![\"Protesters](\"https:\/\/i0.wp.com\/www.dougsbriefcase.com\/blog\/wp-content\/uploads\/2015\/03\/credit-AP.jpg\")
<\/a>Pro\u00adtest\u00aders gath\u00adered out\u00adside the Supreme Court yes\u00adter\u00adday as judges heard argu\u00adments over the legal\u00adi\u00adty of Oba\u00admacare sub\u00adsi\u00addies. [Cred\u00adit: AP<\/span>]<\/p><\/div>The future of Oba\u00admacare hangs on the Supreme Court\u2019s rul\u00ading in King v. Bur\u00adwell<\/em> for a very good rea\u00adson: unless health insur\u00adance is sub\u00adsi\u00addized, mil\u00adlions of Amer\u00adi\u00adcans don\u2019t want it, even if they can afford it.\n The Supreme Court heard oral argu\u00adments on the case yes\u00adter\u00adday. They are expect\u00aded to announce their deci\u00adsion at the end of June. Plain\u00adtiffs, cit\u00ading the text of the statute, con\u00adtend that sub\u00adsi\u00addies can only be paid to peo\u00adple who have enrolled in cov\u00ader\u00adage through an \u201cexchange estab\u00adlished by the state<\/a>.\u201d Just 12 states and the Dis\u00adtrict of Colum\u00adbia oper\u00adate their own exchanges. The Admin\u00adis\u00adtra\u00adtion argues that, regard\u00adless of what the law actu\u00adal\u00adly says, the IRS<\/span> has pow\u00ader to dis\u00adpense tax cred\u00adits and exact tax penal\u00adties in the 37 states that have not estab\u00adlished their own exchanges.<\/p>\n As of mid-Jan\u00adu\u00adary, an esti\u00admat\u00aded 6.2 mil\u00adlion<\/a> peo\u00adple had been deter\u00admined eli\u00adgi\u00adble for sub\u00adsi\u00addies for cov\u00ader\u00adage they select\u00aded through fed\u00ader\u00adal exchanges. If the plain\u00adtiffs pre\u00advail, these sub\u00adsi\u00addies would no longer be avail\u00adable, cre\u00adat\u00ading con\u00adsid\u00ader\u00adable dis\u00adrup\u00adtion for mil\u00adlions of peo\u00adple and polit\u00adi\u00adcal crises for Gov\u00ader\u00adnors, Con\u00adgress and the President.<\/p>\n Those who lose their sub\u00adsi\u00addies could, of course, con\u00adtin\u00adue to obtain cov\u00ader\u00adage through fed\u00ader\u00adal exchanges. That would mean pay\u00ading their own pre\u00admi\u00adums with\u00adout help from the gov\u00adern\u00adment, impos\u00ading a hard\u00adship on many. The aver\u00adage month\u00adly pre\u00admi\u00adum for a sil\u00adver plan for a 40-year-old non-smok\u00ader is $276<\/a>,<\/span> accord\u00ading to the Kaiser Fam\u00adi\u00adly Foun\u00adda\u00adtion. A bronze plan can be had for less ($213), but requires more cost-sharing.<\/p>\n Those with seri\u00adous med\u00adical con\u00addi\u00adtions might try to find a way to pay their pre\u00admi\u00adums any\u00adway, giv\u00aden the cost of their treat\u00adment. But most like\u00adly would not.<\/p>\n Among the more sur\u00adpris\u00ading devel\u00adop\u00adments of Obamacare\u2019s imple\u00admen\u00adta\u00adtion has been this: many unin\u00adsured peo\u00adple who can afford cov\u00ader\u00adage don\u2019t want it. In the first year, mil\u00adlions of peo\u00adple who could have bought insur\u00adance chose not to, once they learned that tax\u00adpay\u00aders wouldn\u2019t help pay their pre\u00admi\u00adums. There appears to be a lot less demand for health insur\u00adance than Wash\u00ading\u00adton pol\u00adi\u00adcy\u00admak\u00aders imagined.<\/p>\n Under the health care law, indi\u00advid\u00adu\u00adals and fam\u00adi\u00adlies whose earn\u00adings are less than four times the pover\u00adty lev\u00adel are eli\u00adgi\u00adble for sub\u00adsi\u00addies. In most states, the medi\u00adan income is below that lev\u00adel, which means that most house\u00adholds qual\u00adi\u00adfy for sub\u00adsi\u00addized cov\u00ader\u00adage. A fam\u00adi\u00adly of three, for exam\u00adple, would receive sub\u00adsi\u00addies unless their income exceed\u00aded $80,360<\/a>. That is high\u00ader than the medi\u00adan income for a three-per\u00adson house\u00adhold in all but two states<\/a> that use the fed\u00ader\u00adal exchange (New Hamp\u00adshire and New Jersey).