Supreme Court Hears Arguments On Affordable Care Act Subsidies

Supreme Court Hears Arguments On Obamacare Subsidies. On March 4, the Supreme Court will hear oral arguments on King v. Burwell in “a major test” of the president's health care law and its subsidies to help qualified low-income households afford health care. As the Associated Press reported:

The Supreme Court is hearing arguments in a major test of President Barack Obama's health overhaul that threatens insurance coverage for millions of people.

The justices are meeting Wednesday to try to determine whether the law makes people in all 50 states eligible for federal tax subsidies to cut the cost of insurance premiums. Or does it limit tax credits only to people who live in states that created their own health insurance marketplaces?

A ruling that limits where subsidies are available would have dramatic consequences because roughly three dozen states opted against their own marketplace, or exchange, and instead rely on the U.S. Health and Human Services Department's healthcare.gov. Independent studies estimate that 8 million people could lose insurance coverage. [Associated Press, 3/4/15]

Millions of Americans Could Become Uninsured Without The ACA's Subsidies

Urban Institute: 8.2 Million Americans Could Become Uninsured If Court Rules In Favor Of The Plaintiffs In King. According to a January analysis of the potential consequences of King conducted by the Urban Institute and the Robert Wood Johnson Foundation, if the court strikes down the subsidies, “8.2 million more people would be uninsured than would be the case with the financial assistance” previously provided:

However, if the Supreme Court rules in favor of King and federal tax credits and cost-sharing reductions are eliminated in these states, health coverage would be dramatically different. About 8.2 million more people would be uninsured than would be the case with the financial assistance provided under the ACA as currently implemented. The nongroup market would only cover about 4.5 million people, far less than the 14.2 million enrollees with the tax credits and even less than the 7.3 million absent the ACA at all.

Medicaid and CHIP [Children's Health Insurance Plan] enrollment would be about 500,000 lower without tax credits and cost-sharing reductions. Many children eligible for Medicaid or CHIP have parents eligible for marketplace tax credits under the current implementation. Without tax credits, fewer parents would seek marketplace coverage and, as a result, fewer children would be screened for and enrolled in public insurance. [Urban Institute, January 2015]

New York Times: At Least 7.5 Million Could Lose Their Subsidies. According to The New York Times, “if the court rules against the Obama administration in the King v. Burwell case, about 7.5 million people could lose their subsidies in 34 states that use the federal health care marketplace.”

[The New York Times, 3/3/15]

National Women's Law Center: Women Would Be Disproportionately Impacted By Loss of Subsidies. According to analysis from the National Women's Law Center (NWLC), women would be disproportionately impacted by the loss of subsidies should the courts rule against them in King:

According to our analysis, nearly seven million women, including those already enrolled, are eligible for tax credits in the federally-facilitated Marketplaces. These seven million women are at risk of losing the financial help they need to buy health insurance coverage.

• The vast majority of women eligible for financial help live in states with federally-facilitated Marketplaces. Across the country, over nine million women are eligible for financial help, but nearly seven million of these women live in states with federally-facilitated Marketplaces. These women are at risk of losing their access to affordable, comprehensive health insurance just because of where they live.
• Women of color would be disproportionately affected. Of the nearly seven million women at risk of losing their eligibility for financial help, approximately half (3.4 million) are women of color.

o This includes 1.8 million Latinas, 1.1 million African American women, 250,000 Asian women, and 106,000 Native American women.

• Over two million of the women at risk live in just two states.

o Over 1.2 million women in Texas and over 900,000 women in Florida are at risk of losing access to affordable health coverage.

o Other states with the largest numbers of eligible women include Georgia, North Carolina and Illinois. [National Women's Law Center, 2/23/15]

Pediatricians And Family Physicians: Without Subsidies, “Up To 5 Million Children Could Lose Access To Affordable Insurance Coverage Based On The Happenstance Of Geography.” A brief filed by pediatricians, family physicians, and children's health advocates points out the devastating effect the lack of subsidies could also have on the continued vitality of the Children's Health Insurance Program (CHIP). As the brief explains, the challengers' argument would also disallow the use of the federal exchanges as a backstop for CHIP recipients, but "[n]othing in the program's history or the proceedings surrounding CHIP reauthorization suggest that Congress had such a counterintuitive result in mind, and no sound policy reason supports it". [Brief For The American Academy Of Pediatrics, American Academy Of Family Physicians, Children's Health Fund, Et Al. As Amici Curiae In Support Of Respondents, 1/28/15, via Media Matters]

