Some 6.4 million low- and middle-income people receive federal subsidies to make the insurance they buy through the Affordable Care Act (ACA) exchanges truly affordable. But with the U.S. Supreme Court set to rule on whether those subsidies should be allowed in states that use the federal insurance exchange, coverage for millions of Americans hangs in the balance.
The decision will not directly affect subsidies in states that have local exchanges. Even some states that currently use the federal marketplace have come up with contingency plans that would enable their residents to receive federal assistance if the Supreme Court strikes down the subsidies.
But Missouri relies on the federal exchange, and it has not devised a backup plan.
Missouri voters have been staunch in their opposition of the ACA, voting in 2012 to prevent the governor from setting up a state exchange without approval from voters or the Missouri Legislature. Attempts by Missouri lawmakers to adopt pieces of the ACA have been met by strong opposition from the legislature’s Republican majority.
If the high court rules against the subsidies, young and healthy people who have relied on federal help to buy insurance would become more likely to go uninsured. That would drive premiums up for the remaining pool of people buying insurance, which would include a higher proportion of old and chronically ill people.