The U.S. Supreme Court could take until late June to announce a decision on King vs. Burwell (Case Number 14-114), and it’s still not certain whether the court will make a decision that deals with the merits of the case.
Meanwhile, insurers are mostly stuck with the prices they set for individual major medical insurance and small-group major medical insurance for 2015, whether those products are sold through a Patient Protection and Affordable Care Act (PPACA) public exchange or outside the exchange system, in a state with a PPACA exchange established by the U.S. Department of Health and Human Services (HHS) or by a state government.
Timelines vary from state to state, but insurers are already creating health insurance form and rate filings for 2016.
Insurance company actuaries are already having to try to come up with 2016 rates at a time when they’re under pressure from both the left and the right to give everyone a pony, a unicorn and a rainbow palace without imposing any cost increases or mandates on anyone; when they have no idea whatsoever whether any of the three PPACA risk-management programs will work; and when they have only a vague idea how PPACA provisions affected claims in 2014.
Meanwhile, they face the possibility that anything they think they might know about PPACA World could turn upside down in an instant, in June, if someone looks at Chief Justice John Roberts or Justice Anthony Kennedy the wrong way, or serves them a bad breakfast, or runs a horoscope that tells them to try a new approach to life.
The justices could simply save or kill the ability of HHS exchanges to offer PPACA premium tax credit subsidies, but it seems from Kennedy’s remarks during oral arguments as if the court could do something unexpected, such as finding a way to declare most or all of the PPACA provisions that limit commercial health insurance underwriting to be unconstitutional.
Even if all the justices do is get rid of the HHS exchanges’ ability to offer the premium tax credit, that move could have unexpected consequences. One health policy watcher put out a statement declaring that California residents would be safe, because California has a state-based exchange and could still offer subsidies. But what would California health insurers do, in that situation, if moderate-income Arizona residents with HIV and imminent organ transplant needs poured across the border and applied for coverage?
Certainly, some LifeHealthPro.com readers would cry if the Supreme Court rules against the Obama administration on King vs. Burwell. Many more would cheer.