Perhaps concerned that the Supreme Court is thinking too much about the devastation they might cause if they decide that Congress intended to withhold Obamacare subsidies from something like 8 million people buying insurance on the federal exchanges, Obamacare opponents are now suggesting that
it wouldn't be such a big deal. The new narrative also could be an effort to either give cover to a Republican Congress that is utterly incapable of crafting a fix, or an effort to convince them that they don't need to.
A few weeks ago, the Heritage Foundation’s Edmund Haislmaier published an "Issue Brief" entitled "King v. Burwell: A Loss of Subsidy Does Not Mean a Loss of Coverage." That’s a provocative title, considering 87 percent of the 8.8 million enrollees from federal exchanges receive those tax credit subsidies, meaning they have low or moderate incomes.
There's another argument about why the Obamacare lawsuit won’t be as bad as everyone else has said. This one comes from Joel Zinberg, a surgeon and lawyer from the Mount Sinai Hospital in New York who's a visiting scholar at the American Enterprise Institute. In a March article, Zinberg questioned the mere concept of an insurance "death spiral," not just whether a Supreme Court ruling gutting Obamacare could cause one. […]
"Are 'death spirals' real, or just a way to frighten the public?" Zinberg writes, foreclosing the possibility they are both. "There is little reason to believe a death spiral would follow a plaintiff's victory in King v. Burwell," he continues.
In fact, neither assertion has any basis in fact. The vast majority of people getting health insurance through Obamacare—
83 percent of them—getting the subsidies have an income of 250 percent of the federal poverty level or less. That's $23,450 for a single person. Good luck to that person—and the other 83 percent—getting affordable health insurance that's not subsidized. They are policies that might have lower deductibles, so the people buying them don't have to pay huge amounts out-of-pocket. Getting a Silver Plan at $20 a month, subsidized, makes a great deal more sense than a Bronze plan that has a deductible of $5,000 or more.
As for the death spiral, well, if you live in a fantasy world in which all those subsidized people at 250 percent below the poverty line can still afford to buy insurance, sure there won't be a death spiral because they won't be dropping their insurance. In the real world, health insurance will once again be a luxury they can't afford, and only the people who need insurance the most—the sick ones who cost the most—will find a way to keep it. That's a death spiral, and that's the likely end of the whole system of reforms Obamacare has created.
These conservatives can do their damnedest to try to convince the Supreme Court, congressional Republicans, and the public that wrecking this system isn't a big deal. But the fact that they're working so hard to do so reflects the fact that Republicans are getting really worried that the court is going to grant them their most fervent wish. And when it all falls apart, the voter is definitely going to know who to blame.