The Supreme Court is expected to issue a ruling next month in King v. Burwell, a case that could gut Obamacare and leave millions of Americans without health insurance. The case hinges on what is essentially a typo in the Affordable Care Act, a mistake that conservative opponents claim invalidates most of the subsidies the law provides to help people buy insurance.
If the justices buy the conservatives’ argument, residents of the 34 states that provide health insurance via the federal government’s HealthCare.gov, rather than through a state-run exchange, could lose their subsidies. Many people — up to 13 million — would be unable to afford to buy insurance (as the ACA requires), and the whole system could collapse.
“The immediate effect [of a ruling against the administration] would be that 7.5 million people would lose the federal subsidies that are helping them buy insurance,” Larry Levitt, a senior vice president at the Kaiser Family Foundation, told CBS News. Even more significantly, he said, “it would trigger a meltdown in the individual insurance markets in the 34 states that are affected.”
The impact of such a ruling would create an even greater divide between the mostly-Democratic states that have embraced all of the various elements of the Affordable Care Act — like the expansion of Medicaid and the establishment of state-run exchanges– and the mostly-Republican states that have rejected them, Levitt told CBS. “You’d almost have two Americas in terms of health care coverage,” he said.
The Huffington Post put together a map showing how many people stand to lose health insurance in each state if the Supreme Court rules against Obamacare. Here’s how it breaks down:
Research shows that gaining health insurance coverage results in significant improvements in health outcomes, including reducing the incidence of premature death. “Uneven implementation of the ACA, therefore, could increase preexisting disparities in the health and health care available in high- and low-performing areas of the U.S.,” said Dr. David Blumenthal, president of the Commonwealth Fund, a non-partisan healthcare research foundation.
As you can see in the map above, Republican-led states stand to lose the most if the Court strikes down subsidies for those who purchased insurance through exchanges operated by the federal government. Note that there is also a lot of overlap between states which haven’t expanded Medicaid and states that are not running their own exchanges.
Most of these states have poorer health to begin with, and a ruling against Obamacare could put residents of these states on radically different health care trajectories, with some enjoying progressively better health and health care and others falling further and further behind.
“The Supreme Court’s decision on King v. Burwell is the difference between lives saved and lives lost, a healthier nation or a sicker one,” said Dr. Georges Benjamin, MD, executive director of the American Public Health Association, which filed an amicus brief outlying the ramifications of a ruling against the Obama administration. “A ruling in the plaintiff’s favor would force millions of Americans to lose health coverage, and we know being uninsured is a driver of preventable deaths.”