The Supreme Court's decision to hear the challenge to subsidies under the Patient Protection and Affordable Care Act could cut off subsidies for millions of Americans and might ultimately unravel the law, the Kaiser Family Foundation is warning.
New analysis by the group finds that 13 million Americans could lose financial assistance, with more than half living in five states: Florida, Texas, North Carolina, Georgia and Pennsylvania.
In total, 100,000 to 500,000 people in 22 other states would become ineligible for financial assistance.
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"Of the 37 states affected, several would probably scramble to establish minimal state-run exchanges to retain eligibility for tax credits for residents, particularly if the federal government makes back-end exchange technology available," Kaiser Family Foundation CEO and President Drew Altman wrote in an opinion piece for the Wall Street Journal, published Wednesday.
The court's announcement to hear the subsidy case came shortly before the second open enrollment period for PPACA began. The justices will consider an appeal filed by four Virginia residents seeking to block the subsidies in 36 states.
Altman wrote that the ruling could ultimately trigger a rising pool of uninsured, as the vast majority wouldn't be able to afford any coverage without financial help. And, he wrote, because the very sick would be most likely to remain in the insurance markets, rates would spike and carriers would leave, "possibly causing the marketplaces in states with federally run exchanges to collapse."
"It will be another high-stakes moment for [PPACA], which has been making steady progress since surviving a constitutional challenge in the Supreme Court, a presidential election, a government shutdown (in which it was a hostage), and an infamous Web-site meltdown," Altman said. "The enrollment season that opened Saturday has been mostly problem-free."
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