Thread by @charles_gaba

🚨🚨🚨 REMINDER: The Supreme Court *may* save *or* strike down the entire #ACA as early as...TOMORROW MORNING:
acasignups.net/21/01/29/heads…

After #SCOTUS heard oral argument in the absurd GOP-brought, GOP-blessed #TexasFoldEm lawsuit to strike down the #ACA last November, the assumption was that there's no way that they would issue their opinion any earlier than April - June. 2/

HOWEVER, both @ShermanCourt and @AHoweBlogger have noted that the #SCOTUS website indicates that they're scheduled to issue opinions on several cases "argued in the fall and/or winter" tomorrow (Wednesday) morning.

It's unknown which cases this may include. 3/

.@NIcholas_Bagley remains confident that the #ACA case *won't* be among those ruled on tomorrow. In fact, he suspects the only reason they'd release their decision this soon is if it's *good* news--that is, if it's 9-0 to uphold the law.

HOWEVER, anything's possible... 4/

IRONICALLY, I happen to have a can't-miss medical appointment myself tomorrow morning, which means if they *DO* issue a ruling, I'll be unable to post anything about it until the early afternoon!

WITH THAT IN MIND, a reminder that there's basically 6 possible decisions: 5/

1. Throw whole case out (yay!)
2. Strike down mandate but keep the rest (fine!)
3. Strike down mandate & patient protections, keep the rest (an mess)
4. Throw out most of the law, keep bits (disaster)
5. Throw out the entire law (disaster)
6. Kick it back to the circuit court (?)

Obviously #1 would be best. #2 would be annoying but would be fine for practical purposes.

#6 is very unlikely but if it happened, the case could bounce around the court system for another couple of years, leaving everyone stuck in limbo even longer. 7/

#3 would result in actuaries & risk adjusters having aneurysms left & right. The good news is Medicaid expansion *and* #ACA subsidies would remain in place. The bad news is the ACA's protections for coverage of pre-existing conditions would be gone... 8/

...which means there'd be NOTHING TO BASE THE SUBSIDY FORMULA ON anymore.

ACA subsidies are based on the "benchmark Silver plan" premium...but there'd no longer be a "benchmark Silver plan" to calculate subsidies off of.

Plus, carriers could just deny coverage altogether. 9/

Assuming carriers were willing to sell to high-risk enrollees, they'd have to go back to medically underwriting each one individually. Someone low-income w/hemophilia, for instance, might be offered a "benchmark Silver plan" at $20,000/month...with $19,800/month in subsidies. 10/

Of course if you earn more than 400% FPL, you'd be eligible for NO subsidies at all, which means a single hemophiliac earning $55K/year would be utterly unable to afford coverage.

Plus, again, carriers could just not even offer them coverage again. 11/

#4 would mean leaving a handful of oddball ACA provisions like "calorie counts being posted in restaurants" and letting kids stay on their parents plan until age 26 (except there'd be no pre-existing condition protections anymore). It would effectively amount to the same as #5.

#4 & #5 would be about the same in practice: Utter catastrophe.

--23 million losing coverage ( Medicaid & subsidized ACA plans)
--132 million w/pre-existing conditions losing protections
--Medicare "donut hole" reopening
--Much, much more...in the middle of a pandemic. 13/

Anyway, crossing my fingers that, when they DO rule (whether tomorrow or this spring/summer), SCOTUS throws the case out or only eliminates the mandate itself at worst.

Alternately, Congress has a chance to #MootTheSuit no matter how SCOTUS rules: /END
acasignups.net/21/01/29/heads…

UPDATE:

https://twitter.com/charles_gaba/status/1356986093841887234