Appeals courts attack and support Obamacare. What impact and reaction can we expect?

There is a great deal of confusion over the recent appeals courts decisions on Obamacare   At issue is whether those who got Obamacare through the federal exchanges could have their policies subsidized to make them affordable. One appeals court dominated by Republicans ruled against the ACA subsidies of federal exchange issued policies  and the other dominated by  Democrats ruled support for  the subsidies.

This  issue will go to a Supreme Court that has already once before upheld Obamacare, but given the 5/4 split against the administration in recent decisions, who knows. The appeals will take many months. In the meantime, the administration announced the subsidies would continue.

What sort of a reaction could we expect if the Supreme Court rules against Obamacare? There will not be much impact in Colorado.  Any of these court rulings  will not affect Colorado because Colorado and fourteen other states  set up their own exchanges and can subsidize premiums.. 

 For those 4.7 million who would   lose their affordable insurance, the reaction would  be an angry one. The Journal of the American Medical Association, July 9, 2014 reported that Obamacare is working as designed . The article reported  ""that 87% of the people signing up for coverage in the federal marketplace qualify for income-based premium subsidies that lower their average premium from $346 per month to $82, a reduction of 76%."

Many would not be angry. The ACA's acceptance has been particularly  challenging, because experience with it has been  short.. Employer provided insurance has been vastly improved , stopping  insurance companies from overcharging, discriminating against women and setting lifetime caps. Now employer insurance is  covering cancer screenings without copays. Consumers wanting to work part time or leaving a job will always have the security of  access to affordable health care.  Those advantages  will only be  fully appreciated and understood when the beneficiaries experience them.   

Complicating acceptance of the ACA is political polarization , coloring any objective views of it. About 60 percent polled recently by the Kaiser Family Foundation (May 30, 2014) said they had not been affected by the law yet the majority still disapprove of the law, affected or not.  Approval of the ACA  remained at about 38% and disapproval at around 45%.   Per the same Kaiser poll:." As in the past, most Democrats view the law favorably, and most Republicans view it unfavorably." Count on any reaction to be mostly partisan.

  What a decision to  deny subsidies will mean, is that either the  states who declined to set up their own exchange/marketplaces, or who  refuse to do it in the meantime, will leave their near poor who could not afford insurance again uninsured as  before Obamacare. . Most of those are in red states that  also refused to expand Medicaid.

  State budgets will also feel the strain of covering more  uninsured.  How long that will last depends on whether their voters demand that their states set up their own exchanges when they see how disadvantaged so many of them  are compared to other states.

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There is an excellent discussion in the Wall Street Journal. For those wanting fuller explanation of the appeals  and the potential impacts, go to http://online.wsj.com/articles/key-section-of-health-care-law-struck-down-by-appeals-court-1406039685.

Another good read (I didn't see it until after I posted the above)  but this one also speculates on whether and how the Supreme Court will rule as well as the significance of the Obama administration's request that the appeals court as a whole hear the case. The whole thing could die there. 

PS: writing in the Wall Street Journal blog 7/26/14, Drew Altman has a posting worth reading, that the public polls show voters do not want the ACA repealed, just improved. If they view this case as a back door attempt to kill it by defunding it, there could be repercussions against the political proponents and the plaintiffs, in the case. The legislative intent for the subsidies of the federal exchange premiums are clear.  This is recommended reading.
http://blogs.wsj.com/washwire/2014/07/25/the-stakes-beyond-the-halbig-lawsuit/

Sources for data in this blog posting.
 http://www.washingtonpost.com/blogs/wonkblog/wp/2014/07/23/wonkbook-what-you-need-to-know-about-obamacares-wild-day-in-court/

http://kff.org/health-reform/press-release/majority-of-the-public-say-they-havent-been-affected-by-the-health-reform-law/

http://www.businessweek.com/articles/2014-07-22/obamacare-ruling-by-the-numbers-4-dot-7-million-could-lose-subsidies