New York Times' The Upshot: Court's Decision On Subsidies Could “Deepen A National Health Divide.” A March 4 article for the New York Times' The Upshot blog explained that a ruling against the ACA's subsidies had “the power to deepen a national health divide”:

But a ruling for the King plaintiffs could make things even more disparate than they were before the law passed -- in addition to the new taxes, new insurance regulations could mean skyrocketing individual insurance premiums in states that lose their subsidies. That could cause even people who had bought their own insurance before the law to be priced out of the market.

The new policy universe created by the law means the court can't just turn the clock back to 2009. If insurance subsidies are eliminated, a new era will begin in which, instead of a more uniform health care system, Obamacare will wind up bringing one that is more unequal than ever before. [The New York Times, 3/4/15]

Conservative Media Gloss Over Those Most Impacted By Loss Of Subsidies

Wall Street Journal Encourages Court To “Vacate The Subsidies.” In a March 2 editorial, the Wall Street Journal promoted the conservative challenge to the ACA, encouraging the Supreme Court to “vacate the subsidies” for health insurance through the health care law. The Journal failed to note that millions of Americans would lose insurance. [The Wall Street Journal, 3/2/15, via Media Matters]

Betsy McCaughey: Supreme Court Decision “Will Have No Impact On The Poor.” In a March 2 opinion post for FoxNews.com, serial health care misinformer Betsy McCaughey claimed that “no matter how the Justices rule” in King, “it will have no impact on the poor.” McCaughey went on to encourage readers not to be “bamboozled” by the Obama administration “ghoulishly predicting” that there will be “hardships” if subsidies are eliminated. [FoxNews.com, 3/2/15]

Breitbart.com: Many Are “Predicting The Sky Will Fall And Sick Children Will Die” If Subsidies Are Eliminating. Conservative blog Breitbart accused “the political left” of using “scare tactics” in an attempt to sway the Supreme Court's ruling on ACA subsidies. The post mocked those pointing to the millions of Americans who would be harmed by such a ruling, accusing them of arguing that “the sky will fall and sick children will die”:

Even so, the political left is playing with the mind of Chief Justice John Roberts in advance of oral arguments this Wednesday. They are spinning tales about how going the wrong way in this case, Armageddon will happen and the integrity of the court will be ineluctably harmed.

The scare tactics are coming fast and furious. Writing in the New York Times a few weeks go [sic], predictable left-wing court watcher Linda Greenhouse, said, “The court has permitted itself to be recruited into the front lines of a partisan war. Not only the Affordable Care Act but the court itself is in peril as a result.”

[...]

There are also the arguments that the sky will fall and sick children will die. They say it is Obamacare or nothing and that the Republicans have nothing to make up for its loss. Leo says nonsense to this. [Breitbart, 3/2/15]

Townhall Deems Negative Impact Of Ruling Against Subsidies A “Myth.” In a March 3 column, Townhall listed the assertion that “millions of people will be harmed” if they lose their subsidies following the Supreme Court's ruling in King among the “Top Five Myths” about the case. [Townhall, 3/3/15]

National Review Online: Department Of Health And Human Services Is Using “Scare Tactics” By Pointing To Those Who Would Lose Insurance. In a March 2 post, National Review Online dismissed warnings from Department of Health and Human Services (HHS) Secretary Sylvia Burwell that “millions of people would lose their health insurance subsidies” depending on how the Supreme Court rules in King, calling Burwell's statement a “scare tactic”:

Burwell's scare tactics were transparent: “First, millions of people would lose their health insurance subsidies and therefore would no longer be able to afford health insurance; second, without tax subsidies healthy individuals would be far less likely to purchase health insurance, leaving a disproportionate number of sick individuals in the individual insurance market, which would raise the costs for everyone else; and third, states that did not establish a state marketplace would return to a time when the recourse for those without insurance was to seek care in hospital emergency rooms, further driving up insurance costs for everyone.” Never mind that her first two points describe problems that were largely created by Obamacare. As for the third point, multiple studies have shown that Obamacare has, at least temporarily, increased ER visits. [National Review Online, 3/2/15]