<\/p>\n And yet, dur\u00ading the 2014 open sea\u00adson<\/a>,<\/span> few\u00ader than 800,000 of the near\u00adly 3.4 mil\u00adlion peo\u00adple who were deter\u00admined eli\u00adgi\u00adble to buy cov\u00ader\u00adage but inel\u00adi\u00adgi\u00adble for gov\u00adern\u00adment assis\u00adtance signed up (click on chart below to enlarge<\/em>). Put anoth\u00ader way, more than 2.6 mil\u00adlion peo\u00adple \u2013 78 per\u00adcent of those whose earn\u00adings dis\u00adqual\u00adi\u00adfied them from gov\u00adern\u00adment assis\u00adtance \u2013 decid\u00aded to remain unin\u00adsured rather than pay an unsub\u00adsi\u00addized premium.<\/p>\n The take-up rate was much high\u00ader among those eli\u00adgi\u00adble for pre\u00admi\u00adum assis\u00adtance. Near\u00adly 4.7 mil\u00adlion of the 6.1 mil\u00adlion who qual\u00adi\u00adfied for sub\u00adsi\u00addies select\u00aded a plan. Their take-up rate of over 76 per\u00adcent was almost the exact inverse of the rate for those who didn\u2019t qual\u00adi\u00adfy for tax-sub\u00adsi\u00addized help \u2013 3 out of 4 peo\u00adple who qual\u00adi\u00adfied for sub\u00adsi\u00addies signed up; 3 out of 4 who did not qual\u00adi\u00adfy for sub\u00adsi\u00addies refused coverage.<\/p>\n The expe\u00adri\u00adence so far this year has been a bit dif\u00adfer\u00adent, with take-up rates ris\u00ading both for those who get assis\u00adtance (90 per\u00adcent) and those who do not (64 per\u00adcent). The num\u00adber of peo\u00adple who select\u00aded a plan with sub\u00adsi\u00addized cov\u00ader\u00adage already has risen sharply (from near\u00adly 4.7 mil\u00adlion to more than 6.2 mil\u00adlion) with a month still remain\u00ading in open season.<\/p>\n The sto\u00adry is quite dif\u00adfer\u00adent for those inel\u00adi\u00adgi\u00adble for assis\u00adtance. Plan selec\u00adtions among this group have risen only slight\u00adly. What is more strik\u00ading is that only 1.5 mil\u00adlion appli\u00adcants so far have been found inel\u00adi\u00adgi\u00adble for sub\u00adsi\u00addies. That is less than half last year\u2019s total of 3.4 mil\u00adlion sim\u00adi\u00adlar\u00adly sit\u00adu\u00adat\u00aded appli\u00adcants. It is as though peo\u00adple who didn\u2019t qual\u00adi\u00adfy for sub\u00adsi\u00addies last year did\u00adn\u2019t even both\u00ader to shop on the exchange this time around.<\/p>\n It should be not\u00aded that the 2015 fig\u00adures are still pre\u00adlim\u00adi\u00adnary, run\u00adning only through Jan\u00adu\u00adary 15. Open sea\u00adson did not con\u00adclude until Feb\u00adru\u00adary 15. It is pos\u00adsi\u00adble that the num\u00adbers changed sub\u00adstan\u00adtial\u00adly over that last month. CMS<\/span> also has decid\u00aded to hold anoth\u00ader open sea\u00adson<\/a> on the fed\u00ader\u00adal exchange that will run from March 15 through April 30. This \u201cspe\u00adcial enroll\u00adment peri\u00adod\u201d will give peo\u00adple who refused cov\u00ader\u00adage in 2014 one last chance to sign up in 2015 and may pro\u00adduce some inter\u00adest\u00ading results.<\/p>\n Sec\u00adond\u00adly, I\u2019ve looked only at data from the fed\u00ader\u00adal exchanges. So far this year, state exchanges have pub\u00adlished very lit\u00adtle infor\u00adma\u00adtion. Cal\u00adi\u00adfor\u00adnia, Col\u00adorado and Mass\u00ada\u00adchu\u00adsetts, for exam\u00adple, haven\u2019t report\u00aded the num\u00adber of sub\u00adsidy-eli\u00adgi\u00adble peo\u00adple who have select\u00aded a plan. State exchanges are, in any event, less a con\u00adcern, since sub\u00adsi\u00addized cov\u00ader\u00adage will con\u00adtin\u00adue to be avail\u00adable there regard\u00adless of what the Supreme Court decides.<\/p>\n The same can\u2019t be said for fed\u00ader\u00adal exchanges. Mil\u00adlions of peo\u00adple who pre\u00adsum\u00adably can afford their own cov\u00ader\u00adage with\u00adout gov\u00adern\u00adment aid (those with incomes more than four times the fed\u00ader\u00adal pover\u00adty lev\u00adel) have cho\u00adsen to remain unin\u00adsured. Those for whom such pre\u00admi\u00adums would pose finan\u00adcial stress almost cer\u00adtain\u00adly would let their cov\u00ader\u00adage lapse, engen\u00adder\u00ading a polit\u00adi\u00adcal conundrum.