How they think: "If the ACA is struck down, it will lead to M4All!"
Reality: If the ACA is struck down, 23 million will lose healthcare coverage, hundreds of thousands will go bankrupt each year, tens of thousands will die each year, and no, M4All still won't happen.
Reality: If the ACA is struck down, 23 million will lose healthcare coverage, hundreds of thousands will go bankrupt each year, tens of thousands will die each year, and no, M4All still won't happen.
https://twitter.com/Fraud4Less/status/1356263681294798856
It's important to understand that the SCOTUS decision isn't necessarily all or nothing. A few options would be acceptable. A few would be disastrous. And one in particular would be just a surreal actuarial mess.
Best to worst:
1. SCOTUS throws out entire case.
2. SCOTUS strikes down mandate, leaves everything else.
3. SCOTUS strikes down mandate & guaranteed issue, leaves everything else.
4. SCOTUS rules most of ACA must go; leaves odds 'n ends
5. SCOTUS strikes down EVERYTHING.
1. SCOTUS throws out entire case.
2. SCOTUS strikes down mandate, leaves everything else.
3. SCOTUS strikes down mandate & guaranteed issue, leaves everything else.
4. SCOTUS rules most of ACA must go; leaves odds 'n ends
5. SCOTUS strikes down EVERYTHING.
#1 would be best both for the ACA and future precedent.
#2 would be a minor annoyance and bad precedent for severability in the future but the full federal ACA mandate is never coming back anyway so it’d be mostly irrelevant.
#2 would be a minor annoyance and bad precedent for severability in the future but the full federal ACA mandate is never coming back anyway so it’d be mostly irrelevant.
#4 or 5 would be utter disasters. #4 means leaving a few token provisions in place like calorie counts and letting kids stay on their parents plan until 26...which was already in place in many states pre-ACA anyway.
#3 would actually be the strangest outcome of all. ACA subsidies would still be available to those in the 100-400% income range...but with the return of medical underwriting, there’d be almost no standard upon which to base the formula.
ACA subsidies are based on the price of the 2nd lowest-cost Silver plan available on the exchange...but with the exchange gone and no standard on which to base Silver plan pricing, how would you even calculate the subsidy amount?
Even assuming existing exchanges managed to survive via some regulatory interpretations, and even assuming carriers didn't voluntarily go back to denying coverage to those w/pre-existing conditions outright (some states prohibit it), how would the calculate "2nd lowest Silver"?
One surreal scenario would be for carriers to individually calculate 2 Silver plans for *each individual enrollee* via medical underwriting. Someone w/hemophilia might have a "benchmark plan" costing $20,000/month, minus a $19,500/month subsidy so they'd pay $500/month.
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