.

ACA proponents anticipate that the law will provide health care to the vast majority of two million uninsured Illinois residents through provisions like the individual requirement, or mandate, to buy insurance, the creation of a state health care exchange, and a historic expansion of the federal-state Medicaid program.

These component parts kick in at the start of 2014, unless a hypothetical Mitt Romney presidency or Republican-controlled Congress worked to repeal the law.

“The high court’s ruling ensures that the benefits of this landmark health care reform, which has already made medical care more accessible and affordable for millions of Illinois residents, will continue to multiply,” said Keith Kelleher, president of SEIU* Health Care Illinois and Indiana.

Illinois Republicans are upset with the decision. State Sen. Bill Brady (R-Bloomington) said in a statement that the ruling would have “tragic consequences”, such as increasing the financial burden on small business. Interestingly, though, Brady was not entirely defeatist: The 2010 GOP nominee for governor said, “Illinois would be exploring options available for implementing this sweeping law.”

Proponents also noted landmark parts of the law will stay intact, such as an insurer no longer being able to deny care for pre-existing conditions.

“This will literally help people live who before this law, if they were sick and couldn't afford care or couldn't switch health policies, were sentenced to death or poverty or both,” said U.S. Rep Luis Gutierrez (D-Chicago) in a statement.

“As someone who survived a serious health care crisis I can understand how important it is to have affordable and quality health care,” stated Tammy Duckworth, the Democratic nominee in Illinois’ nationally-watched 8th congressional district race against U.S. Rep. Joe Walsh (R-McHenry). Duckworth lost her legs in the Iraq War.

Duckworth, though, also expressed concern in her statement that some provisions may burden small businesses.

The exchange is partly intended to address these small business concerns. Under the program, the state sets up requirements for what health care provisions insurers must provide patients. The health exchange is also meant to help patients negotiate with insurers. In theory, employees of small businesses can use the exchange for health care instead of relying on their employers.

But, like all but 12 states, Illinois has not set up an exchange. State Rep. Frank Mautino (D-Spring Valley), the lawmaker who drafted exchange legislation, told the Associated Press yesterday that the state could not set up an exchange blueprint prior to a November 16 federal deadline.

Mautino also told the AP that time had run out for Gov. Pat Quinn to issue an executive order that lays out the contours of an exchange.

But a spokeswoman from Quinn’s office said that an executive order “is certainly an option on the table.”

A message left with Mautino today was not returned, and a spokeswoman said that he would be out of the state until Monday.

Jim Duffett, executive director at the Campaign for Better Health Care vehemently disagreed with Mautino, saying that “there is no time element” for setting up an exchange. Duffett again called on Quinn to issue an executive order to start the exchange.

Under ACA, Illinois will also administer a huge change in Medicaid. Every resident with income below 133 percent of the federal poverty level will qualify for the government-subsidized health care program. While the state must administer the expansion, the federal government will entirely pay for it until 2019. After that point, the federal government will foot 90 percent of the bill.

The high court ruling strips away a federal penalty for states that do not participate in the Medicaid expansion. But under Quinn, Illinois is expected to go forward with the federally-paid program expansion.

Already today, Cook County Board President Toni Preckwinkle stated that the Medicaid change means federally-paid health care for thousands in Cook County. The Medicaid changes should help alleviate problems in the Cook County budget.

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