The Supreme Court is poised to issue its ruling in King v. Burwell – a case that will decide whether health insurance premium subsidies for moderate- and middle-income Americans will continue to be available in all states, or whether they will be withdrawn from the 34 states that deferred to the federal government to run their insurance marketplaces.
There is ample reason to believe that the court will rule for the government and allow the subsidies, offered through the Affordable Care Act (ACA), to continue nationwide. Abundant court precedent makes clear that statutory interpretation requires an examination of the whole statute and its context, and this makes it likely the court will continue subsidies throughout the country.
But the court is often unpredictable. If it does the unexpected and rules against the Administration, Congress will have to step in and save these subsidies that are so critical for more than 6 million Americans – about 412,000 in Georgia. Ending these subsidies would cause premiums to skyrocket throughout the market.
To show the extent of the damage, Families USA has drawn a map that shows, by congressional district, how many people in Georgia would lose their subsidies if the court eliminates them. (U.S. Rep. Rob Woodall’s District 7 has the most at-risk residents, 48,000.)
Here’s what could happen if subsidies vanish in federal exchange states like Georgia.
In Georgia, the average monthly premium for an individual with subsidized insurance is $73, versus $346 without a subsidy, according to a report by the Department of Health and Human Services (HHS). At the unsubsidized price, most people are likely to find that insurance premiums are unaffordable, and most of them would drop coverage and go back to being uninsured.
Without subsidies, many healthy people would find that the cost is too steep, and they would drop their insurance. Sicker and older people would also find the premiums are very high, but they would be less likely to end their coverage. The inevitable result is that insurance pools would disproportionately be filled with people needing significant care, rates would skyrocket, and an insurance “death spiral” would occur, causing premiums to continuously rise.
Hospitals and other health care providers would feel the weight of this as well. Estimates indicate that the millions who would become uninsured because of a ruling against the government would result in $12 billion in uncompensated care in 2016 alone.
With an adverse decision, we would be headed back to where we started before the ACA, when, according to the Census Bureau, nearly 45 million Americans – about 1.8 million in Georgia – went without health insurance, largely because they couldn’t afford it.
The people the ACA has helped know it has set this nation on the right course toward the goal of affordable, high-quality health care for all. It is imperative that the court recognize this too and uphold premium tax credit subsidies for residents of every state.
But if not, Congress must step in.
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