<\/p>\n Gov\u00ader\u00adnors of the 37 affect\u00aded states will be under pres\u00adsure to keep sub\u00adsi\u00addies flow\u00ading by estab\u00adlish\u00ading state exchanges. Some will resist that pres\u00adsure. The House Repub\u00adli\u00adcan cau\u00adcus, which last Fri\u00adday frac\u00adtured over a rel\u00ada\u00adtive\u00adly rou\u00adtine bill to pro\u00advide three weeks of fund\u00ading for the Home\u00adland Secu\u00adri\u00adty Depart\u00adment, will strug\u00adgle to reach con\u00adsen\u00adsus on much more com\u00adplex health leg\u00adis\u00adla\u00adtion. Some Repub\u00adli\u00adcans will be hap\u00adpy that the sub\u00adsi\u00addies have been inval\u00adi\u00addat\u00aded and will oppose efforts to \u201cfix\u201d Oba\u00admacare. Oth\u00aders will advance com\u00adpet\u00ading plans to pro\u00advide mod\u00adi\u00adfied forms of pre\u00admi\u00adum assis\u00adtance and repeal some of the law\u2019s man\u00addates. Even if Repub\u00adli\u00adcans were to ral\u00adly around a sin\u00adgle pro\u00adpos\u00adal, the Pres\u00adi\u00addent may very well rather have mil\u00adlions of peo\u00adple lose their cov\u00ader\u00adage than com\u00adpro\u00admise with Congress.<\/p>\n Still, com\u00adpro\u00admise is not out of the ques\u00adtion. Democ\u00adrats have large\u00adly acknowl\u00adedged that the law is flawed. Were the Supreme Court to declare most of its sub\u00adsi\u00addies ille\u00adgal, those flaws would cry out for atten\u00adtion. Many Repub\u00adli\u00adcans, though implaca\u00adble in their oppo\u00adsi\u00adtion to Oba\u00admacare, have embraced some of its goals. Vir\u00adtu\u00adal\u00adly every\u00adone believes that peo\u00adple with seri\u00adous med\u00adical con\u00addi\u00adtions should have access to afford\u00adable health insur\u00adance and that low-income peo\u00adple with\u00adout access to job-based cov\u00ader\u00adage should get some help in insur\u00ading them\u00adselves and their families.<\/p>\n Should the high court rule in favor of the plain\u00adtiffs, it would present Con\u00adgress and the Pres\u00adi\u00addent with that rarest of oppor\u00adtu\u00adni\u00adties: a do-over, a chance to replace a health care law that has riv\u00aden the coun\u00adtry along par\u00adti\u00adsan and ide\u00ado\u00adlog\u00adi\u00adcal lines with one that would gar\u00adner at least some degree of bipar\u00adti\u00adsan consensus.<\/p>\n Judg\u00ading from reports of yes\u00adter\u00adday\u2019s oral argu\u00adments, at least four jus\u00adtices doubt the capac\u00adi\u00adty of the Pres\u00adi\u00addent and Con\u00adgress to achieve such con\u00adsen\u00adsus. That leaves the out\u00adcome of the case to Chief Jus\u00adtice Roberts and Jus\u00adtice Kennedy. One or both may decide that it is bet\u00adter in the cur\u00adrent envi\u00adron\u00adment to let the IRS<\/span> effec\u00adtive\u00adly rewrite tax law than to affirm the con\u00adsti\u00adtu\u00adtion\u00adal axiom<\/a> that Con\u00adgress alone holds the pow\u00ader to legislate.<\/p>\n If the Court grants the IRS<\/span> such extra-con\u00adsti\u00adtu\u00adtion\u00adal pow\u00ader, it will be Oba\u00admacare\u2019s most con\u00adse\u00adquen\u00adtial and endur\u00ading deformation.<\/p>\n <\/p>\n","protected":false},"excerpt":{"rendered":" The future of Oba\u00admacare hangs on the Supreme Court\u2019s rul\u00ading in King v. Bur\u00adwell for a very good rea\u00adson: unless health insur\u00adance is sub\u00adsi\u00addized, mil\u00adlions of Amer\u00adi\u00adcans don\u2019t want it, even if they can afford it.<\/p>\n","protected":false},"author":3,"featured_media":3314,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","wp_typography_post_enhancements_disabled":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"nfd_image_url":"","nfd_onboarding_generated":"","footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[16,124],"tags":[51,1121,119,623,1008,1190,1192],"class_list":["post-3308","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-care","category-obamacare","tag-cms","tag-exchange","tag-health-insurance","tag-health-insurance-exchanges","tag-king-v-burwell","tag-president-obama","tag-supreme-court"],"aioseo_notices":[],"aioseo_head":"\n\t\t\n\t\n\t\n\t\n\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t\n\t\t<\/a><\/p>\n