The U.S. Supreme Court ruling on the Affordable Care Act means that more than 80,000 Oklahomans can continue to receive federal subsidies to help them pay for health insurance.
It will be days, possibly weeks, before the full impact of the ruling is assessed. In this Q&A, Oklahoma Watch addresses some of the immediate issues raised by the ruling.
Q: Does this mean “Obamacare” is still the law of the land in Oklahoma?
A: Yes. The original Affordable Care Act of 2010 already has been modified somewhat by court rulings and legislation. But most of its original provisions remain intact.
Q: How many Oklahomans are affected by today’s ruling?
A: As of March 31, a total of 87,136 Oklahomans were receiving subsidies for individual policies they bought through the “health care marketplace” created by the Affordable Care Act. Tens of thousands more will be affected, too.
Q: How so?
A: Many Oklahomans already qualify to receive Obamacare subsidies but haven’t applied for them yet. Today’s ruling might influence their thinking. Leavitt Partners, a Utah-based consulting firm, estimates that as many as 208,000 Oklahomans will now be able to afford insurance. Leavitt’s estimate includes people expected to join the rolls through next year.
Q: What happens next? What will Oklahoma officials do?
A: Gov. Mary Fallin and U.S. Sen. James Lankford, among others, issued statements expressing disappointment in the ruling. Since this was a U.S. Supreme Court ruling, it’s doubtful they would attempt to defy it or challenge it directly.
Q: What about Oklahoma Attorney General Scott Pruitt and his lawsuit against the subsidies?
A: Pruitt’s lawsuit was consolidated with challenges by several states and was effectively settled by today’s Supreme Court ruling. Pruitt issued a statement saying the rule of law “took a hit,” but hinted that he’s not done fighting.
Q: What other options do Obamacare opponents have?
A: They might use this as an opportunity to make good on previous promises to develop an “Oklahoma Plan” addressing the needs of people covered by the original provisions of the Affordable Care Act.
Q: Will they create an Oklahoma-operated health care marketplace?
A: It’s always possible. But so far they’ve rejected that idea. They can continue to let the federal government operate the marketplace in Oklahoma.
Q: What’s the political impact of today’s ruling?
A: The initial assessment of political analysts seems to be that the ruling was a relief to Republican opponents of Obamacare in political terms, even if they dislike the legal impact. Because the subsidies weren’t overturned, those officials are under no additional pressure to do anything about the 6 million Americans who might have lost their health insurance.
Q: What about the presidential campaign?
A: In a conference call briefing with health reporters today, experts with the Henry J. Kaiser Family Foundation in Washington, D.C., predicted the ruling would lower the political temperature of Obamacare in the presidential race. They expected it would still be debated, but that the candidates would mainly tailor their remarks to appeal to their core constituents.
Q: Will the ruling encourage more states to set up their own health marketplaces?
A: Not necessarily. In fact, it could have the opposite effect. The Kaiser experts said some states have concluded that the information technology challenges associated with setting up a state marketplace are too daunting. The ruling might cause some undecided states to continue relying on the federal government to run things. One state, Pennsylvania, has decided to do so already.
Q: I’m confused about today’s ruling. Is this the same thing as Medicaid expansion?
A: No. The Affordable Care Act had many provisions. Oklahoma officials have made important decisions about more than one. In one case, Gov. Fallin decided that Oklahoma would not participate in a proposed expansion of its Medicaid program, called SoonerCare. In another, Fallin decided that Oklahoma would not create its own health care marketplace. Today’s decision only involves the marketplace issue.
Q: Are the same people affected by Medicaid expansion and the health care marketplace?
A: No. Oklahoma’s Medicaid program, SoonerCare, only covers some working adults who fall below the federal poverty line, and pregnant women and children up to the poverty line and somewhat above. The health care marketplace only affects people above the poverty line.
Q: I keep hearing about the “coverage crater.” What’s that?
A: An estimated 150,000 adult Oklahomans earn too much to qualify for SoonerCare but not enough to qualify for health marketplace subsidies, according to the Oklahoma Policy Institute. Those people fall into the so-called coverage crater.
Q: What about Insure Oklahoma? Is it important?
A: Insure Oklahoma is an existing program that provides state-subsidized health coverage to nearly 18,000 working Oklahomans who meet its eligibility requirements. Many of the people affected by Medicaid expansion and the health marketplace don’t qualify for Insure Oklahoma. Some political analysts have speculated that Oklahoma might have tried to expand Insure Oklahoma if the marketplace subsidies had been struck down. They might do so anyway.
Q: What about the Obamacare premium increases I keep hearing about?
A: The private insurance companies that participate in the health care marketplace in Oklahoma all requested and received approval for premium increases for 2015. The amount of the increases varied widely. They are expected to seek another round of premium increases for 2016 coverage.
Q: How can I find out more about the health care marketplace?
A: The federal marketplace website, or its Spanish-language equivalent. The Henry J. Kaiser Family Foundation also has a subsidy estimator.
Q: What if I don’t have Internet access or need help with my application?
A: The federal government’s toll-free help line is 1 (800) 318-2596. In addition, you can meet with a federally certified application counselor or a certified insurance agent or broker. Find one.
Q: Can the government force me to buy health insurance?
A: No. But if you don’t have health insurance and don’t buy any, you may be subject to a fine. For 2015 coverage, the minimum fine was $325 per person. Some uninsured people, including Native Americans and people below the poverty line, are exempt from the fines.
Q: Are undocumented immigrants in Oklahoma receiving subsidized health coverage?
A: Only if they go to hospital emergency rooms and risk the possibility of detection and deportation. The Affordable Care Act only applies to citizens and lawfully present immigrants.
Health Experts: Political Implications
Oklahoma Watch asked three experts with the Henry J. Kaiser Family Foundation in Washington, D.C., the largest health foundation in the country, about the political impact of today’s Supreme Court decision upholding Affordable Care Act health insurance subsidies.
The exchange occurred during a conference call briefing with health care reporters across the country. Here are their responses. They have been condensed slightly for the sake of brevity.
Oklahoma Watch: In states like Oklahoma where Republican officials have opposed almost every aspect of Obamacare and have shown no interest in creating a state-based exchange, will today’s ruling change the political equation?
Kaiser Senior Vice President Larry Levitt: I don’t think it changes the political equation relative to the status quo. If the decision would have gone the other way, it would have put red state governors in a very difficult spot. They would have had to choose between opposing Obamacare versus making sure that billions of dollars in subsidies were flowing to their residents. With this decision, governors are free to oppose the Affordable Care Act on political grounds. But that doesn’t have consequences for the subsidies. There’s still the question of Medicaid.
State Health Reform Director Jennifer Tolbert: Currently 30 states have expanded the Medicaid program, leaving 20 states that have not yet expanded Medicaid. There are discussions in several states. It’s unclear whether [today’s ruling] will affect any of the decisions by legislatures and governors that have not yet expanded Medicaid. The Medicaid expansion can happen at any point. The 100 percent federal funding is available for one more year, through 2016. There’s still a great deal of federal funding available to the states should they choose to implement the expansion.
Senior Fellow Karen Pollitz: Oklahoma is one of a handful of states that has declined to enforce any of the insurance market reforms and has left that to the federal government. I think there are still several ways for states to decline to participate or try to throw up other roadblocks to successful implementation.
