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Health careCharlotte Observer reporter Ann Doss Helms makes things perfectly clear this morning just how big the stakes will be this week when the U.S. Supreme Court hears the King v. Burwell case challenging the lawfulness of Affordable Care Act health insurance subsidies in states like North Carolina.

“More than 500,000 North Carolinians stand to lose subsidized health coverage based on a challenge to the Affordable Care Act that goes to the U.S. Supreme Court this week.

Also at stake is the financial stability of the insurance companies, medical professionals and others that have come to count on the federal money the act provides to help low- and moderate-income people who don’t have workplace health coverage.”

And as was explained in last week’s N.C. Policy Watch Weekly Briefing, that could be just the beginning of our problems if the Court opts to provoke a crisis because of what amounts to a typo.

Fortunately, congressional Republicans have a contingency plan if the Court really issues such a terrible ruling…NOT. As Ezra Klein argues this morning on Vox, Congress isn’t at all likely to be able address the crisis if the Court sets it in motion:

“If the Court rules against the Obama administration, the outcome is perfectly predictable: nothing will happen. Some Republicans will come up with some plan to gut Obamacare that the Obama administration could never accept. The Obama administration will ask Republicans to simply fix the law, which they’ll never do. The two sides will blame each other just as always happens, and their attached partisans will think their side has the better of the argument, just as always happens. We have seen this movie before.”

Let’s fervently hope, however, that the Court does the right thing and if it doesn’t, Klein is wrong.

News

Supreme courtIn case you missed it yesterday, be sure to check out this article by NC Policy Watch’s Sharon McCloskey about North Carolina’s support for the provision of subsidies to low-income residents purchasing Obamacare.

Last week, Attorney General Roy Cooper signed on to a brief, on behalf of North Carolina, supporting these subsidies for low-income enrollees on the federal exchange.

In a number of lawsuits filed in federal courts, ACA opponents have argued that the law as written limits those subsidies to those who purchase on a state exchange and not, as interpreted by the Internal Revenue Service, to purchasers on either a state or federal exchange.

That interpretation would exclude North Carolinians, as well as the residents of the 33 other states in which governors opted to join the federal exchange rather than construct one of their own, from receiving the aid.

The lawsuit has been through several appeals and will now be heard by the U.S. Supreme Court on March 4th.

Twenty-two other states also signed the brief and collectively argue that a challenge to the subsidies should be rejected because they weren’t informed that residents of their state would be harmed if the state chose to use the federal exchange.

Most experts agree that a decision limiting subsidies to purchasers on state exchanges would cripple Obamacare.

The non-partisan Urban Institute projects that in 2016, the loss of subsidies in the 34 states using the federal exchange would deprive more than 9.3 million Americans of almost $29 billion in financial assistance — an average of $3,090 per eligible person — and increase the number of uninsured by about 8.2 million people nationally.

To read the full article, visit Policy Watch’s main page here.

Commentary

NC Left Me OutA group of coalition partners working in North Carolina to close the Medicaid coverage gap has launched a new website called NC Left Me Out to collect stories of people who make too much for Medicaid and too little for private insurance. As the website explains, the Affordable Care Act specifically allocated funds to provide affordable insurance coverage to approximately 500,000 people in our state. Unfortunately, the Governor and the legislature have blocked those funds from coming to North Carolina. Many of the individuals and families who could use this money to get insurance coverage work in low-wage professions like construction, day care, and food service.

At a press conference today Dana Wilson, a woman in the coverage gap who suffers from MS, shared her story. You can watch her video here.

The legislature and the Governor need to hear from more people like Dana, the working poor who are being unfairly denied coverage. If you are in the coverage gap please consider sharing your story on the NC Left Me Out website. If you want to support the campaign then you can sign up as well.

Every week a new Governor shows the leadership to formulate a plan for extending insurance coverage to people in the Medicaid gap. Last week the conservative state of Indiana had a plan approved. States like Wyoming and Utah are moving forward with similar ideas. We need Governor McCrory to show us his plan for closing the coverage gap. He has publicly hinted that he wants to design a state-specific Medicaid waiver. Great, let’s get moving. Every day that we wait is another day people like Dana suffer.

We need to continue telling our stories to the media, to legislators, and to the Governor. If the economic arguments and moral arguments don’t win the day, maybe looking into the eyes of those who have been denied coverage will begin changing minds.

News
(Graphic: Center for American Progress)

(Graphic: Center for American Progress)

Things at the U.S. Supreme Court may seem a bit quiet right now, with conferences and oral arguments not scheduled to start up again until later in the month, but don’t let that lull you into a sense of calm.

Once the justices reconvene, all hell could break loose, with same-sex marriage, Obamacare, lethal injection and redistricting among the issues being reviewed.

“The term went from being one of the more uneventful terms in recent years to potentially one of the biggest ones in a generation,” SCOTUSblog editor Amy Howe said.

For a look at what big issues have been argued and decided as well as what’s in queue, read the update by CNN’s Ariane de Vogue here.

Commentary

We have written before about King v. Burwell, the case that will be heard before the US Supreme Court to determine whether or not health insurance subsidies can flow to states that refused to establish state-based marketplaces under the Affordable Care Act. As John Stewart has noted, justices would have to be more literal than Amelia Bedelia to find for the plaintiffs, but we live in strange times where anything seems possible.

The next question then is if the Supreme Court strikes down subsidies how many people would it impact? Now Kaiser Family Foundation has a helpful interactive map to estimate an answer. KFF researchers think more than 13 million people nationally, and about 1 million people in North Carolina, would lose tax credits if the Supreme Court denies subsidies to federal marketplace states. For most of these folks insurance would immediately become unaffordable. This is especially true because prices would most likely spiral upward as younger, healthier enrollees lose coverage.

That is a stunning figure. It would be like the Supreme Court cutting the number of North Carolinians receiving Medicare in half.

The cruel truth is that Congress could easily fix this problem by adding a few words to the Affordable Care Act, but they are so obsessed with repealing the legislation that they are unlikely to repair it. The state legislature could also provide a patch by at least establishing a governance structure for a state-based marketplace, but they are also unlikely to move. After all, the federal government stands ready to pay the state to expand insurance to 500,000 more state residents and that hasn’t gained any legislative traction.

So, we wait, while medical care for 1 million North Carolinians hangs in the balance.