While I’ve started my new job at ICER, I can't help but continue to pay attention to the ACA J
This morning the Supreme Court rejected Maine's challenge to the constitutionality of an ACA provision governing Medicaid. This was the administration's attempt to drop 19 and 20-year-olds from Medicaid, claiming that the Maintenance of Effort provision of the original law was unconstitutional. The Supreme Court refused to hear the case so eligible 19 and 20-year-olds will remain covered in Maine.
That’s what they announced. What they did not do was release their opinion on King v. Burwell (the subsidy case). However, with the ruling expected in the next few weeks, focus is again turning to the case and what would happen if the court rules that subsidies cannot be provided through the federal exchange.
First, for those needing a refresher, here is a review of the oral arguments: Revisiting Oral Arguments In The King v. Burwell Obamacare Supreme Court Case.
Now, let’s take a look at what the public thinks the court should do. While they are still ambivalent about “Obamacare” as a whole, the majority of the public don’t want the subsidies to end (55% to 38%): Public to Supreme Court: Don’t gut Obamacare.
But what happens if the court finds against the subsidies? You end up with a case of the dog catching the car. Once it happens, the dog is not sure what to do...
The Republicans keep saying they have a plan, but in fact they have several (meaning there is no agreement on how they would proceed). Here is a great review of potential Republican “fixes” to an adverse Supreme Court decision. As the article makes clear, they all attach conditions to extending the subsidies that would end up destroying the individual insurance market: The GOP has 5 plans to fix Obamacare if the Supreme Court blows it up. They're all a mess.
That’s on the Federal level, but what about the states? Not much hope there either as: Most states unlikely to create insurance exchanges to save ACA subsidies.
If there is an adverse decision but no fix, we’ll see the blame game play out. In the President’s remarks today, you can see he has begun to frame the issue a certain way: Barack Obama Wants You to Think the Obamacare Lawsuit Is Ridiculous: President says the Supreme Court probably shouldn’t have even taken up the King v Burwell case.
Here the New Yorker takes an overall look at how the politics may play out: The Obamacare Lawsuit Is a Government Shutdown, But for Health Care
And finally I share with you Republican Senator Thurn’s tweet from today:
Six million people risk losing their health care subsidies, yet @POTUS continues to deny that Obamacare is bad for the American people.
Think about how ridiculous that is. The best response I saw (h/t to @sethdmichaels) was the following:
(A is bringing you a birthday cake)
(B smashes it with a bat)
B: "I can't believe A made it possible for you to lose your cake-he's so bad."
Kind of crazy if you ask me…
To conclude, let me say that I still think that the court will allow the subsidies to continue. Based on nothing I give that a 75% chance of happening. I even think it could end up being a 6-3 decision with both Roberts and Kennedy voting to allow the subsidies. But that means I think there is a 25% chance that the ruling will determine that subsidies are not allowed on the federal exchange, thus putting into play the discussion above.
Stay tuned!
