Mazel Tov, GOP: Winning King v. Burwell will screw your base while helping those you hate!

A little while ago, Greg Sargent of the Washington Post asked the following via Twitter:

Serious Q for wonks: If O'care expanded coverage by 16 million, & SCOTUS guts 5 million, Ocare still covering over 10 million, right?

— Greg Sargent (@ThePlumLineGS) April 16, 2015

As I recently noted, I actually question the 16 million number; by my count it's actually more realistically like 14-15 million, so there's that.

I also noted in response that the fallout of the plaintiffs winning King v. Burwell will cause a lot more than 5 million people to lose their healthcare coverage. Technically speaking, here's the hard numbers:

  • Around 12 million people are currently enrolled via the exchanges nationally
  • Of those, around 10.1 million should actually have effectuated policies throughout the summer/fall of 2015 (i.e. with active enrollments at that time). This is important because the SCOTUS decision comes out in June, so any potential impact would presumably start as of July unless they issue a stay, as Alito suggested.
  • Of those, roughly 76% should be enrolled via the federal exchange (7.7 million), and of those, around 87% will be receiving tax credits as of July, or about 6.7 million.
  • Assuming that NM, OR & NV are "in the clear" for federal subsidies (and this still isn't clear), you'd have to subtract around 175K from the total; call it 6.5 million who would actually lose their federal tax credits.
  • Of those, let's assume that perhaps a 5% are at the upper end of the tax credit limit and are therefor only receiving nominal credits (say, $30 or less per month). For those folks, losing these credits, in and of itself, would be annoying but hardly devastating; I have to imagine they won't drop their coverage if that was the only change (which it isn't, but I'll get to that in a moment).

So, we're talking about perhaps 6.2 million people who would be directly screwed, in that they're of limited means and their insurance premiums just got jacked up by a good $300/month or more (yes, the overall average is $263/month, but remember that I've already subtracted out those at the upper end of the income range who would only lose $30/month or so). Direct effect: Every damned one of them would probably have to drop their policy entirely.

HOWEVER, remember that the premiums for those 6.2 million as well as the other 1.3 million people in those 34 states via would, as a result, shoot up a good 35% or more.

Now, some of those 1.3 million who are receiving no credits at all (or only nominal ones) would presumably stick it out by either keeping their current policy or moving down the ladder (from Gold to Silver, Silver to Bronze or whatever), but it's safe to say that most of them would also have to drop their coverage as well. Let's call it an even 1 million.

That brings the tally to around 7.2 million so far, leaving perhaps a half a million left in their policies in those 34 states when the dust settles.


As I also noted last month, the millions of people who enrolled in the same/similar policies OFF of the exchanges...directly through the insurance companies...would also face the same 35%+ premium increases. Assuming a similar 76% or so are in the 34 states in question, that's likely around 6 million people.

These people are in the same boat as the 13% of exchange enrollees who aren't receiving credits anyway: They have a considerably higher income, but a 35% price hike is several hundred dollars per month on average; that'd sting for anyone below the $250K+ line, which is practically everyone.

Just like the exchange QHP enrollees, some percent of those 6 million or so off-exchange enrollees won't pay, and there is a lot of churn/attrition throughout the year, so let's figure that perhaps another 5 million of these folks will be actively enrolled in off-exchange QHPs in the same risk pool as the exchange-based ones by July. How many of these people will be forced into dropping their policies? Hard to say, but if 20% of them drop coverage (1 million), that would line up perfectly with this estimate by the Urban Institute which pegs the total number (including both on- and off-exchange enrollees) at around 8.2 million people losing their coverage.

Meanwhile, the remaining 4-5 million still enrolled in their policies (half a million via, another 4 million or so off-exchange) will remain covered...but at a dramatically higher price. Thanks, Republicans!!

OK, so 8.2 million working class / middle class Americans will lose their coverage. That still leaves a net gain of 7 million or so, right?

Well, sure...assuming, that is, that you consider people on Medicaid to be human beings.

Yes, of course I do, and it's shocking that the clarifier above needs to be stated at all, but for a lot of Republicans, "...but almost all of the gain is thanks to Medicaid!!" seems to be a rallying cry that they use to suggest that people on Medicaid "don't count" or are some sort of anomaly.

Why? Because to (many) in the GOP, Medicaid is for Poor Lazy America-Hating Moocher-Takers, paid for by Hard-Working God-Fearing Tax-Paying Patriotic People, bla bla bla. As such, they Don't Count® as being "newly insured" because of course they don't.

It reminds me of all the people who, after Barack Obama crushed John McCain in 2008 (70 million to 60 million), said that he "only won" because "so many Black people voted". As if this somehow makes his winning the Presidency with more votes than any other candidate in history any less significant. After all, every other President "only won" because "so many men voted" or "so many U.S. citizens over 18" voted, but somehow that didn't make anyone question the legitimacy of their administrations.

Which is exactly what makes a King v. Burwell plaintiff win for the GOP so deliciously (and sadly) ironic. According to the Urban Institute, look who would be most likely to lose their healthcare coverage:

Most are adults who are low and middle income but not poor, most are white, non-Hispanic, and most reside in the South. Financial burdens would increase substantially for those wishing to continue buying the same coverage they would have under current implementation of the law.

So basically, you're mostly talking about working-class white Southerners. Got it.

Meanwhile, who would continue to benefit from the Affordable Care Act?

  • People in the 17 (or 14) states with their own exchange...such as CA, NY, MA, MD, etc. You know...middle-class Democrats, for the most part.
  • The millions who are newly insured thanks to Medicaid expansion...which are, again, mostly in blue-leaning states. You know...poor Democrats, for the most part.

Final punchline? In addition to those 14 (17?) states, guess who would still have to pay the additional taxes mandated by the Affordable Care Act?

Yes, that's right...every other state, including all of the ones controlled by Republicans.

Mazel Tov, GOP!! You've screwed over your own base while simultaneously continuing to pay for a "handout" to those lazy, socialistic Democrats in the blue states!

Well done!!

(that's sarcasm, for those who aren't savvy about such things)