In case you haven’t heard, Obamacare is working. The latest figures show that a whopping 16 million fewer Americans are uninsured because of Obamacare’s coverage expansion, which has driven the national uninsured rate down to historic lows. But the upcoming Supreme Court ruling on King vs. Burwell could change this situation dramatically.
The Supreme Court is considering whether states using a federally run exchange are ineligible to receive subsidies under the Affordable Care Act, with a decision expected in June. The case was formulated by a group of conservative lawyers backed by the Koch-funded Competitive Enterprise Institute, which has repeatedly stated that it would stop at nothing to kill the health care law.
The plaintiffs claim that the law allows residents to receive premium tax credits only in states that run their own health insurance marketplaces directly, rather than the federally facilitated marketplaces operated by many states. The argument is founded on a superficial and dishonest reading of the law that has been thoroughly discredited by legal scholars, but the impact of the Supreme Court ruling would be very real.
The map above from the Washington Center for Equitable Growth at the Center for American Progress shows how things could change with the Supreme Court ruling. The states in brown use federally run health care exchanges, with darker colors representing areas with more people who are eligible for the ACA’s subsidies. If the Supreme Court sides with the plaintiffs, the ruling would invalidate the subsidies received by more than 85 percent of exchange enrollees and make health care unaffordable for many people. The Rand Corp. estimates that this decision would result in 9.6 million people becoming uninsured — a devastating consequence that can be expected to result in the deaths of 9,800 people a year.
The states in gray run their own exchanges and would not be impacted by the ruling, at least initially. But many policy experts are concerned that striking subsidies for the states in brown would destabilize the insurance markets and ultimately undermine the ACA, dragging our country back to the dark days when healthcare was only for the healthy and the wealthy.