Economists predict shockwaves if Obamacare subsidies are nixed

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States Move to Insurance Markets as Obamacare Decision Looms

As the U.S. Supreme Court prepares to rule on whether people in 34 states can continue to receive Obamacare health insurance subsidies, economists are projecting billions of dollars in lost healthcare spending for hospitals, drugstores and drugmakers if the justices say the payments are illegal.

The immediate consequences of such a ruling would fall on the 6.4 million people who receive the subsidies and live in states that did not establish their own insurance exchanges under President Barack Obama's healthcare law, instead relying on the federal HealthCare.gov website.

The case, known as King v Burwell, would not affect subsidies in the District of Columbia or in the 13 states that run their own exchanges. The decision is expected sometime this month.

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Economists predict shockwaves if Obamacare subsidies are nixed
MIAMI, FL - DECEMBER 15: A person walks into the UniVista Insurance company office where people are signing up for health care plans under the Affordable Care Act, also known as Obamacare, on December 15, 2015 in Miami, Florida. Today, is the deadline to sign up for a plan under the Affordable Care Act for people that want to be insured on January 1, 2016. (Photo by Joe Raedle/Getty Images)
House Health subcommittee member Rep. Diane Black, R-Tenn., questions Dr. Mandy Cohen, chief of staff, Centers for Medicare and Medicaid Services, during a hearing on the state of Obamacare's CO-OP Program, on Capitol Hill in Washington, Tuesday, Nov. 3, 2015. The argument at the hearing was the Obama administration's most direct response to a wave of seven co-ops closing in Oct., 2015. (AP Photo/Cliff Owen)
US President Barack Obama speaks about healthcare reforms and the Affordable Care Act, known as Obamacare, during the Catholic Hospital Association Conference in Washington, DC, June 9, 2015. AFP PHOTO / SAUL LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
President Barack Obama speaks during Catholic Hospital Association Conference in Washington on Tuesday, June 9, 2015. Obama defended the health care overhaul just days ahead of an anticipated decision by the Supreme Court that could eliminate health care for millions of people. (AP Photo/Jose Luis Magana)
WASHINGTON, DC - MARCH 04: Supporters of the Affordable Care Act gather in front of the U.S Supreme Court during a rally March 4, 2015 in Washington, DC. The Supreme Court was scheduled to hear oral arguments in the case of King v. Burwell that could determine the fate of health care subsidies for as many as eight million people. (Photo by Alex Wong/Getty Images)
Protestors hold placards challenging 'Obamacare' outside of the US Supreme Court on March 4, 2015 in Washington, DC. The US Supreme Court faces a momentous case Wednesday on the sweeping health insurance reform law that President Barack Obama wants to leave as part of his legacy. The question before the court is whether the seven million people or more who subscribed via the government's website can obtain tax subsidies that make the coverage affordable. A ruling is expected in June. AFP PHOTO/MANDEL NGAN (Photo credit should read MANDEL NGAN/AFP/Getty Images)
WASHINGTON, DC - MARCH 04: Supporters of the Affordable Care Act gather in front of the U.S Supreme Court during a rally March 4, 2015 in Washington, DC. The Supreme Court was scheduled to hear oral arguments in the case of King v. Burwell that could determine the fate of health care subsidies for as many as eight million people. (Photo by Alex Wong/Getty Images)
Speaker of the House John Boehner, R-Ohio, returns to his office after the House voted to repeal the Patient Protection and Affordable Care Act, at the Capitol in Washington, Tuesday, Feb. 3, 2015. The Republican-controlled House voted along party lines to repeal the health care law that stands as President Barack Obama's signature domestic achievement, but this time the bill carried instructions for several committees to replace "Obamacare" with new policies. The legislation now goes to the Senate, where it is unlikely to pass, and even if it does, Obama has threatened a veto. (AP Photo/J. Scott Applewhite)
A graph and details on health care costs and the Affordable Care Act are seen in President Barack Obama's new $4 trillion budget plan that was sent to Congress today, on Capitol Hill in Washington, early Monday, Feb. 02, 2015. The fiscal blueprint, for the budget year that begins Oct. 1, seeks to raise taxes on wealthier Americans and corporations and use the extra income to lift the fortunes of families who have felt squeezed during tough economic times. Republicans, who now hold the power in Congress, are accusing the president of seeking to revert to tax-and-spend policies that will harm the economy while failing to do anything about soaring spending on government benefit programs. (AP Photo/J. Scott Applewhite)
