The potential executioners.
Sarah Kliff at Vox has the
story of Marilyn Schramm, a 63-year-old retiree who doesn't yet qualify for Medicare, and who has an $800 plan from Healthcare.gov, because she lives in Texas and Texas didn't create its own exchange. Federal subsidies pick up about half of Schramm's premium costs, so she pays about $400 a month on her $28,000 pension income. Schramm also has colon cancer, and not a lot of choices if the Supreme Court decides to take her subsidy away.
Schramm isn't sure if she will still be able to afford her health insurance come June. She's among the millions of Americans receiving subsidized coverage through Healthcare.gov. A pending Supreme Court case, King v. Burwell, argues that these subsidies are illegal—that the White House does not have the legal authority to give people like Schramm financial help. […]
She can't pay an $800 monthly premium on her $28,000 annual income (mostly from a state pension) if her subsidies disappear. She's thought about dipping into her retirement savings, but hopes to hold onto those for her actual retirement.
"I guess I could do that in the very short term since I have to finish my chemo treatment," she says.
Her best back-up plan right now, she says, is moving to a place with a state-run exchange. She'll live there for the next two years, until she turns 65 and qualifies for Medicare.
Schramm says she hasn't researched yet which states have exchanges and, beyond that, which one she might move to. She's been more focused on her medical issues.
"I haven't wrapped my head around it," she says. "I have so much going on. I've had a colostomy. I'm trying to figure out how to stop the colostomy bag from leaking. I have to wake up every two hours to adjust it. I'm starting to have side effects from chemo. So it's on the list to think about, but not at the top."
There's no telling how many Marilyn Schramms there are in the 8-10 million people at risk of losing their subsidies. If the court decides to strike them down, some of the states which don't have exchanges might decide to try to create them, but that's not at all a certainty. There are
significant barriers for states in both setting up and maintaining exchanges, not to mention the politics. About 5 million people have their insurance in states that neither accepted Medicaid expansion or set up an exchange—those are the states most unlikely to bother to take care of the majority of those 5 million who have subsidies.
This isn't just an arcane legal debate. It's not just another policy fight. It's life and death.