Maybe I'm misunderstanding how this works, but if the DC Circuit's decision holds up and the people who bought an individual health insurance policy in a state that does not run its own exchange lose their subsidy, there will suddenly be tremendous pressure for that state to begin running its own exchange so its residents can get their subsidy back. Am I being over-optimistic to predict that this decision may lead more states to participate in the ACA and not less?
The people who are eligible for subsidies are middle class Americans. They have too high of an income to qualify for medicaid as expanded under the ACA. This is a demographic that votes. I guess conservatives hope if the subsidy goes away and they have to pay more for their insurance these middle class voters will attribute the increased costs to the "skyrocketing premiums" that critics of the law predicted (instead of realizing that the increase in cost is due to the efforts of the opponents of the law). But the subsidy-ending premium increases are only going to happen in states that did not set up their own exchanges. Surely people will notice that. It will create an obvious discrepancy between what people must pay for insurance in states that set up their own exchanges versus those that did not. That may serve as a demonstration of how much better the law works if the state is just willing to cooperate.
UPDATE: Olga Khazan posted an analysis showing how much the average premium rates would rise in each state if today's D.C. Circuit case is upheld. So, as an example, the people who purchased an individual policy via the federal exchange in Pennsylvania will have their rates go up by 70-74% because of the loss of the subsidy. Just over the border in New York or Maryland, people who purchased individual policies will continue to pay the same low rates that Pennsylvanians got a taste of before this decision came down.
How can that not hurt the Republican party in the upcoming gubernatorial election? Tom Wolf is already running on the platform of fully implementing the ACA in this state. Right now, his web site mostly talks about Medicaid expansion. But if the DC Circuit court's decision is applied here, then you can bet he will start talking more clearly about building a state exchange and getting PA residents access to the federal subsidies that keep insurance rates low in neighboring states. Governor Corbett was already a goner before this decision came down. But what about a closer race like Michigan, Florida, Wisconsin, or Georgia? Couldn't this change give a real boost to the democrats?
The people who are eligible for subsidies are middle class Americans. They have too high of an income to qualify for medicaid as expanded under the ACA. This is a demographic that votes. I guess conservatives hope if the subsidy goes away and they have to pay more for their insurance these middle class voters will attribute the increased costs to the "skyrocketing premiums" that critics of the law predicted (instead of realizing that the increase in cost is due to the efforts of the opponents of the law). But the subsidy-ending premium increases are only going to happen in states that did not set up their own exchanges. Surely people will notice that. It will create an obvious discrepancy between what people must pay for insurance in states that set up their own exchanges versus those that did not. That may serve as a demonstration of how much better the law works if the state is just willing to cooperate.
UPDATE: Olga Khazan posted an analysis showing how much the average premium rates would rise in each state if today's D.C. Circuit case is upheld. So, as an example, the people who purchased an individual policy via the federal exchange in Pennsylvania will have their rates go up by 70-74% because of the loss of the subsidy. Just over the border in New York or Maryland, people who purchased individual policies will continue to pay the same low rates that Pennsylvanians got a taste of before this decision came down.
How can that not hurt the Republican party in the upcoming gubernatorial election? Tom Wolf is already running on the platform of fully implementing the ACA in this state. Right now, his web site mostly talks about Medicaid expansion. But if the DC Circuit court's decision is applied here, then you can bet he will start talking more clearly about building a state exchange and getting PA residents access to the federal subsidies that keep insurance rates low in neighboring states. Governor Corbett was already a goner before this decision came down. But what about a closer race like Michigan, Florida, Wisconsin, or Georgia? Couldn't this change give a real boost to the democrats?
