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Why Florida was most at-risk in today's Supreme Court decision

Florida would have been hit harder than any state if the U.S. Supreme Court had ruled against Obamacare subsidies.
Florida would have been hit harder than any state if the U.S. Supreme Court had ruled against Obamacare subsidies.

Obamacare has survived another Supreme Court challenge. Nowhere in the country does that matter more than in Florida.

All Things Considered host Crystal Chavez spoke with health reporter Abe Aboraya about the Supreme Court ruling.

CRYSTAL: Polling shows us that most Americans were not watching King V. Burwell closely. Give us the background:

ABE: Of course. Obamacare has a three-pronged system to get health care to more Americans. One, insurance companies can’t deny you coverage because you’re sick. Two, it requires most Americans to carry insurance, so it’s not only sick people getting it. And three, it provides billions in tax breaks to make that insurance affordable. Now this case was a technical look at how those tax breaks can be delivered in 34 states where the federal government runs health care marketplaces, or www.healthcare.gov.

CRYSTAL: Is Florida one of those 34 states?

ABE: Indeed we are. And it has more people signed up than any other state in the country. Now, this case centers on just four words. The law said tax breaks will be provided in marketplaces "established by the state." So the challengers said, based on how this one sentence reads, people who live in states like Florida should not get tax breaks.

CRYSTAL: Six justices disagreed. What does that mean?

ABE: Broad bush, you couldn’t take this one sentence in the law out of context, you have to read the entire law. So subsidies will continue in Florida. 1.3 million Floridians were in danger of losing these tax breaks for health insurance. That’s more than $389 million coming into Florida every month.

CRYSTAL: So what does $389 million per month buy the average Florida consumer?

ABE: So let’s call him Joe Consumer. Joe Consumer in Florida gets $294 per month shaved off the average health insurance bill. Had the Supreme Court ruled the other way, it would have triggered what insurance people like to call the death spiral, where anyone who’s young and healthy stops buying insurance because , well, it’s $300 bucks more a month, so there are fewer healthy people in the mix, everyone's insurance rate goes up, rinse and repeat.

CRYSTAL: There are 100,000 people getting these subsidies in Central Florida. What are you hearing from them?

ABE: The ones I talked with are relieved. Joan Prendergast is a retired housewife in Pine Hills. With subsidies, her health insurance cost $27 dollars a month. Without subsidies it's $500, completely unaffordable for her. And she does have a few chronic health conditions.

“Well, I have a blood clot I need medication for, a blood thinner, and I need to take that every day for the rest of my life," Prendergast said. "I have a hiatal hernia that’s causing a lot of problem in my breathing, and I need surgery to correct that.”

Prendergrast is also indicative of another issue particular to Florida. Her husband passed away a few months ago, and without his income, she falls into what experts call the Medicaid gap. She now makes too little to get subsidies, and too much money to qualify for Medicaid because the state hasn’t expanded it.

CRYSTAL: That brings up another Florida Obamacare topic: Expanding Medicaid. So how are Florida lawmakers responding to this decision?

ABE: We spoke with Republican Scott Plakon, whose house district is in Longwood. He said this was a political ruling, it was not based on the clear meaning of the text. And as he described it, the Supreme Court jumped the shark on this.

“Everything from Obamacare from top to bottom is fiscally irresponsible,"Plakon said. "It’s putting our nation further in debt, it’s stealing from the piggy banks of our children to finance people’s health care needs of today. I consider that morally wrong. So I voted not to expand Medicaid under Obama and will continue in the Florida legislature to resist it.”

CRYSTAL: What if the court had gone the other way? What would have happened to the 1.3 million Floridians on the federal Marketplace?

ABE: There was an idea percolating for Florida to operate its own marketplace, so those subsidies wouldn’t go away. Florida already has one. It’s called Florida Health Choices. It’s very similar in style to health care dot gov, except there are no tax breaks. It was being groomed as the replacement federal exchange.

“Certainly, state of emergency is avoided now," said Rose Naff, CEO of Florida Health Choices. "States can continue to consider that option in a thoughtful way and no special session or grand discussion needs to take place.”

CRYSTAL: How have local health care providers reacted?

ABE: The ones we’ve spoken to are pleased, excited, relieved. Local hospitals were worried they would see a big spike in the number of people coming through their doors without health insurance. Same with nonprofit clinics who provide health care for the poor and uninsured.

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