Enroll Michigan has a simple message for Obamacare outreach workers: “Stay calm and keep enrolling.”
That's the slogan it has adopted in the wake of the U.S. Supreme Court's decision last Friday to hear the King v. Burwell case. The lawsuit could potentially lead to premium subsidies being invalidated for exchange customers in the 36 states, including Michigan, that did not establish their own state-run exchanges.
“Until the Supreme Court makes a decision, we're going to concentrate on doing our jobs,” said Dizzy Warren, project director for Enroll Michigan, which was awarded $1.5 million by the CMS this year to conduct outreach efforts statewide. “We're not really trying to second guess what they may or may not do.”
That message of steadfastness is being repeated by outreach workers, insurers, hospitals and others with a stake in expanding enrollment as they prepare for the second open-enrollment period that begins Saturday. HHS announced on Monday that it expects between 9 million and 9.9 million individuals to sign up for 2015 coverage through the state and federal exchanges. That's well below the Congressional Budget Office's estimate of 13 million total exchange enrollees.
“Open enrollment still starts in four days,” said Mara Youdelman, managing attorney with the National Health Law Program. “We're trying to share the message with the assister community that life goes on.”
Similarly, Chip Kahn, CEO of the Federation of American Hospitals, which represents investor-owned health systems, said he doesn't expect the high court's decision to change anything for his members, many of whom have aggressive enrollment programs. “This decision is not even possible until June,” Kahn said. “So I just don't see it having a material effect. I think people will sign up and the program will move forward.”
Asked whether the court's decision to take the case could have an impact on consumers, HHS Secretary Sylvia Mathews Burwell said Monday that “the most important thing for consumers to know is that nothing has changed.”
But the court's decision, along with last week's election victories of Republicans who have vowed to repeal Obamacare, has at the least cast a shadow over sign-up efforts and could deter individuals from seeking coverage, some observers say. The Patient Protection and Affordable Care Act would be badly hobbled if the Supreme Court were to strike down subsidies in the 36 states that haven't established their own exchanges.
Exchange subsides are available to households with incomes up to 400% of the federal poverty threshold, and nearly 90% of individuals who signed up for coverage in 2014 through HealthCare.gov qualified for financial assistance, according to the CMS. An analysis by the Urban Institute found that 7.3 million individuals would lose subsidies worth $36.1 billion in 2016 if benefits were no longer available in those 36 states.
“Anything that raises the specter that the Affordable Care Act might be negated in some way creates dissonance in the market,” said Cliff Gold, chief operating officer for CoOportunity Health, a not-for-profit insurer that operates in Iowa and Nebraska, both of which rely on HealthCare.gov for enrollments. “It could certainly dampen people's interest in shopping before the case is resolved. It can certainly create confusion.”
One of the biggest questions for consumers is that those who sign up for subsidized coverage potentially could be on the hook for paying back those premium tax credits if the Supreme Court deems them unlawful. But Timothy Jost, a law professor at Washington and Lee University and an expert on the ACA, said there's no chance of consumers being forced to pay back subsidies. Even if the Supreme Court rules against the Obama administration, it would merely result in the Internal Revenue Service having to draft a new regulation, and current beneficiaries would not be financially penalized, he said.
Most outreach workers have no plans to discuss with enrollment applicants the possibility of the Supreme Court striking down subsidies. They believe that would confuse customers who already are trying to navigate a complex plan selection and enrollment process.
“This will have a negative impact only if the media turn this into a story and start scaring people,” said Elizabeth Colvin, director of Insure Central Texas, which focuses on outreach to Spanish-speaking residents. “I'm just confident reason will prevail.”
Enroll Michigan's Warren offers a similar perspective. “Right now, I'm pretty certain that the average consumer has no clue what is going on,” Warren said. “At this stage, I don't expect the enrollment efforts to be dampened by the Supreme Court.”
Follow Paul Demko on Twitter: @MHpdemko