If the Supreme Court rules against Obamacare in King v. Burwell — an impending challenge to the law that could eliminate the tax subsidies currently helping millions of Americans afford their insurance plans — many people who live in GOP-controlled states could be left scrambling.
That’s because the people who currently rely on subsidies to help them pay for plans purchased on Obamacare’s federal marketplaces are more highly concentrated in red states, according to the latest report from the U.S. Department of Health and Human Services, which provides the most accurate snapshot so far of Obamacare enrollment.
Across the country, about 10.2 million people are covered under plans that they purchased through Obamacare’s marketplaces, according to HHS officials. And about 6.4 million of those Americans are potentially at risk of losing their access to affordable insurance, depending how the justices rule on King v. Burwell, since they’re currently relying on subsidies in a state with a federally-run marketplace.
Mississippi, Florida, and North Carolina are home to the highest percentage of enrollees whose insurance hangs in the balance. In each of those red states, at least 65 percent of the people covered under plans on the marketplace could lose financial assistance if the Supreme Court sides with the plaintiffs in the case.
The plaintiffs in King v. Burwell argue that the Affordable Care Act was written in a way that only allows subsidies to be extended to states that set up their own insurance marketplaces under the law. That would wipe out tax subsidies in 34 states that refused to create their own marketplaces, instead defaulting to federally-run insurance exchanges. For Republicans opposed to the law, the looming ruling presents yet another avenue to deal a serious blow to Obamacare, which has already survived a Supreme Court challenge.
Ironically, however, the nature of the political fight over Obamacare ensures that the 34 states at risk are more likely to be GOP-controlled. Refusing to set up a state-run marketplace is one of many ways that Republican lawmakers have declined to participate in implementing a health care reform law that they bitterly oppose.
Plus, the states whose political leaders have refused to embrace Obamacare are the same ones that have benefited from health reform the most. Those states had higher uninsurance rates to begin with, and they’re home to people who tend to be poorer and sicker than the residents in other states. It’s perhaps no surprise, then, that enrollment in those areas has been booming since Obamacare’s marketplaces first opened for business.
Some deeply red counties in Florida for instance, boast the highest Obamacare enrollment numbers in the entire country. According to a Politico analysis of HHS data, the top ten counties in terms of enrollment are all in South Florida.
But a ruling in favor of the law’s opponents would undo that progress. “There’s a lot of folks who took advantage of the marketplace and are now potentially going to be impacted tremendously by the case if goes the other way,” Nicholas Duran, the Florida state director for Enroll America, a nonprofit organization aligned with the White House that’s been helping people sign up for Obamacare plans, told Politico this week.
The people who live in these areas don’t fit the typical profile of an Obama supporter. In fact, according to a recent report from the Urban Institute, the demographics of the Americans who could be negatively affected by the King v. Burwell case look a lot like the GOP base: Southern, white, employed, and lower middle-class.
Nonetheless, there’s no telling what will happen if the Court rules against Obamacare and all of those people see their annual premiums skyrocket by hundreds or even thousands of dollars. Just this week, House Republicans confirmed that they still do not have a contingency plan in case the justices strike down subsidies in two-thirds of states, despite the fact that the highly-anticipated ruling could come this month. In general, Obamacare opponents in Congress have struggled to coalesce around any consistent health care policy.