House Rules Committee Chairman Pete Sessions, R-Texas, opens a meeting of the House Rules Committee as the panel prepares a bill to repeal the Patient Protection and Affordable Care Act, often called Obamacare, that is scheduled to go to the floor this week, at the Capitol in Washington, Monday, Feb. 02, 2015. (AP Photo/J. Scott Applewhite)
Rep. Michael C. Burgess, R-Texas, left, joined by Rep. Frank Pallone Jr., D-N.J., right, testifies as the House Rules Committee prepares a bill to repeal the Patient Protection and Affordable Care Act, often called Obamacare, that is scheduled to go to the floor this week, at the Capitol in Washington, Monday, Feb. 2, 2015. Burgess, a medical doctor, is a member of the House Subcommittee on Health which has jurisdiction in matters of health insurance. Pallone is the top Democrat on the Health Subcommittee. (AP Photo/J. Scott Applewhite)
FILE - In this file photo taken with a fisheye lens April 6, 2013, Arkansas legislators meet in the House chamber at the Arkansas state Capitol in Little Rock, Ark. Arkansas Gov. A wave of newly elected Republican lawmakers who ran on vows to fight so-called Obamacare, including the state’s “private option” Medicaid expansion, has raised doubts about the future of a leading model for conservative states to gradually adapt to the federal health care law. (AP Photo/Danny Johnston, File)
Rep. Steve Stivers, R-Ohio, a member of the House Rules Committee, makes a point as the panel prepares a bill to repeal the Patient Protection and Affordable Care Act, often called Obamacare, that is scheduled to go to the floor this week, at the Capitol in Washington, Monday, Feb. 2, 2015. (AP Photo/J. Scott Applewhite)
President Barack Obama gestures as he speaks to the Catholic Hospital Association Conference at the Washington Marriott Wardman Park in Washington, Tuesday, June 9, 2015. Obama declared that his 5-year-old health care law is firmly established as the "reality" of health care in America, even as he awaits a Supreme Court ruling that could undermine it. (AP Photo/Carolyn Kaster)
US President Barack Obama speaks about healthcare reforms and the Affordable Care Act, known as Obamacare, during the Catholic Hospital Association Conference in Washington, DC, June 9, 2015. AFP PHOTO / SAUL LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
WASHINGTON, DC - MARCH 04: Five-year-old James Cook of Cleveland, Ohio, participates in a rally to support the Affordable Care Act in front of the U.S Supreme Court March 4, 2015 in Washington, DC. The Supreme Court was scheduled to hear oral arguments in the case of King v. Burwell that could determine the fate of health care subsidies for as many as eight million people. (Photo by Alex Wong/Getty Images)
FILE - In this March 25, 2015, file photo, Margot Riphagen, of New Orleans, wears a birth control pills costume as she protests in front of the Supreme Court in Washington, as the court heard oral arguments in the challenges of President Barack Obama's health care law requirement that businesses provide their female employees with health insurance that includes access to contraceptives. Some insurance plans offered on the health marketplaces violate the law’s requirements for women’s health, according to a new report from a women’s legal advocacy group. The National Women’s Law Center analyzed plans in 15 states over two years and found some excluded dependents from maternity coverage, prohibited coverage of breast pumps or failed to cover all federally approved birth control methods. (AP Photo/Charles Dharapak, File)
WASHINGTON, DC - MARCH 04: Supporters of the Affordable Care Act gather in front of the U.S Supreme Court during a rally March 4, 2015 in Washington, DC. The Supreme Court was scheduled to hear oral arguments in the case of King v. Burwell that could determine the fate of health care subsidies for as many as eight million people. (Photo by Alex Wong/Getty Images)
Graphic previews selected remaining cases before the Supreme Court.
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Health economists calculate the economic impact of a ruling against the subsidies in different ways, but one thing many agree on is that about two-thirds of people who receive subsidies through HealthCare.gov would drop their insurance altogether rather than foot the entire bill.

Businesses that have benefited from spending by the newly insured would take a hit, though estimates of the lost revenues vary significantly based on which assumptions are built into the calculation.

For instance, a Kaiser Family Foundation economist put the 2015 figure at about $15 billion, based on the proportion of insurance premiums that are earmarked solely for medical costs under the healthcare law.

