This week, the Open Enrollment Period for Health Insurance will begin and millions of Americans will have the opportunity shop and buy plans offered via the Affordable Care Act. However, last week, as reported by just about every major and minor media outlet nationwide, the Democratic Party lost control of the Senate and with it, the Republicans now control both Houses of the U.S. Congress. And as you can guess by the anger expressed through months and months of campaigning and more than 50 grand-scale yet pointless votes to repeal, the Republican-controlled House and Senate will undoubtedly have their sites set on the Affordable Care Act and destroying the law as we know it. Every newly elected Republican promised it. Every re-elected Republican voted for it. Now, with control of the senate, they will indeed make it a priority to go after the law anew.
To make matters even more grim, the United States Supreme Court has decided to hear the appeal of King vs Burwell, which will challenge the integrity of the Affordable Care Act, which could do what Congress was never able to do; kill the Affordable Care Act. Not to delve too much in the legalize, but what King v Burwell is challenging is the wording of the law, saying that it does not specifically state that the Advanced Premium Tax Credit, which is largely responsible for making the Affordable Care Act affordable, should be offered to states that do not have a state-run Marketplace or Health Insurance Exchange. In other words, as it was written, the lawsuit is challenging the government’s authority to distribute tax credits to those who enrolled in federally facilitated marketplaces. As of now, 14 states made the decision to establish their own marketplace with which insurance carriers would offer plans that the government would provide tax credits for. The 36 states that chose not to set up a marketplace had one set up and facilitated by the federal government. Although these 36 federally facilitated exchanges are collectively known as the Federal Exchange, carriers and plans themselves vary greatly from state to state and even from zip code to zip code, depending or numerous factors like household size, age, income and gender. So these marketplaces are indeed specific to each state. However, the lawsuit says that the framers of the Affordable Care Act intentionally wrote the law to give the government the authority to ONLY offer the tax credit to marketplaces “established by a state.”
So, if the U.S. Supreme Court were to rule in favor of King v Burwell, then the Advance Premium Tax Credit can no longer be offered to consumers in the 36 states that do not have a state-run Health Insurance Exchange. This will cause approximately 4 million of the 7 million consumers currently receiving a tax credit, to no longer have it and their monthly premiums will increase. Those once affordable monthly premiums will no longer be affordable and thus, likely to be cancelled. If those plans are cancelled, this sudden rise in premiums and resulting dropping of plans would destabilize a frightened insurance market, which could cause premiums to rise outside of federally facilitate marketplaces, which could force millions more to drop their coverage as well. All of this is a side effect of what the Supreme Court could do to the Affordable Care Act. If those premiums cannot be given, then the funding formula for the entire law will collapse, which will in essence kill the bill.
However, this entire scenario can be avoided. The same Republican Congress that controls both Houses, that has also voted to repeal the Affordable Care Act more than 50 times have the ability to pass a law correcting the language of the bill, which would render a decision by the Supreme Court moot. In the same vain, that very Supreme Court could also decide to accept the decisions of lower courts and the IRS, which responsible for interpenetrating the law and agree the government has the authority to give tax credits to the 4 million Americans in 36 states that are currently receiving them. But in the case it isn’t avoided, in the case the Supreme Court rules against the government and congress decides not to fix the wording of the law, and millions end up losing health care, what will be the narrative given to the nation? Will Republicans gamble on the gullibility of the American public and expect them to believe that millions lost their health insurance due to Democratic incompetence of writing, passing and executing the law? Or will Democrats be able to convince America that Republicans, who could have acted, allowed the health care of million to slip right through their fingers and cause these Americans to go uninsured?
It’s an easy narrative to tell. Almost as easy as the successes of the bill and what it has given to millions of Americans already. The rate of increase of health insurance premiums have been slowed nationwide. Gallup has released a poll stating that 90% of those who have purchased a plan on the marketplaces have described their coverage as good, fair or excellent. The number of uninsured has gone down 25% this year alone. 8.7 million have received coverage through the Medicaid Expansion, while as mentioned earlier, 7.3 million have received coverage through state or federally facilitated marketplaces. The Congressional Budget Office has reaffirmed it’s prediction that the Affordable Care Act will cut the deficit by $124 billion in the first decade alone. More than 80% of consumers buying plans on the marketplaces were eligible for a subsidy and those plans purchased have cut the cost of health insurance by an average of 76% to an average of $82 per month. The numbers don’t lie. It has made health care affordable AND accessible for millions. Understandably, not all have been helped. Some hurt. There are winners and losers in every system in any system, but if Republicans are going to bank on these winners to blame Democrats once they’re forced to become losers, then the real losers will be the Republican Party. Allowing these millions of Americans that have tangible benefits from the Affordable Care Act to lose that benefit could potentially jeopardize the electability of Republican candidates. They have the chance to literally save the lives of thousands and to reap a share of those successes only their Democratic counterparts can tell. Or they can continue down the same path they started with irrelevant votes to repeal, passing no plan to replace and government shutdowns that does far more damage than they even realize. Good luck with that. You’ll reap what you sow.