Later this month, millions of people could effectively lose their health insurance in one fell swoop.
The Supreme Court heard a challenge to the Affordable Care Act (ie: Obamacare) earlier this year, and the decision is coming in June. While it doesn’t have the obvious human interest of the court’s other big decision, on gay marriage, (that one, after all, is about love; this one’s about insurance), it’s actually a really huge deal.
Right now, the government gives subsidies to lots of people who buy insurance, whether they buy it through a federal marketplace or their state insurance exchange. Most of those people wouldn’t be able to afford it otherwise. But, the challengers here are arguing that only people who live in states with their own exchanges should get that help.
The caveat: Only 16 states (and D.C.) have those exchanges. That means this could leave residents of the 34 states that didn’t set up exchanges with crushing insurance bills for the insurance the ACA now requires.
How could this happen? It comes down to four words. One part of the bill says Obamacare can help out lower-income people who are buying insurance in “marketplaces by the state.” Federal officials have already admitted that the wording was a “drafting error” — that they obviously assumed all the states would have exchanges. But, that hasn’t stopped the challengers from saying, typo or not, the law needs to be read literally.
It’s not a small deal: 6.5 million people could lose financial help buying health insurance over that typo, and 9 million could end up uninsured.
President Obama’s healthcare law has faced opposition — from both Republicans and Democrats — since the very beginning. Republican opposition has remained fierce; the GOP-dominated Congress has tried to repeal the bill 60 times in the past five years. (Yes, 60.) The Supreme Court has already upheld the law against a different challenge in 2012.
Outside Congress, the law is actually working: Recent evidence has suggested that in the two years of the healthcare exchanges, the law has helped keep prices down and enrollment up, even if some have fallen off this year. A recent TIME poll found that it’s more popular than its ever been.
If the law loses, it’d be a major setback to President Obama, who made passing the 2010 law the centerpiece of his first term. It’s also not clear what would happen next. The ordinary solution to a ruling like this one would be for Congress to take up the bill again and pass an amendment to fix or clarify the typo. But, given how vehemently the party that controls Congress has been trying to kill Obamacare, a fix seems totally impossible. So far, as theHuffington Post reported Tuesday, Republicans in the House and Senate have not reached any agreement on what to do if the ACA gets dismantled.
The other big question critical to people who aren’t political junkies or court-watchers is what this will actually mean for anyone who doesn’t buy insurance through the exchanges. The whole law is based around the idea that if everyone has insurance, it won’t be as likely that uninsured people will have to seek medical care in emergency rooms or after becoming gravely ill, which can lead health care providers and insurers to charge more for everyone.
It’s impossible to predict exactly what will happen if the Supreme Court decides to gut the law, but it could leave millions without insurance and millions more struggling to afford it, which are serious consequences for a typo.
Date: June 8, 2015
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