Why The Supreme Court Obamacare Ruling Mattered For Idaho

Jun 26, 2015

Credit Michael Galkovsky / Flickr

The head of Idaho's state-run health insurance exchange says no matter what decision the U.S. Supreme Court made Thursday on the federal subsidies that are part of Obamacare, the state wouldn't have been affected.  

The court upheld the practice of giving subsidies to people buying health insurance in states that don’t have their own exchanges. Idaho is one of the 16 states that created exchanges.

“No matter what the Supreme Court decided, Your Health Idaho customers were always going to be able to maintain their tax credits as our status as a state based exchange was never in question,” says Pat Kelly, director of insurance exchange Your Health Idaho.

Kelly says he was not worried at all about what the Supreme Court would rule.

Chad DeVeaux says maybe he should have been. DeVeaux teaches constitutional law at Boise’s Concordia Law School. DeVeaux says the Affordable Care Act was a grand bargain between the insurance industry and the government. Insurance companies got on board for the promise of millions of customers buying from them using federal money.

“If you lose [millions of] customers based on a court decision, that basically cripples that bargain,” DeVeaux says. “Is the Affordable Care Act going to continue to function the way it was initially designed for the benefit of 16 states out of 50?”

A lot of pundits have claimed that if the court said people buying insurance on the federal exchange could not get subsidies, Obamacare would have to be scrapped entirely, including state exchanges.

Lynn Quincy says we can’t know if that would have happened. Quincy is associate director of health policy at Consumers Union, the policy arm of Consumer Reports. She says if the decision had gone the other way Idaho’s exchange would have continued to operate as usual with federal subsidies for the immediate future. But Quincy says things would not have stayed the same for Idaho long-term.

“If nothing else happened, if we just got an adverse ruling, and there were no fixes passed by Congress, we would expect health insurance markets for the people who buy on their own to sort of unravel,” Quincy says.

Quincy says that unraveling would have started in the 34 states without their own exchanges, but she says ripple effects would certainly have been felt in Idaho. For example she says, millions of people leaving the pool of insured could have raised costs a lot for the people who were left.

Of course that’s all hypothetical; the court upheld subsidies in all the states. Quincy says because Idaho has been running its own exchange, it’s in a good position to start moving beyond the controversies surrounding Obamacare. That’s something Your Health Idaho director Pat Kelly can agree with.

“The big difference for Idaho is we haven’t been distracted by these court cases,” Kelly says. “We’ve been able to focus on our consumers and improving the consumer experience as we move toward open enrollment in the fall.”

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