Congress in a bind awaiting Obamacare subsidy decision

Republicans, led in the House by Speaker John Boehner, are at odds over a plan.
Republicans, led in the House by Speaker John Boehner, are at odds over a plan.

On a big-picture level, nursing homes would seem to fare better if more and more prospective residents would enter their facilities with private insurance instead of Medicaid. But it's difficult for even the keenest observers to predict the long-term consequences of having to care for potentially larger incoming Medicaid-dependent populations, should the Supreme Court throw out their Obamacare subsidies next month.

Providers are among the numerous groups nationwide awaiting the Highest Court's decision with anxiety.

Republicans in both houses of Congress now find themselves in power —but also fractured over how, or whether, to provide some kind of safety net to millions of Americans who obtained government subsidies to buy private insurance on Healthcare.gov. They risk potentially stiff political fallout in the 2016 elections, as new analysis this week shows.

In June, all eyes and ears on Capitol Hill, and beyond, will be anxiously awaiting the court's verdict in the King v. Burwell case. It could invalidate those subsidies on the grounds that the Affordable Care Act legally allows subsidies provided only by state health exchanges, not Healthcare.gov. Twenty-two of the 24 GOP senators running for election next year are from Healthcare.gov-supported states. Some Republicans have hinted they would support a temporary measure that would ease the loss of those subsidies. Otherwise, some warn, masses of people leaving the market could cause chaos.

One thing may be certain: A mass exodus of insured individuals from the marketplace would likely lead to premium increases for most. The Urban Institute estimates that a ruling for the plaintiffs would increase the number of uninsured by 8.2 million and eliminate $28.8 billion in tax credits and cost-sharing reductions in 2016 ($340 billion over 10 years). “With lower-cost individuals leaving the market, average non-group premiums in 34 states would increase by 35 percent,” the organization notes.