Administration meets health care sign-up goal, but Supreme Court ruling could reverse gains

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WASHINGTON — More than 10 million people have signed up for subsidized private health insurance this year under President Barack Obama's law, the administration reported Tuesday. The positive numbers are finally putting the nation within reach of coverage for all, but the gains may not last.

The report from the Department of Health and Human Services comes as dozens of insurers are proposing double-digit premium hikes for next year, raising concerns about the future affordability of coverage under the program. And the Supreme Court is weighing the legality of subsidies for consumers in more than 30 states, with a decision expected around the end of the month.

The 10.2 million sign-ups represent consumers who enrolled in a plan and followed through by paying their first month's premiums. That number will fluctuate during the year as some people get jobs that offer coverage, and others decide to drop their insurance. For now, it exceeds a target of 9.1 million set last year by HHS Secretary Sylvia M. Burwell.

The combination of subsidized private coverage sold through online insurance exchanges in every state, along with Medicaid expansion in most states, has resulted in historic coverage gains.

Nearly 9 out of 10 adults now have health insurance — about the same proportion of Americans who buckle their seatbelts.

Health insurance is now a federal mandate for most people, with employer plans remaining as the mainstay for workers and their families. Violators risk fines and penalties.

A major private survey, the Gallup-Healthways Well-Being Index, puts the share of U.S. adults with coverage at 88 percent.

The new health insurance numbers could be just an ephemeral high-water mark if the Supreme Court invalidates subsidies for people in states using, the federal government's online exchange. The case revolves around the literal meaning of a handful of words in the complex law.

Opponents say the law only allows subsidies in states that set up their own insurance exchanges. Only 13 states and Washington, DC, are running their own markets this year. The administration says that, when read in context, the law allows subsidies in all 50 states regardless of whether the federal is in charge of sign-ups.

If the Supreme Court invalidates the subsidies, Republican-led states that have resisted "Obamacare" would bear the brunt of the consequences. Of the 34 states that would be most affected, 26 have GOP governors.

The administration says 6.4 million people in those states are getting subsidies to help pay their premiums.

Nationally, 8.7 million people are getting an average of $272 a month, which covers most of their premiums. The national figure includes residents of states running their own insurance markets.

Independent experts estimate 8 million people would lose health insurance if the subsidies are overturned. That includes people who are paying the full cost of their coverage, and don't get any help from the government. They'd still face problems because premiums for individual coverage would spike as healthy subsidized customers drop out of the market.

The Obama administration says it expects to win in court and officials say there is no backup plan if they lose the case. Leading congressional Republicans are promising to help consumers who lose subsidies, but it's unclear Congress could pass any fix that Obama would sign.

The figures released Tuesday cover the period through Mar. 31.

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