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After Supreme Court upholds Affordable Care Act, here's how many people would have lost Obamacare

By Andrew Keshner

The high-stakes court decision ended in a 7-2 vote

The Supreme Court this week upheld the Affordable Care Act (link) in a vote of 7 judges to two judges.

The now-rejected legal challenge from Texas and 17 other Republican-leaning states said the entire Obama-era statute had to fall (link) because the mandate to take out insurance or pay a fee was unconstitutional. In 2017, Congress reduced the mandate's fee for people without insurance to $0. Obamacare also survived two previous Supreme Court decisions in 2012 and 2015.

So what was at stake? Approximately 31 million Americans can now exhale after Thursday's decision. That's the number of people who have coverage in some form or fashion under the 2010 Affordable Care Act, known as Obamacare, according to the U.S. Department of Health and Human Services.

The Urban Institute, an economic- and social-policy research organization in Washington, D.C., estimated that overturning the ACA would have left 21.1 million people uninsured, a 69% increase nationally. Those estimates are based on a projection of coverage and spending in 2022 that anticipates partial economic recovery from COVID-19.

Those people at risk of losing Obamacare would be located in the states where the health-care coverage was most widely adopted per capita. They include Maine, Kentucky, West Virginia, Montana, Michigan, and Pennsylvania. "Overall, un-insurance in the 37 states that expanded Medicaid eligibility under the ACA (including D.C.) will more than double," the Urban Institute said in a recent report. (link)

On Thursday, in California v. Texas, No. 19-840 (link), the Supreme Court's majority said the states didn't have standing (link)to question the ACA's validity. Separately, a group of attorneys general, led by the California attorney general, said that Obamacare was working effectively, given that the penalty was reduced to zero and, as such, they also argued that the "individual mandate" is separate from the workings of the law.

Significant changes

When enacted in 2010, the Affordable Care Act made several significant changes to the health insurance industry. It created new marketplaces for qualified health plans, it offered tax credits as subsidies for income-eligible people using those marketplace plans. It expanded Medicaid eligibility and also barred insurers from using pre-existing condition exclusions.

As of February, there were 11.3 million people enrolled in the marketplace plans, according to the Department of Health and Human Services (link). Approximately 1 million people are also enrolled in the ACA's Basic Health Program for income-eligible consumers. It also includes 14.8 million people with coverage via broadened Medicaid eligibility and around 4 million people who were already eligible for Medicaid, but gained coverage through outreach.

The Biden administration opened a special sign-up window through Aug. 15 to give people the chance to get coverage as the pandemic continued. More than 528,000 people signed up by April, according to the Associated Press. (link)

In the lead up to Thursday's ruling, Democratic-leaning states fighting to keep the law intact emphasized the stakes if the high court ripped up the entire statute. "States, health insurers, and millions of Americans rely on those provisions when making important -- indeed, life-changing -- decisions," those states, including California and New York, said in court papers.

Organizations filing briefs in support the law also emphasized the human aspect of the courtroom drama. For example, an amicus brief filed last year by groups like AARP, Justice in Aging and the Center for Medicare Advocacy said, "Health insurance is an essential part of people's lives, especially for those who have chronic illnesses. As a result, they cannot make informed life decisions while the legal viability of the ACA hangs in the balance."

-Andrew Keshner; 415-439-6400;


(END) Dow Jones Newswires

06-19-21 1013ET

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