ATLANTA — Georgia would have the fourth-highest number of people affected if the U.S. Supreme Court rules against the current implementation of the Affordable Care Act, a study has found.

The case, King v. Burwell, involves a legal challenge to the tax credits in states with federally run exchanges.

Under the ACA, every state has an insurance exchange, with some being operated by the individual states but most by the federal government. Currently, eligible consumers with coverage purchased on an exchange can get federal tax credits, or subsidies, regardless of how their particular exchange is run.

The plaintiffs in the case say the language of the ACA allows the tax subsidies only where there is a state-run exchange. The Obama administration challenges that interpretation.

If the plaintiffs win, the subsidies would end in most states. And these tax credits make ACA health plans more affordable for low- and moderate-income Americans, so the impact would be great.

A Kaiser Family Foundation study notes that 37 states have federally operated exchanges, and finds that of these states, only Florida, Texas and North Carolina would have more people losing subsidies than the Georgia estimate of 784,000.

A court decision is expected next June.

Potential fallout in Georgia 

A recent U.S. House committee minority report analyzed the impact of a ruling against the current system by looking at U.S. congressional districts.

The districts most affected in Georgia would be District 4, where Democrat Hank Johnson is the congressman (91,000 people), and District 7, where Republican Rob Woodall just won re-election (84,000).

The least affected district by numbers: District 8, where Republican Austin Scott serves (28,000).

The total Georgia subsidy amount jeopardized would be $3.8 billion.

The legal challenge centers on a phrase in the ACA requiring that subsidies to help those with incomes below 400 percent of poverty are available only in “exchanges established by a state.”

ACA proponents argue that the rest of the statute makes it clear that subsidies are available not only in state-run exchanges, but in those, as in Georgia, where the federal government operates that marketplace. The plaintiffs argue that only state-based exchanges can offer subsidies – that the federal ones are illegal.

The Kaiser Family Foundation study estimates that a ruling for the plaintiffs would mean 13 million people who get subsidies could be negatively affected.

If the Supreme Court rules on the side of the plaintiffs, many states would probably scramble to establish minimal state-run exchanges, says Drew Altman of the Kaiser Family Foundation in a Wall Street Journal “Think Tank” column.

But in Texas, Florida, North Carolina, Georgia and Pennsylvania – the “big anti-ACA five,” Altman calls them – only Pennsylvania, where a Democrat was just elected governor, would be likely to act to preserve subsidies for residents, he says.
And Georgia is one of a handful of states that have enacted legislation forbidding the state to operate an ACA exchange.

U.S. Senate Republican leader Mitch McConnell of Kentucky, who will become the chamber’s majority leader in January, said recently at a Wall Street Journal event that while a repeal of Obamacare isn’t likely, “who may ultimately take it down is the Supreme Court of the United States.”

“If that were to be the case,” McConnell added, “I would assume that you could have a mulligan here, a major do-over of the whole . . . [ACA] – that opportunity presented to us by the Supreme Court, as opposed to actually getting the president to sign a full repeal, which is not likely to happen.”

Because most people eligible for tax credits have modest incomes, the vast majority would not be able to afford coverage without financial help.

‘A lot of people shedding coverage’ 

Most of those who lose subsidies would no longer be required to have insurance, because they would fall into an ACA exemption for those who have to pay more than 8 percent of family income for premiums, Julie Rovner of Kaiser Health News reported recently.

“Since a lot of people can’t afford insurance without the tax credits, you’re looking at a lot of people shedding coverage,” Nicholas Bagley, a law professor at the University of Michigan, told Rovner.

Georgia and the rest of the nation are in the middle of the open enrollment period for Year 2 of the insurance exchange.
Dante McKay, state director of Enroll America, says the high court’s decision to review the case doesn’t change anything for the current enrollment.

“We know that financial assistance . . . has made a huge difference for thousands of Georgians,” McKay says. “In fact, 87 percent of the 316,000 Georgians who signed up for health insurance on received financial assistance to help pay for their plan. Further, the average monthly cost for Georgians who received financial help was $54.”

It’s critical that the subsidies remain in place, McKay says. “While the judicial process plays out, it’s important for consumers to know that this ruling will not affect the financial assistance they may have received to help pay for their health insurance plan.”


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