Affordable Care Act, healthcare, Obamacare — February 17, 2015 at 8:00 am

Why a Supreme Court ruling against Obamacare would be bad for America’s health


The King v. Burwell case could leave millions without health insurance. That’s not good for anyone.

When Dawn Erina needed some minor surgery early this year, she was able to afford it. She could afford physical therapy visits, too. Without the surgery, Dawn would have struggled to do her job.

When Dawn needed to refill one of her prescriptions, she didn’t have to pay the $400 sticker price. She’d paid her $278 monthly insurance premium so she could get the care she needs.

Without the help of a tax subsidy under the Affordable Care Act (ACA), the same insurance that covers Dawn and her husband, Leonard, would have cost $1,131 a month.

“That’s about $110 less than Leonard’s monthly Social Security check,” Dawn explains. “We could maybe buy groceries for a week after that. I don’t know what we’d do without the tax subsidy.”

The reality is this: Without help paying for insurance, the Erinas wouldn’t be able to afford it.

Regular readers of Eclectablog may remember Leonard and Dawn from my post about them last year. I wrote about how Leonard had lost his job and Dawn was working part-time, so they couldn’t afford the $1,300 a month health insurance would have cost them. But they couldn’t afford to go without. At 63 and 59 years of age, respectively, Leonard and Dawn have a few health issues and take a number of medications.

When I interviewed her in March 2014, Dawn told me in tears that without insurance to pay for their medications, she wasn’t sure how long they’d last, or even if they’d make it to her daughter’s wedding that summer. But thanks to the ACA — aka Obamacare — Leonard and Dawn could afford insurance. They could afford their medications. And they made it to that wedding. The photo at the top of this post was taken that day.

That moment was made possible by Obamacare. That moment — and many others, like Dawn holding her granddaughter for the first time — was made possible by the tax subsidies the ACA provides to working Americans who can’t afford the high cost of health insurance.

If the Supreme Court rules against the ACA in the King v. Burwell case, those tax subsidies would be taken away from the Erinas and millions of other Americans. Maybe some of those moments would be taken away, too.

Because when people can’t afford insurance, they can’t take good care of their health.

Dawn understands how high the stakes are for people like her in the King v. Burwell case.

We could never in our wildest dreams ever pay for health insurance without this subsidy.

I lived for so many years without health insurance, but now I have a whole different perspective on it. I know there are certain things I need to do to stay healthy.

In the past, I would have tried everything I could think of before going to the doctor. But you can wind up with a sinus infection that turns into bronchitis that turns into pneumonia. Now I’m seeking treatment sooner and I’m staying healthier.

Usually by this point in the winter I’ve had at least one knock-down-drag-out kind of flu sickness, but this year I haven’t had any problems. Preventive care has really been working for me.

If the Supreme Court eliminates tax subsidies for people living in states that didn’t create a state-based insurance marketplace, all of that would go away. Without insurance, Leonard and Dawn would not be able to get the routine care required by the chronic health conditions they live with. They couldn’t get preventive care like annual check-ups, flu shots and mammograms. They couldn’t afford their medications.

“It would put us in a tailspin,” Dawn says about the future without help paying for health insurance.

Dawn and I agree that King v. Burwell is an ideological boondoggle for the challengers, who seem to want nothing more than to stick it to President Obama. But taking away health insurance from millions of Americans will only hurt the middle class and the poor.

Do we need to work on lowering the ridiculously high cost of health insurance and healthcare in America? Of course we do — and health advocates are working on that and other necessary health reform. But until that goal is achieved our country’s leaders had to do something to help millions of uninsured Americans. So the ACA includes tax subsidies for people who make too much money to qualify for Medicaid but not enough to afford decent insurance.

Until health insurance is affordable for everyone, tax subsidies help people get insurance so they can stay healthy, instead of waiting until they’re seriously ill before seeking care. The sicker someone is, the more expensive it is to treat them. We all pay for each other’s care one way or another — through higher insurance costs or local tax hikes to help hospitals care for the uninsured.

That’s how healthcare and health insurance worked before the ACA. We all pay one way or another. But under the ACA, keeping people healthier will drive down costs — for everyone. It also means fewer people will die of preventable illnesses.

Remember, before the ACA many insurance plans didn’t include no-cost preventive care. Dawn knows exactly what that means.

If you have insurance that doesn’t include those things, then there’s no purpose for it except for a catastrophe. And sometimes, not having an annual Pap smear or mammogram when you should can lead to a catastrophe.

Dawn also knows how ridiculous the King v. Burwell case is, and she’s not alone in that opinion.

“Everyone knew the ACA was an inclusionary idea, whether the wording was there or not,” she says. “I’m very grateful we’re able to have health insurance, and I’m hopeful the Supreme Court won’t take these subsidies away.”

A ruling on King v. Burwell is expected in June after the U.S. Supreme Court hears oral arguments on March 4th.