Georgia Attorney General Sam Olens has asked the U.S. Supreme Court to strip some 450,000 Georgians of the federal subsidies that have helped them to afford health insurance. Most are lower-income working people, some with pre-existing conditions that had previously made them ineligible for private coverage.
What happens to those people if Olens and his allies succeed in their crusade? What happens to the insurance and health-care industries in the state? Nobody knows for sure, but what is worse, nobody seems to care.
Certainly, many of those 450,000 would be forced to drop their insurance coverage. Georgia’s uninsured rate — already the third highest in the country, according to Gallup — would rise still further. With hundreds of thousands of Georgians again without insurance, the state’s already faltering health-care system would face additional strain. (In a performance ranking by the Commonwealth Fund, Georgia’s health-care system was rated 45th in the country in 2014, a rapid decline from 35th just five years earlier. It’s astonishing to see that same rapid decline in metric after metric, from transportation to economics to health care).
But that’s just the beginning. Most experts warn that if Olens and his allies win their argument, the market for individual health coverage in Georgia and other affected states would collapse into chaos, even for those who haven’t used federal subsidies to buy coverage. (SEE UPDATE BELOW)
According to America’s Health Insurance Plans, the nation’s largest health-insurance trade group, the result would be “severely dysfunctional insurance markets” in Georgia and 33 other affected states. “It would leave consumers in those states with a more unstable market and far higher costs than if the Affordable Care Act had not been enacted,” AHIP warns in a brief filed this week before the Supreme Court.
Nonetheless, Olens and five other state attorneys general — all Republicans — argue in their own brief that an estimated five million Americans are receiving illegal subsidies under the Affordable Care Act.** As they read the law, such subsidies can be offered only in states that establish their own health-insurance exchanges. They argue that in states such as Georgia, which refused to establish such an exchange and relies instead on a federal exchange, such subsidies are illegal. And if that means that a lot of people in their own states lose health insurance, so be it.
The legal virtues of the case, King v. Burwell, are hotly contested, with prominent, well-respected lawyers offering arguments on both sides. It is likely to be decided by yet another narrow 5-4 vote, with arguments in March and a decision expected by June. That’s not much time.
Yet at both the federal and state levels, those who are pushing the case hardest are doing almost nothing to prepare for the chaos that will result should their argument carry the day. They voice confidence that the subsidies will be overturned, yet they show little concern about dealing with the aftermath.
Here in Georgia, for example, the state Legislature could make the issue moot by voting to establish a state-based insurance exchange. It won’t do so. To the contrary, last year it voted to bar state employees from preparing for such a step.
And in Washington, where Republicans control both houses of Congress, no visible progress is being made in preparing options. The GOP can’t bring itself to fix ObamaCare if necessary, and it can’t agree even with itself about an alternative. They are eager to destroy, but they appear to have no idea how to build.
** Tellingly, those six Republican attorneys general are in a distinct minority even among their GOP peers. Most of the 26 states that challenged the constitutionality of ObamaCare in the 2012 NFIB v. Sebelius declined to participate in this case.
UPDATE: I contacted Olens’ office Wednesday seeking comment, but had received no reply by the time this was posted. Here is his response, received Thursday afternoon:
“This lawsuit is about the rule of law, plain and simple. I agree that affordable health insurance and excellent care are absolutely needed, but many Americans are rightly concluding that they are not getting what they were promised.
The Obama administration knows that the law cannot be enforced as written. Otherwise, there would not be a need for the numerous exceptions and delays they have put in place. Just because the Obama administration decides that the law that President Obama himself signed does not meet its objectives in practice, it cannot choose to disregard the law carte blanche.
I will not stand by and let this lawlessness go unchallenged, and I cannot apologize for insisting that the president should follow the law. The fact that a DC Circuit Court of Appeals panel agreed with the states’ position and the Supreme Court of the United States has chosen it for review, indicates that this is a serious legal issue that needs to be settled.”