How many people could lose their subsidies?

If the court rules against the Obama administration in the King v. Burwell case, about 6.4 million people could lose their subsidies in 34 states that use the federal health care marketplace. The status of roughly 166,000 people in three other states — Oregon, Nevada and New Mexico — is unclear because those states at one time intended to run their own marketplaces, but now rely on the federal government to manage them.

Share of population under 65 receiving subsidies

2%
4%
6%
8%
States that have their own exchanges and would not be directly affected by a ruling.
Source: Department of Health and Human Services
Note: Shares are calculated from the number of people in each state on March 31 who had completed enrollment by paying their first premium and were receiving premium tax credits.

When would the subsidies go away?

If the court strikes down subsidies in the federal health care marketplaces, it will most likely take 25 days for the decision to go into effect. But the court could attach a stay to the ruling to give the political branches more time to act, and some lawmakers have already proposed bills that might delay the elimination of subsidies.

June 15 Deadline for the federal government to approve applications for new state exchanges in 2016.

Aug. 25 Insurance rates for 2016 are finalized.

Nov. 1 Shopping for 2016 plans begins.

June

July

Aug.

Sept.

Oct.

Nov.

Dec.

Jan.

Feb.

March

April

May

June

July

Aug.

June 25-July 3

Decision expected. Rulings typically go into effect 25 days later.

Sept. First month subsidies would not be available.*

 

Jan. 2016 Subsidies would go away if the court grants an extension along the lines Justice Alito suggested at oral arguments. Subsidy extension would also end under a bill introduced by Senator Ben Sasse of Nebraska.

Aug. Subsidy extension would end under a bill introduced by Senator Ron Johnson of Wisconsin.

June 15 Deadline for the federal government to approve applications for new state exchanges in 2016.

June 25-July 3

Decision expected. Rulings typically go into effect 25 days later.

June

July

Aug.

Sept.

First month subsidies would not be available.*

 

Sept.

Oct.

Nov. 1

Shopping for 2016 plans begins.

Jan. 2016 Subsidies would go away if the court grants an extension along the lines Justice Alito suggested at oral arguments. Subsidy extension would also end under a bill introduced by Senator Ben Sasse of Nebraska.

Nov.

Dec.

Jan.

Feb.

March

April

May

Aug.

Subsidy extension would end under a bill introduced by Senator Ron Johnson of Wisconsin.

June

July

Aug.

*Insurance companies typically require premium payments a month in advance, meaning subsidies are most likely to be paid on August premiums before the decision goes into effect. Some customers may get an extra month of coverage, through the end of September, because of state laws granting insurance customers grace periods.

How would insurance coverage change?

The effect of a court decision would not be limited to the people currently receiving subsidies in the federal marketplaces. People who buy their own health insurance in those states, even without subsidies, could be affected, because rates would increase if insurance pools become older and less healthy. Estimates from the Urban Institute prepared for The New York Times show how a post-King world would look compared with the current trajectory for the Affordable Care Act — or if the health law had never passed.

How the Ruling Could Reduce Insurance Coverage

Individual insurance

Employer insurance

Uninsured

Medicaid

Other

No Affordable

Care Act

18%

4

17

3

58

Status quo

10%

8

21

3

59

King wins

13%

4

21

3

60

No Affordable

Care Act

King wins

Status quo

Uninsured

10%

13%

18%

Individual

insurance

8

4

4

Medicaid

17

21

21

Other

Employer

insurance

58

59

60

Source: The Urban Institute calculations for The New York Times.
The Urban Institute estimates assume the court ruling would affect 34 states. It does not consider the loss of subsidies in Nevada, New Mexico or Oregon.

Which groups would be most affected?

Percentage who would become uninsured
By race/ethnicity
By region
By education
By employment status
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other, non-Hispanic
61%
14%
20%
6%
Northeast
Midwest
South
West
8%
25%
61%
6%
Less than high school
High school graduate
Some college
College graduate
15%
38%
32%
15%
Full-time
Part-time
Not working
47%
34%
19%
Percent who will become uninsured
By race/ethnicity
By region
By education
By employment status
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other, non-Hispanic
61%
14%
20%
6%
Northeast
Midwest
South
West
8%
25%
61%
6%
Less than high school
High school graduate
Some college
College graduate
15%
38%
32%
15%
Full-time
Part-time
Not working
47%
34%
19%
Source: The Urban Institute
The Urban Institute estimates assume the court ruling would affect 34 states. It does not consider the loss of subsidies in Nevada, New Mexico or Oregon.

What about the rest of the states?

States that run their own insurance marketplaces would be unaffected by a court ruling, meaning a widening gap between insurance coverage in the two groups of states. The Urban Institute estimated the outcome for federal and state-run marketplaces by 2016.

Estimated percentage of population under 65 in 2016

Individual insurance

Uninsured

Other

Medicaid

Employer insurance

Federal exchange state

60

15%

3

3

19

State exchange state

8%

8

24

2

58

Federal

exchange state

State

exchange state

Uninsured

8%

15%

Individual

insurance

8

24

Medicaid

19

Other

Employer

insurance

60

58

Source: The Urban Institute calculations for The New York Times.
The Urban Institute estimates assume the court ruling would affect 34 states. It does not consider the loss of subsidies in Nevada, New Mexico or Oregon.

How will the states react?

Under any court ruling, states will have the power to restore their residents’ subsidies if they establish their own exchanges. It would not be easy, but some states face more hurdles than others. Here is a look at the status of the states that could be affected. Some have already begun doing the work of building exchanges. Some have signaled weak interest and taken little action. Others have already set up legal impediments.

Most likely to preserve subsidies

Planned to run their own exchanges, but are using Healthcare.gov. May be safe from ruling.

