A Huge Hit For Some States If SCOTUS Rules Against Obamacare

The Fiscal Times: “If the Court rules against the administration in the high-stakes case of King v. Burwell, an estimated 9.8 million could become uninsured in states that rely on the federal exchange,, says a new study from the Urban Institute and the Robert Wood Johnson Foundation (RWJF).”

“The report estimates that in the event of such a ruling, the 20 states that did not set up their own exchange or expand their Medicaid programs under the Affordable Care Act would lose an estimated $721 billion in federal funding over the next decade. The study said these 20 states would lose $41 billion in federal spending in 2016 for not expanding Medicaid, and another $21 billion would be lost if the federal subsidies stop flowing.”

“States that have not expanded Medicaid have the most to lose in the King v. Burwell decision if they are not already running their own marketplaces because people with incomes between 100 and 138 percent of the federal poverty level would not get any assistance in affording healthcare,’ the study said.”

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Skyrocketing Medicaid Signups: A Problem?

Politico: “More than 12 million people have signed up for Medicaid under the Affordable Care Act since January 2014, and in some states that embraced that piece of the law, enrollment is hundreds of thousands beyond initial projections. Seven states have seen particularly big surges, with their overruns totaling nearly 1.4 million low-income adults.”

“Some conservatives say the costs that will fall on the states are just too big a burden, and they see vindication in the signup numbers, proof that costs will be more than projected as they have warned all along.”

“Supporters of Obamacare say the enrollment surge might lead to some budget bumps down the road, but that the historic decline in the uninsured is a major achievement. In addition, they say the expansion is providing significant health and economic benefits to states that more than offset costs.”

Audrey Haynes, secretary of Kentucky’s Cabinet for Health and Family Services, has “strong words for the states that are shying away from enacting the Obamacare coverage expansion. Every state is tight on money, and people who say they can’t give health care to the poorest individuals either don’t understand the issue or it’s ‘political fodder.'”

When GOP Resistance to Obamacare Hurts Republicans

Greg Sargent in the Washington Post: “There’s been yet another twist in the seemingly endless battle over the Medicaid expansion in Florida: Rick Scott has now flatly stated that the GOP split over whether to accept it is probably going to cost the state its tax cuts and cost its students higher per-pupil spending.”

“It’s worth reiterating that Scott and state House Republicans want federal money for health care, but only if it’s not part of Obamacare, and this is what is putting all of these other GOP budgetary goals, including tax cuts, at risk. They’ve argued that the feds could reneg on their commitment to fund the Medicaid expansion, putting the state on the hook for it. But Senate Republicans counter that their expansion bill has explicitly been drafted to end the state’s participation if that happens.”

“Either way, this once again shows that the depth of GOP resistance — the determination to accept federal money for health care on the grounds that it isn’t Obamacare — runs so deep that Republicans are willing to sacrifice their other priorities to it.”

Obamacare Shows Signs of Achievement and Acceptance

Carl Leubsdorf in the Dallas News: “After a rough incubation, birth and infancy, the Affordable Care Act is a sturdy 5-year-old, showing increasing signs of achievement and acceptance.”

“Recent progress makes it much harder to justify contentions the controversial law is fundamentally unsound. The number of uninsured Americans has dropped dramatically, the rate of health care cost increases is trending down and some less-publicized, longer-term benefits are starting to show up.”

“When I covered Congress in the 1960s and 1970s, and even later, lawmakers from both parties worked with administrations on ‘technical corrections’ to fix inevitable problems in complicated laws.”

“In today’s hyper-partisan world, that’s largely impossible, though some things are happening: administration officials recently testified before a Senate committee where Republican Sen. Lamar Alexander of Tennessee and Democratic Sen. Patty Murray of Washington have created a working group to improve the health records system the law expanded.”

An Accurate Count of the Uninsured?

