Over 6 million could face Obamacare “death spiral” – arguments start today

The point of discussion may be just four small words, but when the Supreme Court starts listening to arguments today, their subsequent decision could herald a “death spiral” for the Affordable Care Act. The four words in question were spotted by Thomas M. Christina, a lawyer from Greenville, S.C., who specializes in employment benefits.
 
The phrase seems to imply that the tax-credit subsidies offered under the health care law would be limited only to those living in states that had their own exchange “established by the state.” If a majority the justices agree with his interpretation (a decision is likely late June or July), some predict that healthcare costs could soar -- leading to a collapse of the system in most states.
 
The Obama administration is, however, not offering any contingency plans to try to cover such an eventuality, claiming that any preparations would be politically unworkable. 
 
“If they rule against us, we’ll have to take a look at what our options are. But I’m not going to anticipate that,” President Obama told Reuters. “I’m not going to anticipate bad law.”
 
Some legal commentators think this is a remarkably shrewd move – if the justices know there is no Plan B, they may be more cautious when considering whether to strike the law down.
 
So who would be most affected?
 
Of the states without their own exchanges, Florida has the highest proportion of the population under 65 receiving subsidies at 9.4% -- which is close to 1.5 million people. North Carolina and Maine are the second-biggest beneficiaries by proportion of their population at 6.1% (515,000 and 67,000), while by sheer numbers Texas has the second-largest number of recipients of subsidies at just over 1million.
 
Studies by the Urban Institute show that those most affected will probably be white high-school graduates who live in the South and have jobs.

By number of people:

 

State	recipients <65	% of population
FL	1,488,006	9.4
TX	1,022,810	4.4
NC	514,715	6.1
GA	483,236	5.5
PA	382,263	3.6
VA	319,228	4.5
MI	299,996	3.6
IL	270,894	2.4
MO	223,493	4.4
NJ	209,817	2.8
OK	196,986	2.0
IN	192,383	3.4
TN	187,856	3.4
SC	184,600	4.6
WI	183,197	3.7
LA	164,233	4.1
AZ	153,140	2.7
AL	150,246	3.7
UT	123,394	4.7
OK	98,622	3.0
MA	97,385	3.8
OR	85,978	2.6
KS	76,981	3.1
ME	66,565	6.1
Nev	65,229	4.1
NV	64,914	2.7
AR	57,153	2.3
MT	45,651	5.4
NM	38,893	2.2
IA	38,589	1.5
NH	37,061	3.3
WV	28,127	1.8
DE	20,656	2.7
WY	19,245	3.8
SD	18,641	2.6
AK	18,389	2.7
ND	15,588	2.5

 

By percentage of the population:

State	recipients <65	% of population
FL	1,488,006	9.4
NC	514,715	6.1
ME	66,565	6.1
GA	483,236	5.5
MT	45,651	5.4
UT	123,394	4.7
SC	184,600	4.6
VA	319,228	4.5
TX	1,022,810	4.4
MO	223,493	4.4
LA	164,233	4.1
Nev	65,229	4.1
MA	97,385	3.8
WY	19,245	3.8
WI	183,197	3.7
AL	150,246	3.7
PA	382,263	3.6
MI	299,996	3.6
IN	192,383	3.4
TN	187,856	3.4
NH	37,061	3.3
KS	76,981	3.1
OK	98,622	3.0
NJ	209,817	2.8
AZ	153,140	2.7
NV	64,914	2.7
DE	20,656	2.7
AK	18,389	2.7
OR	85,978	2.6
SD	18,641	2.6
ND	15,588	2.5
IL	270,894	2.4
AR	57,153	2.3
NM	38,893	2.2
OK	196,986	2.0
WV	28,127	1.8
IA	38,589	1.5