2.4M people given right to marry! (but how about that Obamacare ruling)

The marriage equality Supreme Court ruling (Obergefell v. Hodges) legalizing gay marriage this past week was in very little doubt, so as historic as it may be, it wasn’t the most controversial ruling of the week. The SCOTUS ruling on the defense of the Affordable Care Act (King v. Burwell), however, popularly known as Obamacare, was the ruling that was in doubt.

In the weeks leading up to the ruling, Republicans were getting worried that the SCOTUS would actually rule against the subsidies:

June 4 on The Hill: “GOP open to extending ObamaCare subsidies”

June 5 on the National Review: “How a Conservative Victory in King v. Burwell Could Quickly Turn Into a Political Defeat”

June 17 on the NY Times: “G.O.P. Is Wary About Winning on Health Law”

June 23 on NPR: “Republicans Don’t Have A Plan Yet To Replace Obamacare Subsidies”

What was incendiary to me was how the main solution Republicans talked about was to extend the subsidies until after the upcoming 2016 election. A purely political move because they know that it’ll be easy for constituents to blame their candidates in the 2016 election for the lost subsidies, in addition to the fact that more of the federal exchanges in the 34 states that would lose subsidies were Republican-controlled states.

It’s an interesting quandary. 55% (v. 38%) say that they support the subsidies. However, 54% (v. 39%) of survey respondents said that they oppose Obamacare, which is amongst the worst in the poll’s history.

So, on one hand people oppose Obamacare, but on the other, do support one of its provisions. There have been polls ever since the beginning, that show this recurring theme of support (Kaiser March 2013 poll): tax credits for small businesses (88% in favor); creation of health care exchanges (80% in favor); extend dependent coverage till 26 (76%); medicaid expansion (71%); even Employer mandate (57% in favor); just Individual Mandate (40% in favor).

Some quick facts to think about regarding Obamacare:

  1. Health and Human Services (HHS) state that the uninsured % has gone down from 20.3% (in 2012) to 13.2% (Q1 2015).
  2. Gallup poll shows uninsured % has gone down from 18.0% (Q3 2013) to 11.9% (Q1 2015).
  3. CDC numbers show number uninsured dropped from 48.6 Million (2010) to 37.2 Million (2014).
  4. Commonwealth Fund study shows that the number of Americans who had trouble with medical bills/debt dropped from 75 Million (41%, 2012) to 64 Million (35%, 2014).
  5. Premiums have gone up, but not necessarily as quickly as before.
  6. High-deductible plans are on the rise, though.
  7. Number of plans & insurers are increasing (meaning potentially more competition).
  8. 2013 NerdWallet study: 3 in 5 bankruptcies due to medical bills.
  9. In 2015, we’ll hit $10,000 in healthcare spending per capita.
  10. In 2013, we were spending 17.1% of our GDP on healthcare (highest for a developed country).
  11. Ranked 11th out of 11 developed countries in overall healthcare, though we are the most expensive.
  12. Our healthcare system ranked 37th in the world (out of 191, 2000), but again, the most spent per capita.
  13. 2nd (31.8%) only to Mexico (32.8%) in obesity rate among populous countries.

So here’s my view on healthcare in the US and Obamacare’s role in it:

  • Healthcare is complicated. You can’t evaluate it on just one metric necessarily.
  • But still, we spend the most on healthcare, yet have bad accessibility and was rated the worst overall among 11 developed nations. A third of our nation is obese, the next third overweight. Multiple metrics show that something is wrong with our healthcare system.
  • Obamacare, though not perfect by any means, has helped: less people uninsured; pre-existing conditions don’t matter anymore; less people worrying about medical debt.
  • One question that I want to ask is: should our healthcare be a profit-driven industry? Yes, the medical devices & pharmaceuticals industries should be profit-driven, but how about our hospitals?

Please, let’s stop making Obamacare a political lightning rod. Our Congress has wasted their time with over 50 attempts at repealing the law. Republican politicians still make an issue of Obamacare, because people still have this negative impression of it, even when they agree with most of its provisions. Instead of giving politicians political fodder, let’s start coming up with some real solutions.

Population Affected by SCOTUS decisions last week

Marriage Equality

Before the ruling, there were 15 states that had questionable statuses or bans on same sex marriages (with corresponding 2012 LGBT estimated population):

Top 5 in population (1,573k): Texas (580k); Ohio (316k); Michigan (285k); Georgia (264k); Tennessee (128k)

Next 5 (577k): Missouri (151k); Kentucky (130k); Louisiana (112k); Alabama (103k); Kansas (81k)

Last 5 (212k): Arkansas (78k); Mississippi (59k); Nebraska (38k); South Dakota (28k); North Dakota (9k)

-So, an estimated 2.4 Million people were affected by this ruling (out of an estimated US LGBT population of 9 Million).


There were 34 states running federal exchanges, whose residents would have lost their health care subsidies (average of $272/month) had the ruling gone the other way. These 34 states, mostly Republican states, have 6.4 Million people enrolled in Obamacare.

Obamacare (6.4M) > Marriage Equality (2.4M)