Health Affairs: “A May 5 government report claims that over 16 million Americans have obtained coverage as a result of the Affordable Care Act. This estimate, as well as others that are being or will soon be circulated, are based on rapid turnaround surveys conducted by telephone or over the web.”

“It is important to recognize that in the past such surveys have been shown to underestimate the number of people who lack coverage.”

“We will soon have estimates from sources using in-person interviews. These sources are likely to document a dramatic decrease in the number of Americans who lack health insurance. It is understandable that there is intense interest in results under the ACA, but caution is warranted in using results from the rapid turnaround surveys.”

“The ACA debate remains polarized; and those of us who support the law will not be helped by any research that is subsequently shown to have undercounted the uninsured and thus even moderately inflated the actual number of people who obtained coverage.”

“We might also consider allocating additional resources to strengthen and expedite the release of critical Government surveys that will help us better evaluate the ACA.”

Congress Exempt from Supreme Court Obamacare Ruling

Associated Press: “Members of Congress, staffers and dependents actually get their health insurance under a little-known provision of ‘Obamacare.’ But if the Supreme Court strikes down government health care subsidies for millions of people in more than 30 states, legal and benefits experts say coverage for lawmakers from those states won’t be affected.”

“It could be a politically painful unintended consequence.”

“‘Congress is covered under a completely different section of the Affordable Care Act,’ said Tim Jost, a law professor at Washington and Lee University in Virginia. ‘The provision for covering Congress is completely unrelated to income-based tax credits.'”

“And there’s a second reason why congressional coverage would be safe: The District of Columbia health insurance exchange that lawmakers and staff use is considered a state-run marketplace.”

“‘If King v. Burwell goes for the plaintiffs, 8 to 9 million people will lose coverage in 34 states, and their congressmen will continue to get coverage through the D.C. exchange,’ added Jost.”

GOP Defends Obamacare Against a Fellow Senator’s Attack

Politico: “One fellow senator calls David Vitter’s years-long crusade to scrap health care subsidies for lawmakers and their staffers ‘disingenuous.’ Another says it’s obviously being done ‘for political purposes.”

“Within the chummy confines of the U.S. Senate, Vitter has emerged as one of the most disliked members. The second-term senator’s effort to kill the federal health care contribution, worth several thousand dollars to lawmakers and their staffers, is a big part of it.”

“The most recent repudiation of Vitter … came a month ago in the Senate Committee on Small Business and Entrepreneurship, which he chairs. He tried to subpoena documents to investigate how members of Congress and their aides became eligible for health care under Obamacare’s D.C. exchange.”

How Obamacare Would Unravel if Supreme Court Rules Against Subsidies

The Hill: “The CEO of on Monday said states would not be able to immediately set up their own insurance marketplaces if the Supreme Court rules against ObamaCare this summer.”

“Kevin Counihan, the director of, told an audience at the National Health Insurance Exchange Summit that creating an exchange is a ‘very, very complex activity’ that could not be achieved in just a few months … ‘It would not be something that folks could do for this next open enrollment period.'”

“The federal marketplace director’s comments serve as a warning for Republicans who are working to draft a King v. Burwell response, which could give power to the states.”

“Many court watchers have said that states could be forced to set up their own exchanges if the justices decide that subsidies were not intended for people using That is even more likely if Republicans in Congress and President Obama can’t agree on a legislative fix to prevent 7.5 million people from losing their subsidies.”

Democrats Chastise Republicans on Blocking Obamacare Improvements

“Democrats are chiding Republican leaders in Congress as standing in the way of improvements to ObamaCare that enjoy bipartisan support,” The Hill reports.

“More than a half-dozen proposed changes to the law boast approval from at least some Democrats, including legislation to repeal a controversial cost-cutting board for Medicare, which gained its 218th cosponsor this week. None of the ObamaCare proposals have been taken up by Republican leaders, angering Democrats who say important fixes are being bottled up by the GOP’s fixation on full repeal.”

