BUFFALO, N.Y. – The Supreme Court handed a huge victory to about 6.4 million people in 34 states on Thursday, says University at Buffalo senior associate dean for health policy Nancy Nielsen.

Those people would have lost their health insurance premium subsidies had the justices not upheld a central part of the Affordable Care Act. The court ruled that the law may provide tax subsidies for people who buy health insurance through a federal exchange, and not just for people in states that have exchanges.

The ruling was also a huge win for President Obama, said Nielsen, a past president of the American Medical Association.

“This could be the end of serious legal attacks on Obamacare,” said Nielsen, a health policy expert and clinical professor in the UB School of Medicine and Biomedical Sciences. “There will still be legal challenges, and political moves to alter the law, but the structure will remain. Everything was riding on this. Now the country and Congress can get serious about fixing the things in the law that need improvement.”

The country has seen the biggest decline in uninsured citizens in decades, she said, and that is a result of important provisions of the Affordable Care Act. The 6-3 decision highlights the fact that subsidies are there for anyone who qualifies, regardless of where one lives.

“Even those states where opposition to the Affordable Care Act still rages should breathe a little easier today knowing their citizens will not suffer and their tax dollars will not flow to the 16 states who operate their own exchanges,” she said.