I know the site has been pretty much All King v. Burwell, All The Time for the past month or so, and no doubt that'll continue for the next few months (if the plaintiffs win) or the next week (if the government wins). However, with the decision imminent (expected either Friday or Monday now), I thought this would be a good time to update The Graph.
As you can see, assuming appx. 7,500 QHP selections per day nationally, the grand total for 2015 should have crossed the 12.7 million mark sometime over the past few days. Of course, it's possible that this average has become substantially higher or lower over the past few weeks as people learn more about the impending KvB decision...some eligible off-season enrollees might be jumping on it in hopes of snapping up at least a month or two worth of tax credits before the Supreme Court lowers the boom, while others who were planning on doing so may have decided not to bother even trying, figuring that it'll just be a lot of paperwork for nothing (shrug).
A couple of weeks ago I posted my own crude state-level graphics breaking out just how many people in each of the 34 states which would be impacted by an adverse King v. Burwell ruling who are currently receiving federal tax credits would be screwed by having said credits torn away, as well as a rough estimate of how much of an immediate tax hit they'd take to keep their policies through the end of this year and how much they'd likely see their premiums skyrocket next year as a result.
There was a time when I thought that ACA-related news would quiet down after the Open Enrollment Period ended. That day may come at some point, but with the King v. Burwell decision bearing down on everyone, forget about it.
In addition to this morning's release of the big CDC National Health Interview Survey, here's not one, not two, but five major pieces out today. Unfortunately I don't have time for lengthy write-ups for each, but they're all pretty important in different ways:
As the U.S. Supreme Court prepares to issue a ruling that could impact the Affordable Care Act, 47 percent of Americans now approve of the health care law, the highest in CBS News and New York Times polling (although support is still short of a majority). For the first time, more Americans now approve than disapprove of the ACA, but by a narrow margin.
The Centers for Disease Control has released their big National Health Interview Survey, which confirms what every other study, survey and poll has: The Affordable Care Act did indeed caused the uninsured rate to plummet last year. On the one hand, this isn't exactly surprising news to anyone other than former U.S. Senator/NH Governor Judd Gregg and current U.S. Representative Gary Palmer, but whatever.
Monday's New York Times has a pretty thorough look at just what the "establish an exchange" status is across the various states which would otherwise have millions of people devastated by the impact of the GOP's King v. Burwell court case, which will be decided on either Thursday, Friday or next Monday (most likely Friday now, as I understand it).
They cover the three states which already have a "federally-assisted" state-based exchange (Oregon, Nevada, New Mexico); Hawaii, which is in the process of moving to that status; the two states which are hoping to do so next year (Delaware and Pennsylvania)...as well as the other 32 states which don't have bupkis at the moment.
At first, this article in the Washington Times doesn't look like anything special...it's basically one of dozens of stories about the potential political and real-world impact of the King v. Burwell decision on a specific state...in this case, Oklahoma:
OKLAHOMA CITY (AP) - While the U.S. Supreme Court considers a key case related to the Affordable Care Act, officials in Oklahoma have taken little action to prepare for a ruling that could threaten the tax subsidies nearly 90,000 residents are using to purchase health insurance.
HOWEVER, it's the next couple of paragraphs which made me do a double-take:
Because Oklahoma opted not to create a state exchange where residents could shop for health insurance, Oklahomans instead purchased their plans through a federal exchange, but opponents who are challenging the law, including Oklahoma Attorney General Scott Pruitt, argue the law only allowed for the subsidies through state exchanges.
Note: My estimate for Alaska is actually slightly lower than this (16K), and my estimate of the average tax hike those Alaskans would have to pay is actually half of the amount in the article ($3,200 vs. $6,400), but that's because I'm assuming only the 2nd half of the year's credits would be rescinded:
Robin Barker, a longtime resident of Fairbanks and Bethel, struggled with chronic illnesses for years that kept her from working. Her only option for health insurance cost nearly $800 a month for a policy that came with a $15,000 deductible. Prescriptions alone set her back $12,000 a year.
“Money was just pouring out of our retirement savings,” she said.
...Interviewed at her Fairbanks home as she recovered from a bout with pneumonia, Barker said she was happy to qualify for Medicare but was concerned about Alaskans who won’t be able to afford health coverage if the U.S. Supreme Court strikes down subsidies. If that happens, she says, “families will be destroyed.”
Well, since King v. Burwell was not announced today, I guess I'll clear out another mess of stuff from my in box (Note: Many of these stories should have their own full entries, but I just don't have time at the moment):
IMPORTANT: The "death spiral" which isn't happening referred to in the link below is the one which Republicans claimed would happen due to the ACA itself. Ironically, if they win King v. Burwell, such a death spiral would almost certainly happen in the 30+ states which aren't running their own exchange.
Not so long ago, critics of Obamacare were warning of death spirals, the risk that too many sick people and not enough healthy ones would sign up for insurance, triggering a cycle of ever higher costs for insurers and steep premium hikes for consumers.
No King v. Burwell Supreme Court decision again today, but most pundits were always expecting it nextMonday, June 29th, anyway.
However, there's a total of 7 cases still left to announce (including Obergefell v. Hodges, aka the same-sex marriage case), so they've also tacked on another extra Opinion announcement day: Thursday the 25th.
I'm not gonna get a damned bit of billable work done this week, am I?
UPDATE: According to CNBC's Dan Mangan, they've added Friday the 26th as well...
At this point, pretty much every healthcare reporter, pundit and especially the healthcare actuaries are pretty much reduced to this:
Welp, it's Monday again, which means it's time to once again huddle in front of my keyboard while anxiously watching SCOTUSblog's Live Blog of the Supreme Court's opinion announcements...
Of course, they might not make the King v. Burwell announcement today, either; it could still be next Monday, the 29th. Or, they could throw in another surprise "bonus" decision day on Thursday. (sigh)...
UPDATE 10:20am: NEVER MIND. No King v. Burwell announcement today.
