A potentially lid-blowing ruling momentarily will come from the U.S. Supreme Court.
Then there also is the other one on gay marriage, which is imminent as well.
Obamacare--love it or misunderstand it or reject it irrationally--could be largely undone by the court's interpretation of a single word in the law, that word being "state."
If that happened, Gov. Asa Hutchinson would have to decide whether to take affirmative action in Arkansas to remake our health-care exchange from a federal one to a state one and thus salvage vital subsidies for health-insurance coverage for 57,000 or more working low-middle and middle-class residents of the state.
He would need to do that to keep on course whatever it is that he and his task force have in mind for long-term health-care reform in the state.
They talk of seeking a waiver in 2017 to remake in a more conservative image the way the health-care exchange works for Arkansas customers. But they couldn't very well do that if the exchanges nationwide had crumbled under the Supreme Court's ruling about the effect of that single word.
The politics would be nigh unto impossible for Hutchinson. His right-wing base might revolt if he tried to rescue Obamacare in the state, no matter how humane, practical and important to broader reform that might be.
Maybe Chief Justice John Roberts or Associate Justice Anthony Kennedy will save him, and the 57,000, and right-thinkers among us. Either could do that by joining the four court liberals to say that Congress clearly intended something different than that specified by a single sloppy word in a massive law--and that, therefore, we may proceed on course as usual.
If not, much the same dilemma facing Hutchinson would apply to congressional Republicans.
Some of them will want to respond to an anti-Obamacare ruling by finding a way to keep the system working at least for a while and on a reduced basis. But presidential candidate Ted Cruz will want to kill all of Obamacare in six months and presidential candidate Rand Paul will want to establish a system of cheap insurance policies so that lower-income people could go from adequate coverage to inadequate coverage.
So here is the situation: Obamacare seeks to extend universal health insurance from several directions. One is to grant subsidies in the form of tax credits to people not in poverty and Medicaid-eligible, but working and in lower-middle and middle classes. These subsidies cushion the premiums these Americans are mandated to pay--in order to make reform work overall for private insurers--but which they could not reasonably afford on their own.
The section of the Affordable Care Act authorizing a declining scale of subsidies as incomes rise refers to these subsidies applying to premiums for policies purchased on a customer's "state" exchange.
Alas, 34 states including Arkansas didn't create state exchanges, mainly because their conservative politicians lacked the political nerve to appear to be acquiescing to Obamacare. In those states, customers have shopped through a state portal from an exchange actually set up by the federal government.
If "state" means "state" and only "state," then subsidies for residents of those 34 states using the federal exchange would no longer be authorized. Millions would fall out of the system for lack of personal funds for premiums. Then everybody else's premiums would go up, because private insurers won't pay for expensive mandated benefits without premium income to defray them.
Obamacare would still exist legally, but, absent subsidies for vital participation, could very well collapse.
The noted Arkansas private option presumably would continue with federal Medicaid-expansion funds buying policies from the exchange. But with the loss of other paying and subsidized policyholders, the great financial and political success of the private option in holding down premiums would be undone.
There would be an easy fix for states relying on the federal exchange and not having a state one. That would be to create a state exchange.
I am led to believe that Hutchinson actually holds that possibility, one requiring either a donnybrook of a special session or a bold and dubious administrative action, under consideration.
The state has in place a health-exchange governing council that once voted to set in place the transition to a state exchange. But then a bill passed in the last session delayed that conversion pending this looming court decision. So there may be some disagreement--political and legal--about how the state might proceed.
The Supreme Court presumably will rule either that congressional intent was plainly to subsidize all eligible policy purchasers, or that the word "state" means "state" and only "state."
We ought to know by the end of the month, which also happens to be the timetable for the same-sex marriage case.
So it seems that June 2015, or what's left of it, is a big month for the United States of America and her people--the gay ones, the sick ones, the health-care-providing ones and the health-care-insuring ones.
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John Brummett's column appears regularly in the Arkansas Democrat-Gazette. Email him at [email protected]. Read his blog at brummett.arkansasonline.com, or his @johnbrummett Twitter feed.
Editorial on 06/18/2015