Saturday, June 20, 2015

What a negative SCOTUS ruling might mean: Universal health care in blue states?

That's what Greg Sargent at the Plum Line (Washington Post) suggests.

As we come closer to a Supreme Court ruling in King v. Burwell, news organizations are gearing up to portray a decision nixing subsidies in three dozen mostly-Republican states as a fatal blow to the whole Affordable Care Act. CNN predicts such a decision could send "Obamacare" into a "death spiral." Reuters blares: "Obamcare faces latest brush with death."

But in fact, the absolute worst-case scenario you can envision unfolding from an adverse ruling is a considerably less awful outcome. Put simply, it’s very plausible the health care system would continue progressing towards universal health care in around 16 to 18 mostly blue states, while in many red states, something approaching chaos would set in, at least in the short term.

... what continues to get lost in the coverage is that even if you assume that neither Congress nor state lawmakers do anything, much of Obamacare would remain in place, and significantly more people would retain its benefits than would lose them. This is important, not just to get the significance of the ruling right, but also because it has direct relevance to the policy and political story that will unfold after it.

"You would start to see a major division between states that had willingly participated in the ACA, which suddenly have an economic boon and high rates of insurance, and states that returned to pre-ACA standards or worse, with a continuation of under-insurance and a struggling health economy," says Caroline Pearson, a senior vice president for Avalere Health, a health care consulting firm. "Those states would have an incentive to implement state-based reforms. But where would the money come from? They would need federal funds to create state-based solutions."

So the pressure would be on. GOP lawmakers would certainly pat themselves on the back for a body blow to ACA, but in the longer term, something would give.

... all indications are that in the mostly blue states that were undisturbed by the lawsuit, the progression towards universal health care would continue.

That means that you would have health-care-have states and health-care-have-not states. And that would lead to the question here phrased in terms of an earlier stage of human development: "Mommy, why can't I have toys like Johnny?" Mommy needs to answer. And so would the health-care-have-not states. The answers might bring the entire nation closer to universal health care. Finally.

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