A bit of contrast here.
During oral arguments in King, Justices Anthony Kennedy and Ruth Bader Ginsburg expressed concerns that not allowing subsidies in the 37 states using the federally established exchange would set off a death spiral in those states. Their fear was that while subsidies would no longer be available, and there would effectively be no individual mandate, community rating and guaranteed issue would remain.But the Obama has an answer to that. Obama: Obamacare was Republicans' plan
Many commentators saw Justice Kennedy’s comments as a signal he isn’t willing to stop subsidies on federal exchanges, either because of the serious consequences of doing so or because surely Congress could not have intended to put states in the position of choosing between creating an Obamacare exchange or seeing health insurance markets destroyed.
What Justice Kennedy and many others may not understand, however, is the death spiral is probably already underway in all 50 states, regardless of how the Supreme Court rules in this case.
According to the Manhattan Institute, premiums climbed by 41 percent on average from 2013 to 2014, and premiums are likely to rise sharply again after two insurance company bailout programs included in Obamacare expire in 2017.
The other sign health insurance markets are in the early stages of a death spiral is the age mix of those buying policies through Obamacare. Originally it was estimated that around 40 percent of enrollees had to be in the relatively healthy 18 to 34-year-old age segment, so their premiums could be used to pay for the health expenses of older, less-healthy enrollees. So far it appears only some 28 percent of enrollees are in that coveted age group, which also comprises around half of the uninsured.
All of this means insurers are getting a risk pool that is less healthy than expected, and more premium hikes are around the corner. While subsidies hide some from the full impact, others in the middle class will not be shielded.
It will undoubtedly take a few years to know for sure, but for anybody concerned about setting off a death spiral or thinking Congress surely didn’t intend to do so, don’t worry. It looks like it’s already here, whether Congress intended it or not.
He reminded Republicans that some of the ideas behind the Affordable Care Act — most notably its individual mandate to buy coverage — were once supported by some conservatives, although its Medicaid expansion and some other big parts of the law stem more from liberal thought.And yet none of them voted for it. Maybe because they thought about it a little more and saw the pitfalls.
"The Affordable Care Act pretty much was their plan before I adopted it," he said.