"There will absolutely be these second-order effects," said Larry Levitt, a senior vice-president and healthcare researcher at the Kaiser Family Foundation. "A reasonable assumption is that (spending on) healthcare by people who lose their existing subsidies will drop by at least half."

That would represent about $7.5 billion in spending on hospitalizations, doctor visits and prescriptions, depending on the baseline estimate.

Another rough estimate based on 2014 medical claims data and 2015 government enrollment data, suggests the federal marketplace states will see about $22 billion in healthcare spending this year among Obamacare plan holders assuming subsidies remain in place, according to Katherine Hempstead, a director at the Robert Wood Johnson Foundation. The majority of Obamacare members receive subsidies.

Health policy experts who are critical of the law have taken a different tack, focusing more on the potential financial returns to individual citizens if the Supreme Court ruling exempts them from penalties for not having insurance.

Conservative economist Douglas Holtz-Eakin and Brittany La Couture of the American Action Forum wrote recently that such a ruling could give a boost to small businesses by removing requirements on employers to provide health coverage.

Joseph Antos of the right-leaning think tank American Enterprise Institute says the estimates of healthcare spending effects are imprecise at best. He expects that a ruling invalidating the subsidies would be followed by a "fix" in which Congress or states somehow restore subsidies, at least temporarily.

In that case, he said, any drop in healthcare spending would be temporary and only "a very minor downward bump."

