Reaction was swift to this morning’s much-anticipated U.S. Supreme Court ruling, which upheld critical language in President Barack Obama’s health care law and maintained the status quo for millions of Americans receiving federal subsidies that help them to afford insurance.

Chief Justice John Roberts wrote the court’s majority opinion in the 6-3 ruling, and was joined by Justices Anthony Kennedy, Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayer and Elena Kagan in upholding the legality of the subsidies, U.S. News & World Report reported.

The ruling, the second case in which the justices have decided in favor of the Affordable Care Act, preserves benefits for an estimated 6.4 million Americans and deals a crippling blow to the law’s Republican opponents, who have attempted to undermine it since its passage in 2010.

From a health care provider perspective, UnityPoint Health said today in a release it “applauds today’s Supreme Court ruling that upheld crucial insurance premium subsidies for more than 430,000 residents in Iowa, Illinois and Wisconsin who obtained health coverage through the federal exchange.”

Sabra Rosener, vice president of government relations for the integrated health system that serves patients in all three states, said, “Today’s ruling assures Midwestern families of moderate means that they will not be forced to choose between paying for essentials, such as food and rent, or health insurance.”

King v. Burwell centered on whether plaintiffs’ arguments that middle- and low-income adults who purchased health insurance through the federally run Healthcare.gov marketplace were entitled to subsidies based on the language of the law that says tax credits are only to be distributed for marketplaces “established by the state.”

Approximately 33,000 Iowa residents who obtain coverage through the Iowa Marketplace, which is one of 37 “federally facilitated” exchanges, would have lost subsidy eligibility and possibly their ability to continue to pay for coverage had the Supreme Court ruled in favor of the plaintiffs.

“I think the court got it exactly right,” said Mark Kende, a law professor at Drake University and director of Drake’s Constitutional Law Center. “You had some language in the statute that was ambiguous. … (Chief Justice) Roberts said the overall goal was improvement of the health care system; it wouldn’t have been Congress’ goal to pass a bill that would fail.”

Kende said he believes the ruling will at least temporarily put arguments to rest that the law is invalid. “For the Republicans to do something about the law, it’s probably not going to happen through the courts, so they’ll have to win the presidency to do it,” he said.

A conservative think tank opined that “the Supreme Court’s ruling in King v. Burwell means Americans will have to wait longer for greater liberty in their health care system.”

David Hogberg, senior fellow at the National Center for Public Policy Research, said the court’s decision merely delays the movement toward a free-market-based health care system.

Hogberg said in a statement that a ruling in favor of the plaintiffs “would have been a great opportunity to start replacing ObamaCare with free-market based policies. Rather, Americans will have to suffer the problems of ObamaCare for the foreseeable future.”

The exchanges are already exhibiting signs of a death spiral, Hogberg said, where insurance premiums rise precipitously, causing young and healthy people to drop their insurance. This renders the “risk pool” older and sicker, causing premiums to rise again, and the process repeats.

“We’re seeing loads of insurers ask for big premium hikes, at least 20 percent and in many case much higher,” said Hogberg, who recently examined this issue in a national policy analysis.

Zane Benefits Inc., a Utah-based provider of individual health insurance reimbursement for small businesses, called the decision “a huge win for small business owners and employees across the country.” Since the passage of the Affordable Care Act, small businesses have been saving up to 60 percent by giving money to employees to buy their own personal plans directly from insurance companies, the firm said.

Zane Benefits President Rick Lindquist said he believes that with the ruling now made, both Congress and Obama will focus on passing piecemeal improvements to the Affordable Care Act to make the law better for consumers and employers alike. He expects a flurry of new bills to be introduced in the coming months, among them measures to expand health reimbursement arrangements and to simplify IRS reporting requirements.