Ohio mom wor­ries King rul­ing could threaten her fam­ily’s cov­er­age

Modern Healthcare - - NEWS - By Bob Her­man

Kris­ten Clark re­mem­bers the days when buy­ing health in­sur­ance used to be not only com­plex but also pro­hib­i­tively ex­pen­sive. “A lot of times, it’s like pay­ing a sec­ond mort­gage,” she said.

The loom­ing U.S. Supreme Court rul­ing threat­en­ing to wipe out pre­mium sub­si­dies in up to 37 states could force Clark and mil­lions of other Amer­i­cans to ex­pe­ri­ence those days all over again.

Clark, 31, her hus­band, and their two daugh­ters live in Delaware, Ohio, just north of Colum­bus. She is a stay-athome mom, and her hus­band is a min­is­ter earn­ing a mod­est in­come. This year, they bought cov­er­age on Ohio’s fed­eral ex­change from In­Health Mu­tual, the state’s not-for-profit co-op in­surer cre­ated un­der the Af­ford­able Care Act.

Her fam­ily is rel­a­tively healthy, Clark said. Like most peo­ple, she wants health cov­er­age for her chil­dren and to pro­tect against worst-case sce­nar­ios. The plan they bought had all of their doc­tors in net­work. They re­ceived a sub­sidy un­der the ACA, which cut their monthly pre­mium by about half, to less than $400 per month. “It helps hav­ing a sub­sidy be­cause we can af­ford it a whole lot eas­ier,” Clark said.

The Supreme Court is sched­uled to is­sue its de­ci­sion in King v. Bur­well this month, and those pre­mium sub­si­dies are in dan­ger. The plain­tiffs ar­gue that pre­mium tax cred­its are only avail­able through “an ex­change es­tab­lished by the state” and not through the fed­er­ally run ex­changes. The Obama ad­min­is­tra­tion ar­gues that the law read in its en­tirety makes clear that sub­si­dies are al­lowed in all states.

Ohio is one of 37 states us­ing the fed­eral mar­ket­place. It’s ques­tion­able whether its Repub­li­can­con­trolled gov­ern­ment would be will­ing to es­tab­lish a state-run ex­change if the Supreme Court kills the sub­si­dies.

A loss of sub­si­dies in these states could throw the en­tire in­di­vid­ual health in­sur­ance mar­ket into chaos. Premi­ums for ex­change plans would jump 287% on av­er­age across the coun­try, ac­cord­ing to the Kaiser Fam­ily Foun­da­tion. An es­ti­mated 6.4 mil­lion peo­ple who live in states us­ing the fed­eral mar­ket­place would lose sub­si­dies, and most would be ex­pected to drop cov­er­age be­cause it would no longer be af­ford­able.

Clark said she and her fam­ily would do what­ever they could to keep their in­sur­ance. But adding hun­dreds of dol­lars to their monthly bill would be a big bur­den.

Jesse Thomas, CEO of In­Health Mu­tual, the plan cho­sen by Clark and her hus­band, said about half of his plan’s 22,000 mem­bers bought plans through the fed­eral ex­change. More than 80% of Ohio’s ex­change en­rollees re­ceive pre­mium tax cred­its. Over­all, Ohio has about 189,000 ex­change en­rollees, 85% of whom re­ceive sub­si­dized cov­er­age.

Thomas be­lieves his plan has in­jected a new source of in­sur­ance ac­cess and com­pe­ti­tion for Ohioans look­ing for health cov­er­age. Now the King case has cre­ated ma­jor un­cer­tainty for peo­ple who want to keep their health plans.

Many healthcare lead­ers have warned that toss­ing the sub­si­dies would plunge the sys­tem into chaos. Dr. Jay Shan­non, CEO of Cook County Health and Hos­pi­tals Sys­tem, said char­ity care at his safety net sys­tem in Chicago has dropped the past two years un­der the ACA’s cov­er­age ex­pan­sion. With­out pre­mium sub­si­dies, char­ity care would likely re­turn to pre­vi­ous lev­els. Many peo­ple would be con­sid­ered too poor to af­ford health in­sur­ance but not poor enough to be el­i­gi­ble for Med­i­caid.

“I can’t imag­ine, both at the per­sonal level and at the state level, how the Supreme Court could imag­ine that work­ing out for the good,” Shan­non said. “That’s un­be­liev­ably cruel.”

Le­gal ex­perts are split on how the high court will rule. Re­nee Lan­ders, a law pro­fes­sor at Suf­folk Univer­sity and for­mer HHS deputy gen­eral coun­sel, pre­dicts a 6-3 vic­tory for the gov­ern­ment, but with no ma­jor­ity opin­ion. Chief Jus­tice John Roberts and Jus­tice An­thony Kennedy may up­hold the sub­si­dies for dif­fer­ent le­gal rea­sons than the four lib­eral jus­tices, she said. That could cre­ate more po­lit­i­cal un­cer­tainty about the fu­ture of the sub­si­dies.

In the just-as-likely sce­nario of the sub­si­dies be­ing in­val­i­dated, Lan­ders sees a de­struc­tive ef­fect on lower- and mid­dlein­come Amer­i­cans. “I don’t think the (ACA) is per­fect, but I think it has given a lot of peo­ple the op­por­tu­nity to have some health in­sur­ance, which gives them some peace of mind,” she said.

Clark was not aware of the King v. Bur­well case un­til she was in­ter­viewed Thurs­day by Mod­ern Healthcare. She and her fam­ily are in the process of mov­ing, and it hasn’t been a pri­or­ity for her to keep up with Supreme Court news. Now know­ing what’s at stake, she ex­pressed con­cern. “It would def­i­nitely af­fect us,” she said. “It would add a whole lot more stress.”

“I can’t imag­ine, both at the per­sonal level and at the state level, how the Supreme Court could imag­ine that work­ing out for the good. That’s un­be­liev­ably cruel.” Dr. Jay Shan­non, CEO, Cook County Health and Hos­pi­tals Sys­tem

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