The Supreme Court has yet to announce its ruling on the Affordable Care Act (ACA) – and for California, that ruling is worth about $15 billion annually.
The Los Angeles Times reports that should the entire ACA be struck down on grounds that it is unconstitutional, California could lose up to $9 billion a year in expansion money for Medi-Cal (the state's Medicaid program) and $6 billion a year that would go directly to folks who buy subsidized insurance policies through a state-run exchange.
California is a huge beneficiary of the ACA because of the number of uninsured people within its borders – one in five Californians are uninsured, says the Times. That's about 7 million people.
A recent Familes USA report found that 26,100 people between the ages of 25 and 64 died prematurely due to a lack of health coverage in 2010, which works out to three deaths every hour. Between 2005 and 2010, that number in California was 16,285; in 2010 alone, it was 3,164.
Some of the ACA's provisions, like guaranteed coverage for kids and allowing people to remain on their parents' insurance plans until they're 26, are required by the state now, so those will still stand if the ACA if struck down. But without the ACA, insurers won't have to cover people with pre-existing conditions or certain medical histories.
Jim Mangia is president and CEO of South L.A.'s St. John's Well Child and Family Center, whose patient demographic is largely uninsured. He says the ACA essentially provides public health insurance for everyone who's eligible – and thousands of St. John's patients are.
"If the Medicaid mandate is struck down, then it's going to have a profound impact on the number of patients who have public health insurance," he said.
That's because St. John's makes money on public health insurance – they make a profit by treating their insured patients, and use that surplus to treat their uninsured, usually for free. But if all that extra Medicaid funding goes away – or in California's case, Medi-Cal funding – St. John's capacity to treat the uninsured "substantially diminishes."
It's also possible that the ACA will not be struck down or upheld entirely; many have speculated that the court will only strike down the individual mandate portion of the law, but uphold the rest, including the Medicaid expansion. The individual mandate would require that all Americans buy health insurance by 2014 or pay a penalty (with some exemptions).
No matter what the outcome is, though, a recent survey shows that the majority of Americans will not be happy.
Mangia certainly won't be if the law is struck down.
"What that would effectively say is that the American people don't have a right to health and that the partisan political agenda of the far right – and the ideological agenda of the Supreme Court that adheres to that far-right agenda – is more important than the health of the population of this country," he said.
Felix Aguilar, chief medical officer at South Central Family Health Center, said the best-case scenario for his clinic and patients is that the entire law is upheld. Even if the Supreme Court strips the ACA of the individual mandate, he says, at least the state will be able to move forward. But a complete overturn would make things difficult.
"If the Supreme Court strikes down the whole law and says it's unconstitutional, then the Medicaid money goes away," he said. "And then things are going to get a lot more complicated for the state – and for us. It's a trickle-down effect."
Likewise, Nina Vaccaro, the executive director of the Southside Coalition of Community Health Clinics – of which St. John's and South Central Family are both a part – said the court's striking down the Medicaid expansion as unconstitutional would be a huge blow to public health.
"It would be devastating that folks that have been promised the hope of health insurance would no longer have that access," she told OnCentral in March. "One of the things we've been working on is looking at health access in South L.A. as a human right, and that would be a tremendous loss."
Mangia said if the nation's highest court rules against the ACA, it would be a "travesty" as well as an "overstep of judicial intervention."
"If the Supreme Court were to rule against health reform, it would be an abomination and it would be a purely political, partisan ideological, decision that flies in the face of modernizing our health care system," he said. "And how is it that we spend more money on health than any other nation in the world, but we're 50th in life expectancy and 173rd in infant mortality? That's unconscionable."
The next opportunity for the Supreme Court to read a decision on the ACA is Monday, June 25.