Before the month is over, the Supreme Court will issue its decision in King v. Burwell, a major case that will drastically affect healthcare in most states. One of those states is Indiana.

The case is pretty tangled in legalese, so I’ll try to explain it as succinctly as possible: Under the Affordable Care Act (colloquially known as “Obamacare”), citizens without insurance from an employer or by family extension must sign up for insurance themselves or incur a tax penalty. To help them find their ideal insurance plan, the federal government set up an insurance marketplace, or exchange, where people can shop around. The law intended for each state to set up its own exchange, as well, but so far most states have not, leaving the federal exchange as the only option for millions of people.

Federal subsidies and tax credits aid insurance buyers in affording their plan. However, a legal challenge contends that the language of the law stipulates only the states can offer such subsidies, not the federal government. If the Supreme Court should side with them, all federal subsidies in states without their own marketplace will end, resulting in millions of insurance enrollees being unable to afford their plan. Almost literally, it comes down to the interpretation of the words “the state” in the law.

Indiana, unfortunately, is one of those states without its own exchange, so things could get pretty bad for Hoosier ACA enrollees. Lower-income residents at least have the option of the Healthy Indiana Plan, but those who don't qualify will either be left with extreme sticker shock, or even worse, have no choice but to pay the penalty for being uninsured. Make no mistake, it’ll be bad if the Court strikes down those subsidies.

The ACA isn’t the political hot potato it was as little as two years ago, and people everywhere are using it. For this reason, some are anticipating that some sort of fix could be made at the state or federal level, but so far the Republican Congress and state legislatures have been pretty vague on the subject. Here in Indiana, Governor Mike Pence has said he’ll wait for the Court’s decision to decide his course of action.

It might seem hard to imagine an ideologue like Pence doing much to fix the situation. However, he did set up the Healthy Indiana Plan amidst pressure from the state and its healthcare workers over his party's orthodoxy. He could have more easily just taken the ACA’s guaranteed Medicaid expansion, sure, but instituting HIP as an alternative is better than simply leaving residents who could use such a program with nothing, which is what several Republican states have done. Also, several recent polls show his popularity has tanked in the wake of the state’s Religious Freedom Restoration Act. Saving peoples’ healthcare and looking like the good guy on the eve of next year’s reelection campaign could be the shrewd political move he's looking for.

But that’s all speculation. For the time being, all Hoosiers should keep an eye on the Supreme Court and their health insurance. Brace yourselves. This could get ugly.


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