If the Supreme Court rules against government subsidies in the 34 states that have not set up their own health insurance exchanges, millions of Americans could lose their health insurance. The policy question is whether subsidies are legal and Americans should be required to have insurance. But the personal question is whether uninsured people can avoid financial ruin.
This question is very real to me, having just suffered a serious bicycle accident. On May 9, I was participating in a 100-mile ride from Richmond to Williamsburg and back, a "Century Ride" that I had completed several times before. At the 30-mile mark, two riders in front of me bumped wheels, and one of them fell down. I could neither stop nor swerve, so I hit his bike and flew over my handlebars. I landed flat on my back, breaking my collarbone and suffering nine rib fractures.
After being taken by ambulance to the VCU Medical Center in Richmond, I spent 11 days in the hospital and received surgery to clean out the blood that had accumulated in my lungs. The care was excellent, and I am on a slow road to a complete recovery. I am fortunate that my bicycle helmet protected me from brain damage and that I avoided any injury to my spine. But the bill for my hospitalization: $134,279.40.
I am a Presbyterian pastor, so I am not a wealthy man. My wife and I would have to sell our house to get our hands on this amount of money. But I benefit from excellent health insurance provided by my church, so I will have to pay only about $3,500.00 in out-of-pocket costs. Members of my church without health insurance would face financial ruin with such a hospital bill, and I worry about those in my congregation who now benefit from the Affordable Care Act (ACA). In my home state of Virginia, 285,938 people are at risk of losing subsidies if the Supreme Court rules against the Obama administration in the current King v. Burwell case.
A 2013 study revealed that medical bills are the biggest cause of bankruptcies in the United States, ahead of bankruptcies due to credit-card bills or unpaid mortgages. That year, about 2 million people were affected, and this number will only grow if changes to the ACA cause people to lose their insurance.
The conservative critics of federal subsidies should balance their policy concerns with the personal question of what will happen to the 6.4 million Americans who stand to lose their health insurance subsidies. Our economy does not benefit from bankruptcies due to medical bills. Our health care system does not benefit from having to cover the cost of treating uninsured people in the emergency room -- a cost which is usually written off or passed on to paying customers. Health insurance for all Americans is the only way to maintain an equitable system for providers and consumers.
Clearly, the cost of subsidies is a concern to many -- an average of $272 a month, according to government data. And the ACA is a program that will need ongoing adjustments in the years to come. But a monthly subsidy is a small price to pay in the face of an unpaid hospital bill of $134,279.40. The Judeo-Christian tradition has always stressed the importance of showing generosity to the vulnerable in society, such as the instruction in Deuteronomy 15:11: "Open your hand to the poor and needy neighbor in your land." Subsidized health insurance is a simple and effective way to fulfill this commandment.
Whatever the Supreme Court decides, our federal and state governments need to find a way to keep our citizens insured, so that individuals won't face financial ruin as a result of an unexpected crash on a Century bike ride.