The Supreme Court has another Chance to Destroy Obamacare

How would it affect you?

          The Supreme Court has yet another chance at destroying the Affordable Care Act.  The situation is this.  A large part of Obamacare is to make health care affordable for Americans.  The plan, therefore, subsidizes premiums paid by families for their health insurance.  For example, in 2014 a family of four making $35,775 per year would not pay more than $1430 per year ($119 per month) for a silver plan.  These subsides apply to annual incomes reaching up to about $100,000 a year.  The subsides are paid for by

       -          a much larger pool of participating and mostly healthy individuals

 

      -          more frequent medical checkups to keep people healthier

      -          additional taxes on those making over $200,000 per year and

      -          taxes on medical devices and health care insurance companies, on expensive “Cadillac”health care plans and on tanning salons. 

            The Patient Protection and Affordable Care Act (i.e. Obamacare) was originally written to have each state set up it own health insurance exchange.  Citizens go on-line to health care exchanges and select which plan they want, from the most economical bronze plan to the most expensive platinum plan.  Along the way though, 34 states opted not to set up their own plan, some because setting up the system was too onerous and others because they just opposed Obamacare.  The federal government then established a system where people without state plans could select an insurance plan through the federal government site, www.healthcare.gov. 

            The only problem is the exact wording of the Affordable Care Act.  The Act states that subsidies will be provided to eligible people who purchase insurance through “exchanges established by the states”.  In King v Burwell (Sylvia Burwell, Secretary of the Department of Health and Human Services) King argues that anyone who obtained health insurance through a federal exchange is NOT eligible for subsidies because they’re not “established by the state.”  Even though Obamacare clearly intended that subsidies could be provided through either a state or a federal exchange, the exact wording of the act does NOT say “or the federal government.” 

            All this turmoil and uncertainty results from conservative zealots that loath Obamacare. So if the Supreme Court decides that the federal government cannot provide subsides, here is what could happen.

1)  Five million people signed up for Obamacare from federal exchanges in 2014.  Of those, 87% or about 4.4 million people, received subsidies.  Without those subsidies, many of the lower income and healthy, generally younger people may opt out¹⁾. The numbers get worse though.  In 2015, the second year of enrollment, the estimated number of Obamacare participates is about 11.4 million and, according to E. J. Dionne of the Washington Post, ²⁾ about 8 million lower income and younger people could opt out and be without health insurance.

 2) Most of those who drop health insurance are from the 34 non-participating states.  These are predominately Republican states.

3) With the younger, relatively healthy people not participating, the majority of the participants would be in poor health and require more medical treatment.  However, without insurance, hospital and doctor payments would drop and medical fees would have to increase in order to compensate.  An economic forecast by the RAND Corporation projects that medical fees would increase by 47%, while enrollment in individual health care insurance market would decline by 70%³⁾.  This too would occur predominately in Red states which did not develop exchanges.

4) People without insurance are reluctant to go to the doctor.  The result is many preventable diseases (e.g. asthma, heart problems, high blood pressure, diabetes, and cancer) will not be detected until late in the disease development when the prognosis is not good and the cost of treatment is higher.  Before Obamacare, the American Journal of Public Health reported that about 44,800 people were dying unnecessary each year due to lack of insurance ⁴⁾.  In addition, lack of pre-natal care results in higher infant mortality rates.  The National Vital Statistics Bureau reports that about 25,000 infant deaths result each year from inadequate prenatal care ⁵⁾.  And again, the increase in death and disease will predominately occur in Republican states.

5) The expanded Medicaid program that provides healthcare for those earning less than 138% of the Federal Poverty Level, (about $33,000 for a family of four in 2014) would continue for those 25 states that opted to participate in the program.  The other 25 states refused to participate in expanded Medicaid, even though the federal government will pay almost all of the costs.  The 25 states not participating in the expanded Medicaid is, you guessed it, mostly Republican states. 

So the end result of a Supreme Court decision to uphold King’s complaint is that part of the nation would be receiving huge Federal subsides for health insurance and the remaining states could receive near nothing.  Secretary Burwell told Congress that the administration knows of no legal action it could take to “undo the massive damage to our health care system that will be caused by an adverse decision.”⁶⁾

In closing this article, I quote Ted Cruz’s statement to the International Union of Firefighter on Tuesday March 10 in Dallas, Texas:

“Five years ago reasonable minds could have differed on whether this was a good idea, but today, seeing millions of American who’ve lost their jobs, who’ve been forced into part time work, who’ve lost their health care, who’ve lost their doctor — it is the essence of reasonableness, it is the essence of pragmatism to acknowledge this thing isn’t working. We need to repeal it and start over.”

I think it is the essence of reasonableness for the states to have joined Obamacare.  Thank goodness Cruz doesn’t work for NASA.

1) Fortune.com, “The Supreme Court’s decision on health care subsidies – what you need to know,” by Laura Lorenzetti, March 3, 2015.

2) The Week, “Obamacare’s looming legal showdown’, March 56, 2015

3) Fortune.com, “The Supreme Court’s decision on health care subsidies –

4) Wilper, Andrew P.; Woolhandler, Steffie; Lasser, Karen E.; McCormick, Danny; Bor, David H.; Himmelstein, David U. (December 2009). "Health insurance and mortality in US adults." American Journal of Public Health 99 (12): 2289–2295. DOI:10.2105/AJPH.2008.157685. PMC 2775760. PMID 19762659.

5) National Vital Statistics Report, Vol. 59, No. 6, June 29, 2011

6) www.csmonitor.com/USA/Justice/2015/0304/supreme-court-could-obamacare-ruling-destroy-health-insurance-for-millions