By the end of this month, the Supreme Court of the United States will have handed down its highly impactful decision that will have a profound effect on access to health care for millions of at-risk individuals across the nation.
At present, there are 34 states that offer health insurance subsidies to middle and low-income individuals by way of the insurance marketplace established under the Affordable Care Act. The case of King v. Burwell questions the legality of this action.
Because the Arkansas legislature decided not to create our state’s own exchange, those who have gained coverage under this program are now in danger of losing their coverage. So what effect will this ruling have on our state if the Supreme Court rules against these subsidies? What actions can be taken to address our needs until a more permanent solution is adopted?
According to the Kaiser Family Foundation, there are 48,100 Arkansans (as of March 31, 2015) who receive premium subsidies. If the court rules in favor of the challengers, these people will lose their subsidies and thus, their coverage. This means that $13.6 million federal subsidies would disappear from our state and that these individuals would see a 270% average increase in premiums if tax credits are no longer available. Under the existing framework, the average tax credit per enrollee is $284 in Arkansas.
Altogether, there are 6,387,789 Americans who stand to lose their healthcare by the end of the month, which is nothing short of a catastrophe. Should this occur, there will most likely be substantial premium increases over the following years. As costs continue to rise, people will be forced to let go of their coverage. Just imagine the negative effect this will have on our insurance risk pool.
Should the worst-case scenario prevail, our state will have to quickly evaluate its options to provide alternatives for people who would like to keep their health insurance. Moving people back onto traditional Medicaid or finding other ways to subsidize private health insurance could achieve this. (Again, this could have been avoided had we not declined the opportunity to set up our own exchange.)
There have been various occasions throughout our nation’s partisan battle over healthcare reform where it looked as if those in opposition to the Affordable Care Act were actually getting closer to unraveling the efforts of previous Congressional bodies, the Obama Administration, and all of the efforts put forth by the President’s predecessors who pursued the same cause. What history will reflect is the first black President of the United States who entered into office with a list of lofty and noble goals, who ultimately decided to hedge his entire tenure in office on an effort to prevent unnecessary deaths in the most technologically advanced nation in the world, and construct a healthier future for generations to come.
Now, as we await the Supreme Court’s decision, I cannot help but picture two chairs outside of a school principal’s office filled by two bodies that have repeatedly fought each other, are battered and bruised, and are at an ultimate crossroads. They are tired, worn down, and awaiting judgment. Soon enough, the principal will walk out and hand down a verdict that speaks to the superficial root of the problem between both parties. Should it be in favor of the challenger, we can only hope that they would quickly see the inheritance that comes with such a victory. But I have little hope for this.
Representative Paul Ryan (R-WI), the chairman of the House Ways and Means Committee, recently stated in an interview that “This is the beginning of the end of the Affordable Care Act.”
I could not disagree more and I can only wonder what the 19,000 people on the chopping block in his congressional district think about that.
What such a ruling would signify is far beyond something as basic and ill-conceived as the “end of Obamacare” – no matter how much it is touted as such. What it would be, rather, is something more like a driver pulling over and giving his keys to the dog that’s been chasing him for years.
May the defeated jump at the chance to open the door for his victor and be kind enough to wish him well as he sets forth into the chaos that awaits him.