As those in the know about King v. Burwell anxiously await the U.S. Supreme Court’s verdict in the PPACA insurance premium subsidy case, the Robert Wood Johnson Foundation and the Urban Institute have teamed up for one more worst-case scenario report.

Assuming that the court strikes down the subsidies, RWJ and the institute produced one last “what-if” forecast. This one looks at the collateral damage that subsidy elimination could cause apart from simply pulling coverage out from under the 6.4 million whose premiums would disappear.

Here are its projections:

#1: “In 2016, the number of uninsured people would be 8.2 million higher than it otherwise would have been.”

Wait, you say: Wasn’t the number receiving subsidized premiums 6.4 million?

That’s correct. But many more among the insured would probably drop coverage because the loss of the 6.4 million would cause premiums to rise by an average of 55 percent for everyone else. And some folks just won’t be able to afford that kind of increase.

Read: Public says replace PPACA subsidies if killed, lower drug costs

#2: “The size of the private nongroup insurance markets in the affected states would drop by about 70 percent due to the loss of financial assistance.”

Another fall-out of the subsidy loss, these markets will be hit hard because premiums will increase across the board for those without insurance premium subsidies. The pool of insured would also be at a higher cost, the study says, presumably because many young, healthy people who were subsidized will vanish from the pool.

#3: “Spending on behalf of those becoming uninsured would fall by 35 percent.”

Without insurance, those 8.2 million won’t be spending nearly as much as they did before on medical services. Worse, they’ll likely seek treatment with greater frequency at the ER or by checking into the hospital, where everyone else subsidizes treatment.

#4: “Of those becoming uninsured, three-fourths are low or middle income, but are not poor; over 60 percent are white, non-Hispanic; and over 60 percent live in the south.”

The point is that lots of people who were subsidized weren’t poor--they just needed some help due to the high cost of medical care in America.

Now, their quality of life slips backwards, especially in the South.

Read: Exchange enrollee study reveals surprises

#5: “20 states that would be affected by such a decision are also states that chose not to expand eligibility for Medicaid under the ACA.”

Folks in these states will be hit especially hard as state budgets for health care plummet.

How hard?“The 20 states would forego $61 billion federal dollars in 2016, $41 billion from not expanding Medicaid and $21 billion from not establishing a state marketplace.”

“The real world effects of a ruling in favor of King amount to millions of fewer Americans having health insurance and state economies missing out on billions in federal revenues,” said Kathy Hempstead, who directs coverage issues at the Robert Wood Johnson Foundation. “The individual insurance market would be severely affected, with millions fewer purchasing insurance, including young, healthy individuals who help to keep premiums low for the broader population.”

Instant Insights /

What if the Supreme Court rules on the PPACA case for King?

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