Thread by @charles_gaba

🚨 REMINDER: The U.S. Supreme Court is scheduled to release one or more opinions TOMORROW MORNING. This may include the fate of the Affordable Care Act. 1/
acasignups.net/21/02/05/democ…

Oral argument *seemed* to go well for the #ACA last November, and the consensus opinion is that #SCOTUS will either throw the case out or, at worst, order the mandate language stricken while leaving the rest intact...which would be mildly irritating but otherwise fine. 2/

HOWEVER, there's 4 *other* possible rulings:
1. They kick it back down to the district court again.
2. They strike down guaranteed issue & community rating only.
3. They strike down most of the law but leave oddball provisions in place.
4. They kill the entire law. 3/

#1 is very unlikely, but if it did happen the case could bounce around the courts for another couple of years.

#2 would be a surreal mixed bag, but also a logistical nightmare to implement.

#3 or #4 would be an utter and complete disaster. 4/

#1 would be annoying but it would leave everything as is, giving Congress ample time to #MootTheSuit (or to pass #ACA2wPO, which would presumably *include*language to #MootTheSuit).

It would keep the Sword of Damocles dangling over everyone's head for awhile longer. 5/

#2 would leave many important #ACA provisions in place, including Medicaid expansion, closing the Medicare Part D donut hole, keeping kids on their parents plan up to age 26, etc. and it would leave the ACA exchanges *and APTC/CSR subsidies* in place, which is all good... 6/

...HOWEVER, #2 would also strip away protections for ~135 million Americans w/pre-existing conditions, and would create a logistical nightmare for the exchanges & subsidy calculations.

ACA subsidies are based on the price of the "benchmark Silver plan" in your area... 7/

...but if you kill Guaranteed Issue, Community Rating & EHB requirements, suddenly there IS no longer a "benchmark Silver plan" to hang the ACA subsidy hat on. We'd go back to *individual enrollee underwriting*, which means a separate "benchmark Silver" plan for each enrollee. 8/

In that scenario, someone with, say, hemophilia who racks up $18,000/month in medical expenses could be offered a "benchmark Silver plan" for $20,000/month...but with $19,500/month in ACA subsidies, assuming the carrier doesn't just deny them coverage outright. 9/

#3 would mean leaving a few scraps of the ACA in place like "mandatory calorie counts posted at restaurants" or whatever, which amounts to the same thing as #4: Striking down the entire law "root & branch" as Mitch McConnell used to gleefully say. 10/

If #3 or #4 happens--again, there's still a chance of that happening--and no legislation is passed to resolve the issue before the ACA is actually dismantled--the odds are that the devastation would happen QUICKLY...potentially as soon as April or May: 11/ acasignups.net/21/02/19/if-ac…

Here's a PARTIAL list of what would happen...and remember, this is from 2019, long before the #COVID19 pandemic hit. 12/
healthinsurance.org/blog/2019/03/2…

Medicaid expansion for 16 million+: GONE.
Premium subsidies for 9 million: GONE.
Cost Sharing subsidies for 6 million: GONE.
BHP coverage for over 800,000: GONE.
Pre-existing Condition protections for up to 130 million? GONE. 13/

Charging women more for their gender? BACK.
Requiring policies to cover at least 60% of expenses? GONE.
Requiring policies to cover maternity care, mental health & prescription drugs? GONE.
Letting kids up to age 26 stay on their parents policy? GONE. 14/

Limits on out of pocket expenses? GONE.
Annual/lifetime limits on healthcare claims? BACK.
Free preventative care services? GONE.
Medicare Part D Donut Hole? REOPENED. 15/

Here's a state-by-state (and district by district!) breakout of the estimated healthcare coverage losses *if* SCOTUS strikes down the entire ACA w/immediate effect & there's nothing immediately in place to deal with it: 16/
acasignups.net/20/11/11/how-m…

Short version: An estimated 23 million Americans would lose healthcare coverage (around 2/3 in Medicaid via ACA expansion, ~1/3 in subsidized ACA exchange plans).

In the middle of a pandemic. /END