Conditionally approved to set up a state-based exchange.

ME

ME

States that run their own exchanges

AK

VT

NH

MA

AK

VT

NH

MA

WA

MT

ND

SD

MN

WI

MI

NY

CT

RI

WA

MT

ND

SD

MN

WI

MI

NY

CT

RI

OR

ID

WY

NE

IA

IL

IN

OH

PA

NJ

OR

ID

WY

NE

IA

IL

IN

OH

PA

NJ

CA

NV

UT

CO

KS

MO

KY

WV

DC

MD

DE

CA

NV

UT

CO

KS

MO

KY

WV

DC

MD

DE

AZ

NM

OK

AR*

TN

VA

NC

AZ

NM

OK

AR

TN

VA

NC

HI

TX

LA

MS

AL

GA

SC

HI

TX

LA

MS

AL

GA

SC

FL

FL

Attorneys general asked the Supreme Court to preserve subsidies.

 

Run an exchange in partnership with the federal government and already perform some critical functions.

Show some interest in preserving subsidies

ME

ME

AK

VT

NH

MA

AK

VT

NH

MA

WA

MT

ND

SD

MN

WI

MI

NY

CT

RI

WA

MT

ND

SD

MN

WI

MI

NY

CT

RI

OR

ID

WY

NE

IA

IL

IN

OH

PA

NJ

OR

ID

WY

NE

IA

IL

IN

OH

PA

NJ

CA

NV

UT

CO

KS

MO

KY

WV

DC

MD

DE

CA

NV

UT

CO

KS

MO

KY

WV

DC

MD

DE

AZ

NM

OK

AR

TN

VA

NC

AZ

NM

OK

AR

TN

VA

NC

HI

TX

LA

MS

AL

GA

SC

HI

TX

LA

MS

AL

GA

SC

FL

FL

Have set up legal impediments

Passed law preventing governor from pursuing exchange-building activities.

Passed a constitutional amendment banning insurance mandates.

ME

ME

NH

AK

VT

MA

AK

VT

NH

MA

MT

WA

ND

SD

MN

WI

MI

NY

CT

RI

WA

MT

ND

SD

MN

WI

MI

NY

CT

RI

WY

WY

OH

OR

ID

NE

IA

IL

IN

OH

PA

NJ

OR

ID

NE

IA

IL

IN

PA

NJ

UT

MO

CA

NV

CO

KS

KY

WV

DC

MD

DE

CA

NV

UT

CO

KS

MO

KY

WV

DC

MD

DE

NC

AZ

OK

AZ

NM

OK

AR

TN

VA

NM

AR

TN

VA

NC

GA

AL

HI

TX

LA

MS

AL

SC

HI

TX

LA

MS

GA

SC

FL

FL

Most likely to preserve subsidies

Planned to run their own exchanges, but are using Healthcare.gov. May be safe from ruling.

ME

AK

VT

NH

MA

WA

MT

ND

SD

MN

WI

MI

NY

CT

RI

OR

ID

WY

NE

IA

IL

IN

OH

PA

NJ

CA

NV

UT

CO

KS

MO

KY

WV

DC

MD

DE

AZ

NM

OK

AR

TN

VA

NC

HI

TX

LA

MS

AL

GA

SC

FL

States that run their own exchanges

Conditionally approved to set up a state-based exchange.

ME

AK

VT

NH

MA

WA

MT

ND

SD

MN

WI

MI

NY

CT

RI

OR

ID

WY

NE

IA

IL

IN

OH

PA

NJ

CA

NV

UT

CO

KS

MO

KY

WV

DC

MD

DE

AZ

NM

OK

AR*

TN

VA

NC

HI

TX

LA

MS

AL

GA

SC

FL

Show some interest in preserving subsidies

Attorneys general asked the Supreme Court to preserve subsidies.

 

ME

AK

VT

NH

MA

WA

MT

ND

SD

MN

WI

MI

NY

CT

RI

OR

ID

WY

NE

IA

IL

IN

OH

PA

NJ

CA

NV

UT

CO

KS

MO

KY

WV

DC

MD

DE

AZ

NM

OK

AR

TN

VA

NC

HI

TX

LA

MS

AL

GA

SC

FL

Run an exchange in partnership with the federal government and already perform some critical functions.

ME

AK

VT

NH

MA

WA

MT

ND

SD

MN

WI

MI

NY

CT

RI

OR

ID

WY

NE

IA

IL

IN

OH

PA

NJ

CA

NV

UT

CO

KS

MO

KY

WV

DC

MD

DE

AZ

NM

OK

AR

TN

VA

NC

HI

TX

LA

MS

AL

GA

SC

FL

Have set up legal impediments

Passed law preventing governor from pursuing exchange-building activities.

ME

NH

AK

VT

MA

MT

WA

ND

SD

MN

WI

MI

NY

CT

RI

WY

OR

ID

NE

IA

IL

IN

OH

PA

NJ

UT

MO

CA

NV

CO

KS

KY

WV

DC

MD

DE

NC

AZ

NM

OK

AR

TN

VA

GA

HI

TX

LA

MS

AL

SC

FL

Passed a constitutional amendment banning insurance mandates.

ME

AK

VT

NH

MA

WA

MT

ND

SD

MN

WI

MI

NY

CT

RI

WY

OH

OR

ID

NE

IA

IL

IN

PA

NJ

CA

NV

UT

CO

KS

MO

KY

WV

DC

MD

DE

AZ

OK

NM

AR

TN

VA

NC

AL

HI

TX

LA

MS

GA

SC

FL

Sources: American Bar Association; Kaiser Family Foundation; National Conference of State Legislatures
*Arkansas is currently approved to run its small-business exchange in 2016 and its individual exchange in 2017, so there would be a year’s gap in coverage for most people there.