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The PPACA Florida puzzle

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Election politics could save the Patient Protection and Affordable Care Act (PPACA) premium subsidy program.

James Slotnick, a broker education specialist at Sun Life Financial (TSX:SLF), talked about the election protection theory in a recent commentary on the King vs. Burwell U.S. Supreme Court case.

The U.S. Department of Health and Human Services (HHS) argues that it has the authority to offer the Patient Protection and Affordable Care Act (PPACA) premium tax credit subsidy through the exchanges it started. The plaintiffs in the case say only state-based exchanges have the authority to offer the PPACA premium tax credit.

If HHS loses the ability to offer the PPACA subsidy through HHS-established exchanges, that could cause what moderate-income consumers have to pay out of pocket for coverage to quadruple, shut many consumers out of the individual market, and, possibly, cause other, hard-to-predict effects on other markets, analysts say.

See also: King vs. Burwell: So what?

The shifts would push younger, healthier people out of the individual market and could make offering affordable major medical coverage without use of medical underwriting impossible.

See also: Obamacare plans: Losing the young

Republicans in Congress have made many efforts to kill PPACA, knowing that Democrats in the Senate would block them.

If, however, the Supreme Court rules against HHS, and the ruling threatens to kill the HHS-established exchanges, presidential election year politics could suddenly change Republicans’ thinking, Slotnick says in the commentary.

For more about the Presidential Year Politics theory, read on.


Republicans in Florida have done what they can to strangle the PPACA exchange system in the cradle but have no success whatsoever.

The HHS has helped 1.6 million Florida residents sign up for private exchange plan coverage. An HHS spreadsheet that gave ZIP-code-zone-by-ZIP-Code-zone exchange plan selection figures for the first two months of the 2015 open enrollment period showed that the top 10 zones were all in south Florida.

See also: 10 ZIP codes that love PPACA exchange plans

In addition to being a state full of wildly enthusiastic exchange plan buyers, Florida is a state with 29 electoral votes. 

In presidential elections, Florida often has hotly contested elections. 

See also: Post-Election Forecast: Cloudy

According to advocates of the Presidential Year Politics theory about King vs. Burwell, “The Republicans can’t afford for there not to be subsidies in Florida,” Slotnick says. “The Republicans cannot win the presidential election without Florida’s 29 electoral votes.”

The Presidential Year Politics theory could also affect Republicans’ level of interest in killing the subsidies in some other states.

Voters in North Carolina, Virginia and Pennsylvania have voted for some Democratic presidential candidates, and has received exchange plan information for about 1.4 million people in those states.