The early field of 2016 GOP contenders is crowded with governors and senators from competitive states—including John Kasich and Rob Portman from Ohio, Jeb Bush and Marco Rubio from Florida, Chris Christie from New Jersey, Mike Pence from Indiana, and Scott Walker from Wisconsin. All are experienced and appeal to crucial parts of the party’s voter and donor bases. They also have something else in common: good reasons to worry about a politically explosive Supreme Court decision to restrict health-insurance subsidies that could come down in June 2015.
The plaintiffs in King v. Burwell claim that a single phrase in the 900-page Affordable Care Act of 2010 precludes the flow of subsidies to reduce premiums for private health-insurance plans purchased in states that have not created their own insurance exchanges. Millions of middle-income people who happen to live in such states rely instead on “federally facilitated marketplaces” set up for each state by the U.S. Department of Health and Human Services.
At issue is a technicality of statutory interpretation with big human and economic consequences. Experts disagree about how much damage a pro-King verdict could do to national health reform overall. But no one doubts that in many states large numbers of Americans with modest incomes could abruptly lose the federal subsidies that 85 percent of them use to reduce the cost of monthly-insurance premiums. Equally worrisome, insurance markets in the affected states would likely collapse, because many healthy customers would drop coverage, leaving companies with disproportionately sick customers desperate enough to pay suddenly higher premiums.