With the Supreme Court set to hand down a ruling in King v. Burwell as early as today, the New York Times comes up with the off-the-wall idea of taking a look at the Affordable Care Act’s subsidies and exchanges to determine whether they are actually working to accomplish the law’s goals.
The answer from Margot Sanger-Katz and Robert Pear? Mostly yes:
Have the subsidies succeeded? By many measures, the answer is yes. More than seven million people are enrolled in the federal health insurance marketplaces, and a majority of them — 87 percent — receive subsidies in the form of tax credits to help pay their premiums, the government says. Without subsidies, many would be unable to buy insurance.
The subsidies also appear to have drawn substantial numbers of younger, healthier Americans into the new insurance markets, stabilizing premiums, even for people who pay the full cost themselves…
Two-thirds of federal marketplace customers have incomes less than twice the poverty level…A survey last year by the Kaiser Family Foundation estimated that nearly six in 10 people with coverage through the exchanges were previously uninsured.
A Supreme Court ruling for King would invalidate the subsidies for over six million people in the three dozen states on the federal exchanges. But note this striking factoid:
The effects would be felt around the country, but disproportionately in the South. More than three million people are receiving subsidies in four states that use the federal exchange: Florida, Georgia, North Carolina and Texas. In Florida alone, 1.3 million people — more than 8 percent of the population under 65 — receive subsidies to buy insurance.
As I noted recently, news orgs are getting the impact of a pro-King ruling wrong. It would not destroy the law. Rather, the worst-case scenario — if lawmakers do nothing to keep subsidies going — would probably be that we’d continue progressing towards universal health care in 16-18 mostly blue states that set up their own exchanges, which would remain untouched by the decision. Meanwhile in mostly red federal-exchange states, the coverage expansion gains would backslide. The loss of subsidies would hit a lot of states that have already declined to expand Medicaid to the poor.
And so, as Larry Levitt of the Kaiser Family Foundation put it to me, in states that are trying to make Obamacare work for their constituents, “the health care system would be functioning exactly as was originally intended with the ACA, with steady movement towards near-universal coverage.” Meanwhile, in the other states, “you would have millions losing coverage and insurance markets thrown into chaos.”
The Times piece suggests there may be also a geographic component to this. As it is, Kaiser studies in 2013 found that the failure by many states to expand Medicaid was causing a hugely disproportionate number of people in the south to fall short of qualifying for coverage. Paul Krugman recently showed that the north-south divide on the Medicaid expansion map remains striking today. Pile on top of this the nixing of subsidies that will disproportionately hit southern states, and this geographic divide may only grow starker.
A Court decision for King will not destroy the law. Rather, it will more likely result in deeper polarization of our health care system, along already-familiar lines.
* REPUBLICANS OPPOSE CONSTITUTIONAL SAME-SEX MARRIAGE RIGHT: A new NBC/WSJ poll finds that 57 percent of Americans want the Supreme Court to rule for a Constitutional right to same-sex marriage. But Republicans are all alone:
58% of Republicans oppose a constitutional right to gay marriage and three-quarters of Democrats support it. Independents would like to see the court protect the constitutionality of gay marriage by two-to-one, the survey found.
Meanwhile, like other polls, this one finds a stark generation gap: “Americans between the ages of 18 and 34 strongly support the court legalizing gay marriage.” Republicans are against it; young people are for it.
* RULING AGAINST ACA COULD ‘ROCK PRESIDENTIAL RACE’: David Drucker reports that Republicans increasingly realize that a “win” in King v. Burwell will put the GOP presidential candidates in a quandary. One camp argues for Republicans to appear as if they want to act:
This strategy assumes it is politically unwise — and unfair — to leave Americans who lose subsidies out in the cold. So, Republican Congressional leaders and some of the GOP presidential contenders have prepared proposals to maintain the subsidies in the interim as part of a plan to radically overhaul the law over the next six to 18 months. Obama would veto it, but this avenue would protect Republicans from blame and force the president to engage with them.
Perfect! It would be “unfair” to abandon those who lose subsidies, so Republicans should pursue a contingency they know will fail to restore those subsidies, because it will allow them to blame Obama!
* SUBSIDY FIX MIGHT NOT EVEN PASS HOUSE: Bloomberg’s Sahil Kapur reports that House conservatives are skeptical of the emerging House GOP plan to temporarily extend subsidies while repealing the individual mandate, because it extends Obummercare. It might not even pass:
Representative Bill Flores of Texas said he’s “willing to look at” a transitional tax-subsidy extension as an “off-ramp,” saying it should have a definitive expiration date. He said he hopes it can pass the House but “I don’t know for sure.”…Representative Ted Yoho of Florida said he’s open but “not in big support” of a subsidy extension. Can it pass the House? “I don’t think it will,” he said.
In other words, Republicans might not even be able to pass a plan that is designed to draw a presidential veto, let alone enter into negotiations in which both sides make workable concessions.
* ANTI-OBAMACARE SENATOR ‘BRACES FOR COURT RULING’: Yes, you read that correctly. Politico reports that Tea Party Obamacare-hating Senator Ron Johnson is “bracing” for a ruling that would do serious damage to the law. That’s because Wisconsin will be left in a peculiarly bad situation after such a ruling.
Johnson has introduced a fake-fix bill that would temporarily extend subsidies while repealing the mandate, which is designed only to allow him to argue that he tried to do something for his constituents. Will his Democratic opponent Russ Feingold go on offense over this? Will other Dems facing GOP Senators in states where large numbers will lose subsidies do the same?
* HEALTH INDUSTRY BRACES FOR COURT RULING: Catherine Ho reports that many in the health care industry had hoped to finally move beyond Washington arguments over Obamacare this year, but they’re now dreading the damage from a court ruling. As one puts it:
“Many people are concerned that if the court reverses, that will consume the rest of the congressional agenda…you’re talking about something…very divisive. You’ve got a pattern in Congress that’s unusually productive, Republicans and Democrats working together in a manner they haven’t in the last five or six years, on anything. That all goes out the window if the court reverses in King.”
It’s a reminder that a pro-King ruling could go well beyond bumping millions off subsidies, hurting health industry stakeholders and possibly cause economic disruptions, theoretically making it harder for Republicans to do nothing.
* AMERICANS WANT COURT TO SIDE WITH GOVERNMENT: A new Associated Press poll finds that 56 percent of Americans want the Court to rule that the subsidies are valid in the states on the federal exchange. Note this:
A significant minority of the law’s opponents (39 percent) think the court should rule that the government can continue to subsidize premiums in all states.
It’s possible that even a lot of people who oppose the law see that it would be fundamentally unfair to nix financial assistance for those millions in states that didn’t set up an exchange.
* AND BEHOLD THE BERNIE-MENTUM!!! New Bloomberg polling finds that Bernie Sanders has sliced into Hillary Clinton’s lead in the early states: She leads him by 50-24 in Iowa and by 56-24 in New Hampshire. What’s going on here? One Iowa voter says this:
“I want to try to get him along as far as I can. He’s going to bring up some issues that she may not want to talk about.”
And so, one thing that may be driving this is a desire among many rank and file Dems to see Clinton challenged on issues important to them.