Lives in the balance

IF THE Supreme Court rules that no federal tax credit subsidies can be provided to Americans buying insurance on federal health exchanges in 34 states, the economic effects could be devastating.

About 7.5 million people who qualified for subsidies this year could have them yanked away after a court decision, and more than 9million people would be unable to get subsidies in 2016.

State economies would suffer, insurance markets would be disrupted, millions of people would lose coverage, hospitals and insurance plans that have counted on revenues from newly insured people would be left high and dry, and people who continue to hold policies would pay a lot more for them. The health-care markets in which individuals and families buy their own policies – on the exchanges and outside them – would fall into chaos.

With subsidies no longer available, the younger, healthier and less costly people to insure would decide to go without insurance, and insurers would be forced to jack up their premiums for the remaining people, likely sicker and requiring more health care. That would trigger a so-called death spiral that would cause more people to drop out and rates to rise even higher, making things worse than they were before the reform law was enacted.

Those who can pay for insurance would face much higher premiums – as high as 47 percent more on average, according to a RAND Corporation analysis, and most likely have a smaller choice of plans and networks of doctors and hospitals.

The American Public Health Association and faculty members at schools of public health warned the court that ending the subsidies would result in more than 9 800 additional deaths a year.

The political opponents of Obamacare seem to think this fight is about ideology. What they refuse to acknowledge is the human toll and the economic devastation that destroying the heart of health reform will bring about.