“Democrats are looking to take advantage of a deepening divide within the Republican Party about what to do with President Obama’s healthcare law during his final two years in office, particularly as they await a key ObamaCare decision from the Supreme Court.”

Americans Doubt Court Will Rule Fairly on Obamacare

“Many people in the United States doubt that the Supreme Court can rule fairly in the latest litigation jeopardizing President Obama’s health care law,” the Associated Press reports.

“An Associated Press-GfK poll found only one person in 10 is highly confident that the justices will rely on objective interpretations of the law rather than their personal opinions. Nearly half, 48 percent, are not confident of the court’s impartiality.”

“In a twist, the poll found that opponents of the law, who tend to be politically conservative, have less confidence in the objectivity of a court with a conservative majority. Among foes, 60 percent are not confident, compared with 44 percent of the law’s supporters.”

“Regardless of how the public feels about the court’s internal deliberations, a majority wants the justices to allow subsidies to continue flowing in all 50 states… Fifty-six percent said the court should keep the subsidies without restriction, while 39 percent said the financial aid should be limited to residents of states that set up their own health insurance markets.”

Obamacare’s Role in Changing Health Insurance

David Diamond, in Forbes, comments on the recent RAND study that shows that nearly 22.8 million people have gained health insurance since the launch of Obamacare.

“On the one hand, RAND’s data is an extremely valuable barometer of how Obamacare appears to be playing out after a turbulent few years that redefined how Americans get health coverage.”

“But at the same time, the numbers aren’t quite ironclad. The data has several significant limitations — the authors even acknowledge this — including a fairly low response rate … RAND also admits that some survey respondents might have mis-stated their source of coverage.”

“So while RAND’s data is helpful, it’s important to keep in mind: The findings are more gestural than definitive. Don’t be surprised when these numbers get revised in future surveys.”

“While nearly 20 million of those people remain uninsured, the rest of them have since obtained coverage, RAND researchers found, and I’ve graphed out those changes below:”


Karl Rove: It’s Time to End Calls of Repealing Obamacare

Karl Rove in the Wall Street Journal: “If the Supreme Court holds in King v. Burwell that the Affordable Care Act—also known as ObamaCare—does not allow subsidies for health coverage to flow through federal insurance exchanges, Republicans better be ready to say what to do next.”

“President Barack Obama will then accuse conservative justices of overreaching and demand that the GOP Congress immediately extend subsidies to every state. His message will be politically potent, as it will turn the words of Republicans in 2013 back on them: ‘If you like your plan,’ Republicans said, ‘you should be able to keep your plan.’ Hillary Clinton will join in depicting Republicans as heartless brutes who would let people die for lack of health insurance rather than fix Mr. Obama’s law.”

“Some Republicans may insist on simply repealing ObamaCare. But doing this would chew up valuable time and give the president a veto opportunity he relishes. For now, Republicans should focus on putting Mr. Obama on the defensive with a proposal that makes sense to Americans.”

Study: 17 Million Gained Coverage Under Obamacare

The Hill: “Around 17 million people have gained health insurance since the core of ObamaCare took effect in 2013, according to a RAND Corporation study released Wednesday. ”

“The study finds that 22.8 million people signed up for coverage between September 2013 and February 2015, while 5.9 million lost coverage, leading to a net gain of 16.9 million.”

Fewer Americans are uninsured

“While there was much concern about plans being cancelled because of ObamaCare, the study notes that the number of people losing coverage was close to the same level it was before ObamaCare.”

“’We found that the vast majority of those with individual market insurance in 2013 remained insured in 2015, which suggests that even among those who had their individual market policies canceled, most found coverage through an alternative source,’ the study states. Still, it finds that 600,000 people who had individual market coverage before ObamaCare ended up uninsured.”

L.A. Times: “The biggest growth has been in the marketplaces created by the law, which now have about 11 million adult customers, about a third of whom were uninsured in 2013, according to the study.”

“Employer coverage was the biggest source of new coverage for previously uninsured people, the study found.”