"We think we will win the case," said a senior administration official this morning. If the Supreme Court decides against the federal government, it will be making a decision that tax credits and subsidies will not be available in the 36 states with a federal marketplace. Eighty-seven percent of the 8.4 million people who have come through the federal marketplace are receiving subsidies, at an average of $263 per individual per month.
"When you do the math, for most people, that's a lot of money," said the official. "The relationship between that drop and the affordability that's created through the tax credits or subsidies, one assumes, is extremely real."
Without subsidies, prices of insurance will rise because only sicker people will buy in. As premiums in the individual market go up, a so-called "death spiral" will ensue. While that might sound like a good thing, officials emphasize that it's not. It remains unclear exactly how many people would lose their insurance, but the same senior official today confirmed that the effect would be "massive damage."
Despite demonstrable evidence that the Affordable Care Act is helping to address America's relative squalor compared to other wealthy countries in terms of citizen access to healthcare, few hearts and minds have been won. As of September, only 37 percent of Americans approved of the law (even though 75 percent of newly-insured people like their plan). House Republicans have voted to repeal or gut the law more than 50 times, often rallying around nebulous evils in a malaise of anti-big-government sentiment.
"This is a market system," said a senior administration official, preemptively addressing concerns to the contrary. "Having a successful open enrollment builds the success of the private sector and a strong market."
Burwell and President Obama have lately taken to underscoring their success by telling compelling individual stories. A tearful 27-year-old Anne Ha of Philadelphia sat to her left at a press conference in October and explained how despite eating well and exercising regularly, she started developing chest pain and indigestion. She couldn't sleep for three days. At the urging of her mother, she signed up for health insurance on the federal exchange website. Two weeks later she ended up in the emergency room with internal bleeding, and an endoscopy found stomach cancer. She had half of her stomach removed. "If my mom didn't push me to sign up, I would be faced with bills up to half a million dollars," she said at the time. With her premium included she ended up paying $5,000.
In fact, at every event where Burwell went during open enrollment, a consumer spoke with her from the podium. Last Monday she highlighted a woman who started an empanada business with her family. She is one who now has coverage, because she was working the 2,000-pound meat grinder, nearly caught her hand, and thought, "What am I doing without healthcare coverage?"