The Supreme Court on Thursday ruled to uphold tax subsidies in all of Obamacare’s state-level marketplaces — a blow to the law’s opponents, but one that effectively provides political cover for Republican politicians, who won’t have to scramble to figure out what to do to preserve millions of Americans’ affordable access to health insurance.
Now, in the aftermath of the second major Supreme Court challenge that has allowed the bulk of the health law to stand, Obamacare supporters are urging to put an end to a debate that’s spanned over the past several years.
But there’s still a major area of health policy that could be a burr in the side of GOP lawmakers: Obamacare’s Medicaid expansion, which was ruled optional by the Court in 2012 and has been implemented unevenly across the country since then.
Similarly to the potential threat posed by a ruling in favor of the plaintiffs in King v. Burwell, which would have put an estimated 6.4 million Americans at risk of losing their health insurance, the current political resistance to Medicaid expansion is leaving millions of people locked out of coverage altogether. According to the Kaiser Family Foundation, about 4 million Americans currently fall into what’s known as a “coverage gap” — they make too much money to qualify for public insurance without the expansion, but too little money to obtain a tax subsidy on the state-level marketplaces. Also similarly to the outcome that could have resulted from King, the bulk of the people affected by this policy issue live in red states in the South:
For the past several years, the evidence in favor of Medicaid expansion has been mounting. Research has confirmed that accepting the expansion — which is almost entirely financed by the federal government — helps save states money, create more jobs, and strengthen the hospital system. It also disproportionately benefits black Americans who have historically struggled with higher rates of poverty and uninsurance. According to one recent analysis, if every state agreed to expand Medicaid, the national uninsured rate would be two percentage points lower.
The GOP resistance to expanding Medicaid has also been increasingly framed as a moral issue, as activists have filled state capitol buildings and participated in acts of civil disobedience to pressure their lawmakers to extend coverage to additional low-income people.
Nonetheless, Republican leaders have dug in their heels. Just this week, ten GOP attorneys general wrote a letter to congressional Republicans asking for help resisting the Obama administration’s pleas to expand the public health program. In their letter, they characterized the Centers for Medicare and Medicaid Services, which has been working with state lawmakers to strike deals to facilitate expansion, as “an agency insistent upon trampling the rights of our sovereign states to make critical policy decisions regarding Medicaid.”
So, now that the Supreme Court has preserved tax subsidies across the country, Republican politicians may no longer come under scrutiny for their position on whether their constituents deserve financial assistance to help them enroll in plans on Obamacare’s marketplaces. But they could still be pressed on their position on Obamacare’s second major prong of coverage expansion — and there’s some speculation that, now that conservatives’ last-ditch effort to thwart Obamacare has failed in the highest court in the country, the GOP may finally be forced to soften.