The U.S. Supreme Court on Thursday voted 6-3 against the plaintiffs in the case of King v. Burwell. The ruling means more than 6 million residents in the 34 states with federal insurance exchanges can keep their tax subsidies for health coverage.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," wrote Chief Justice John G. Roberts Jr. in his majority opinion.

In an impassioned and creatively-worded dissent, Justice Antonin Scalia (who was joined by his conservative colleagues Samuel Alito and Clarence Thomas), called the ruling "pure applesauce."

Other reaction from across healthcare is rolling in.

"The American Medical Association is relieved that today's Supreme Court decision will allow millions of patients to continue accessing the health care they need and deserve," said AMA President Steven J. Stack, MD, in a statement.

"The subsidies upheld today help patients afford health insurance so they can see a doctor when they need one and not have to wait until a small health problem becomes a crisis," he said. "The subsidies provide patients with peace of mind that they will not risk bankruptcy should they become seriously ill or injured and experience catastrophic health care costs."

"The federal premium subsidies will continue to reduce the cost of insurance for the millions of Americans who receive them and continue to improve access to health care," says Mayo Clinic CEO John Noseworthy, MD. "It is important that we not step back from our commitment to health insurance coverage for all Americans."

"As many as 6 million people stood at risk of losing coverage if the court ruled against premium subsidies. With its decision, the court keeps coverage within reach for individuals and families who otherwise have few affordable options to pay for care they need," said Bruce Siegel, MD, president and CEO of America's Essential Hospitals.

"We still have a long way to go to solve the nation's health insurance crisis and ensure affordable and available care for all people," he added. "About 37 million people still lack health coverage in the United States, in part because 21 states still have not expanded Medicaid. We hope this decision will give states the confidence to extend coverage to the millions of vulnerable people who need it."

"Over 6 million Americans and their families will sleep easier knowing they will still be able to afford health coverage," said HHS Secretary Sylvia Mathews Burwell. "Millions more won’t have to worry about an upward spiral in their premiums because of today’s decision, even if they didn’t buy their insurance through the Marketplace. And the law’s financial assistance will be available in the next open enrollment so that others can benefit as well.

"The Affordable Care Act is working to improve access, affordability and quality," she added. "That is the story I hear as I travel across this country. People’s lives have been changed and even saved because they have health insurance – many for the first time. They have coverage that can keep them healthy and provide quality care when they are sick."

Read the Supreme Court's decision here.

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