Progressive researchers continue to pump out survey and studyresults that forecast gloom and doom for the American public shouldthe U.S. Supreme Court gut health care reform by eliminatingpremium subsidies in 20 states in the King. v. Burwell case.

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The latest comes from the Urban Institute, with funding from theRobert Wood Johnson Foundation. This one comes with a twist: Italso looks at the effects of the states’ decisions not to expandMedicaid as allowed by the law.

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Read: 5 things to know about SCOTUS subsidies case

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The conclusion:

  • In total, 9.8 million people in the 20 states would go withoutinsurance in 2016;

  • 4.2 million would have had Medicaid coverage if their state expanded theprogram;

  • Another 5.6 million would have purchased marketplace insurance,most with the help of federal tax credits;

  • From 2016 to 2025, these 20 states will miss out on $483 billionin federal Medicaid funding and $238 billion in federal spending ontax credits and cost-sharing reductions to help people purchasehealth insurance through the marketplaces;

  • Total cost: $721 billion.

“A ruling for King in the King v. Burwell Supreme Court casewould effectively negate the impact of the ACA’s coverage expansionprovisions in those 20 states that have not expanded Medicaid,”said Kathy Hempstead, who directs coverage issues at the RobertWood Johnson Foundation. “In addition to the loss of tax subsidies,the almost inevitable collapse of the individual insurance marketwould truly add insult to injury for residents and health careproviders in states that will suffer under a ruling for King.”

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Dan Cook

Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.