By now you may have learned of the plight of one Luis Lang, a South Carolina man whose story went viral after it was reported that he couldn’t afford to treat an illness that was threatening to make him blind — and blamed Obamacare for it. He has since come around to the view that Democrats may not be entirely to blame for his state of affairs — and says he is going to try to gain coverage through the law.
But there’s another potential twist to the tale: Just as he is now seeking to get on Obamacare, he could very well find himself unable to sign up for coverage, if the Supreme Court rules for the challengers in King v. Burwell next month.
Lang’s story has gone wild on the internet, turning him into a symbol of a number of intertwined narratives about the law: How Republican opposition to the Medicaid expansion has created a coverage gap claiming many low income people; how justifiable confusion about the complicated law is fueling anger at it; and so on.
It all started when the Charlotte Observer reported that Lang, 49, a self-employed Republican handyman who has never bought insurance, developed “bleeding in his eyes and a partly detached retina caused by diabetes.” The paper reported that subsequent medical bills quickly ate up his savings, whereupon he turned to the Obamacare exchange. He discovered his earnings fall below the window to qualify for a subsidy, yet he might not be able to get on Medicaid because South Carolina has not opted into the Medicaid expansion. He risks falling into the “Medicaid gap.”
The paper reported that his family blamed this on Obamacare, prompting criticism from bloggers and others, combined with a crowd-funding drive for his surgery. In a subsequent interview with Think Progress, Lang said he now thinks opposition to the Medicaid expansion is the culprit, is rethinking his GOP affiliation, and is going to try to get coverage from the law, though he still says he has issues with its implementation and blames both parties:
“Now that I’m looking at what each party represents, my wife and I are both saying — hey, we’re not Republicans!” Lang said….
“I put the blame on everyone — Republican and Democrat. But I do mainly blame Republicans for their pigheadedness,” Lang said. “They’re blocking policies that could help everyone. I’m in the situation I’m in because they chose not to expand Medicaid for political reasons. And I know I’m not the only one.”…
“I know we didn’t do it the right way,” Lang told ThinkProgress, explaining that he’s hoping to figure out the situation with his fluctuating income so he can be the first in line to sign up for a plan during the next open enrollment period.
Lang also told Think Progress that he now supports universal health care. As Steve Benen notes, he is only the latest example of people “who thought they hated ‘Obamacare,’ right up until they needed it.”
Ann Doss Helms, the Charlotte Observer reporter who broke the story, backs up what Lang told Think Progress. She tells me she has connected him with a local health care adviser who is ready to help him get on Obamacare, and that he appears ready to do that. “He has told me that he knows he needs to get insurance, and that he would take a federal subsidy to get it,” Helms says.
And an HHS official tells me that if he can get his income up a bit — it reportedly fluctuates — he could probably qualify for a category that would allow him to apply for Obamacare again before next year’s open enrollment period.
But if the Court strikes subsidies for millions of people in three dozen states on the federal exchange — one of which includes South Carolina — it could put Obamacare even further out of reach for Lang.
“Assuming he can make between one and four times the poverty level, he’d be eligible for subsidies to help him pay for coverage,” law professor Nicholas Bagley, who has closely studied the potential impact of a Court decision against the law, says. “But if subsidies are eliminated, he’s unlikely to be able to afford health coverage.”
In fairness, multiple Republicans have said people should not be left stranded without subsidies if the Court nixes them. They are floating various contingency plans that would keep them temporarily covered. But they are likely to demand a repeal of the mandate in exchange, which suggests they may simply be trying to draw a presidential veto of their fix in hopes of winning the blame game that follows. And it’s anybody’s guess whether Republicans will be able to unite behind any fix. If not, it seems unlikely that GOP governors will set up exchanges to keep subsidies flowing.
And in a way, Lang’s story — in which the sudden need for health care led him to learn more about the law than he’d previously known — is perhaps a harbinger of the political problems that an anti-ACA court ruling could create for Republicans, in addition to being a terrible outcome for Democrats.
“This guy only understood how Obamacare works because he needed to get health care,” Bagley says. “There are going to be a whole lot of people with insurance right now who will get a rude lesson in how Obamacare works if subsidies are eliminated. This is maybe the kind of education a big chunk of the American public will get.”
Another way to understand this: If Republican opposition to the Medicaid expansion has created a big “Medicaid gap,” a Court ruling against the ACA — followed by GOP unwillingness to do anything in response — could make that gap in the safety net created by Obamacare a whole lot bigger. And it could claim a whole lot more people.