This July, up to 14 million people could be in Luis Lang's shoes...even if they did the right thing.

(title changed to be more accurate)

I was planning on saving this entry until we were closer to the King v. Burwell decision (expected to be announced near the end of June), but Greg Sargent of the Washington Post has kind of forced my hand with his own excellent follow-up to the Luis Lang saga:

But there’s another potential twist to the tale: Just as he is now seeking to get on Obamacare, he could very well find himself unable to sign up for coverage, if the Supreme Court rules for the challengers in King v. Burwell next month. HHS official tells me that if he can get his income up a bit — it reportedly fluctuates — he could probably qualify for a category that would allow him to apply for Obamacare again before next year’s open enrollment period.

But if the Court strikes subsidies in three dozen states on the federal exchange — one of which includes South Carolina — it could put Obamacare even further out of reach for Lang.

“Assuming he can make between one and four times the poverty level, he’d be eligible for subsidies to help him pay for coverage,” Nicholas Bagley, who has closely studied the potential impact of a Court decision against the law, says. “But if subsidies are eliminated, he’s unlikely to be able to afford health coverage.”


Of course, while Mr. Lang's situation (being denied Medicaid due to the SC GOP's refusal to expand it, then also being denied tax subsidies due to the SCOTUS pulling the plug on the tax credits) would be particularly ironic in this scenario, he's not the only one who would be, as Sargent put it, "screwed again by Supreme Court".

In fact, a bare minimum of 6.2 million and potentially as many as 14 million people (depending on your definition of "screwed") would find themselves in deep, deep financial and healthcare trouble if the Supreme Court takes away the federal tax credits across 34 (potentially up to 37) states. And if that happens:

“This guy only understood how Obamacare works because he needed to get health care,” [U of M Law Prof. Nicholas] Bagley says. “There are going to be a whole lot of people with insurance right now who will get a rude lesson in how Obamacare works if subsidies are eliminated. This is maybe the kind of education a big chunk of the American public will get.”

Another way to understand this: If Republican opposition to the Medicaid expansion has created a big “Medicaid gap,” a Court ruling against the ACA — followed by GOP unwillingness to do anything in response — could make that gap in the safety net created by Obamacare a whole lot bigger. And it could claim a whole lot more people.

The major difference between Mr. Lang and the millions of others who'd be trapped by the King decision is that in his case, he was acting irresponsibly in the first place. The millions of others did take personal responsibility and already have health insurance.

There's a world of difference between never being offered something in the first place and having it torn away from you a year and a half later.