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Economists predict shockwaves if Obamacare subsidies are nixed
WASHINGTON, DC - MARCH 04: Ryan Burrows, right, protests with others that are not in support of the portions of the Affordable Care Act on which the Supreme Court of the United States was hearing arguments on Wednesday March 04, 2015 in Washington, DC. (Photo by Matt McClain/ The Washington Post via Getty Images)
Protestors hold placards challenging 'Obamacare' outside of the US Supreme Court on March 4, 2015 in Washington, DC. The US Supreme Court heard a second challenge to US President Barack Obama's Affordable Care Act. The US Supreme Court faces a momentous case Wednesday on the sweeping health insurance reform law that President Barack Obama wants to leave as part of his legacy. The question before the court is whether the seven million people or more who subscribed via the government's website can obtain tax subsidies that make the coverage affordable. A ruling is expected in June. AFP PHOTO/MANDEL NGAN (Photo credit should read MANDEL NGAN/AFP/Getty Images)
Protestors hold placards challenging 'Obamacare' outside of the US Supreme Court on March 4, 2015 in Washington, DC. The US Supreme Court faces a momentous case Wednesday on the sweeping health insurance reform law that President Barack Obama wants to leave as part of his legacy. The question before the court is whether the seven million people or more who subscribed via the government's website can obtain tax subsidies that make the coverage affordable. A ruling is expected in June. AFP PHOTO/MANDEL NGAN (Photo credit should read MANDEL NGAN/AFP/Getty Images)
Demonstrators from Doctors for America in support of U.S. President Barack Obama's health-care law, Obamacare, hold signs while marching in front of the U.S. Supreme Court in Washington, D.C., U.S., on Wednesday, March 4, 2015. A U.S. Supreme Court argument over Obamacare's tax subsidies divided the justices along ideological lines, potentially leaving two pivotal justices to decide the law's fate. Photographer: Andrew Harrer/Bloomberg via Getty Images
Anna Salerno holds a sign and waits with other protestors for President Barack Obama to arrive at the Temple Emanu-El in Dallas, Wednesday, Nov. 6, 2013. President Obama is visiting the charity to thank local volunteers that are working to sign people up for the health insurance under the Affordable Care Act. (AP Photo/LM Otero)
Anti-abortion demonstrators hold signs during a Priests for Life protest outside the US Court of Appeals for the DC Circuit Court as the Court hears the oral arguments in the 'Priests for Life v. US Department of Health and Human Services (HHS)' case in Washington, DC, on May 8, 2014. The case centers around the HHS mandate in the Affordable Care Act, known as Obamacare, that religious organizations must cover contraceptions and abortion as part of their health insurance benefits, even if that goes against the organization's religious beliefs. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
Anti-abortion demonstrators hold signs during a Priests for Life protest outside the US Court of Appeals for the DC Circuit Court as the Court hears the oral arguments in the 'Priests for Life v. US Department of Health and Human Services (HHS)' case in Washington, DC, on May 8, 2014. The case centers around the HHS mandate in the Affordable Care Act, known as Obamacare, that religious organizations must cover contraceptions and abortion as part of their health insurance benefits, even if that goes against the organization's religious beliefs. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
Anti-abortion demonstrators hold signs during a Priests for Life protest outside the US Court of Appeals for the DC Circuit Court as the Court hears the oral arguments in the 'Priests for Life v. US Department of Health and Human Services (HHS)' case in Washington, DC, on May 8, 2014. The case centers around the HHS mandate in the Affordable Care Act, known as Obamacare, that religious organizations must cover contraceptions and abortion as part of their health insurance benefits, even if that goes against the organization's religious beliefs. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
Anti-abortion demonstrators hold signs stating they regret their abortions during a Priests for Life protest outside the US Court of Appeals for the DC Circuit Court as the Court hears the oral arguments in the 'Priests for Life v. US Department of Health and Human Services (HHS)' case in Washington, DC, on May 8, 2014. The case centers around the HHS mandate in the Affordable Care Act, known as Obamacare, that religious organizations must cover contraceptions and abortion as part of their health insurance benefits, even if that goes against the organization's religious beliefs. AFP PHOTO / Saul LOEB (Photo credit should read SAUL LOEB/AFP/Getty Images)
DORAL, FL - APRIL 23: Joyce Zaritsky, Bob Williams, Serena Perez and Mayte Canino (L-R) show their support for the Affordable Care Act in front of the office of U.S. Rep. Mario Diaz-Balart and Sen. Marco Rubio (R-FL) on April 23, 2014 in Doral, Florida. The protesters wanted to ask the politicians if they still want to repeal their constituents health care now that more than 8 million Americans have signed up for health insurance under the Affordable Care Act. (Photo by Joe Raedle/Getty Images)
A demonstrator in support of U.S. President Barack Obama's health-care law contraception requirement holds up a sign outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
A demonstrator in support of U.S. President Barack Obama's health-care law contraception requirement holds up a sign outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators in support of U.S. President Barack Obama's health-care law contraception requirement hold up a sign outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrator Alan Hoyle holds a bible as he stands outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators in support of U.S. President Barack Obama's health-care law contraception requirement hold up signs outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators opposed to U.S. President Barack Obama's health-care law contraception requirement hold up signs outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators opposed to U.S. President Barack Obama's health-care law contraception requirement hold up signs outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
Demonstrators in support of U.S. President Barack Obama's health-care law contraception requirement hold a sign outside the U.S. Supreme Court in Washington, D.C., U.S., on Tuesday, March 25, 2014. Hobby Lobby, a family-owned business that says it looks to the Bible for guidance, is seeking a religious exemption from the requirement that employers cover birth control as part of worker-insurance plans. Photographer: Andrew Harrer/Bloomberg via Getty Images
MIAMI, FL - SEPTEMBER 20: Deborah Dion (L), Hattie Coleman and other protesters gather in the office of Florida State Rep. Manny Diaz as they protest his stance against the expansion of healthcare coverage on September 20, 2013 in Miami, Florida. As the protest took place, the Republican led House in Washington, D.C. by a 230-189 tally passed a short-term government spending plan that would eliminate all funding for 'Obamacare.' The Florida State government is also working against the Affordable Care Act by refusing to set up its own health care exchanges and they also have highlighted concerns about the navigators, federally funded workers who will help enroll people in health plans. (Photo by Joe Raedle/Getty Images)
Anti-abortion protesters pray outside the US Supreme Court on the third day of oral arguements over the constitutionality of the Patient Protection and Affordable Care Act on March 28, 2012 in Washington, DC. The 26 states challenging the law argue that Obama's Affordable Care Act must be completely repealed if the requirement that all Americans buy health insurance -- known as the 'individual mandate' -- is found to be unconstitutional. AFP PHOTO/MLADEN ANTONOV (Photo credit should read MLADEN ANTONOV/AFP/Getty Images)
A masked pro-Obamacare demonstrator stands outside the US Supreme Court June 25, 2012, in Washington, DC, as they await the court's ruling on the Healthcare Reform Law. The court announced the decision on healthcare will not happen before June 28. AFP PHOTO/Jim Watson (Photo credit should read JIM WATSON/AFP/GettyImages)
Anti-abortion protesters pray outside the US Supreme Court on the third day of oral arguements over the constitutionality of the Patient Protection and Affordable Care Act on March 28, 2012 in Washington, DC. The 26 states challenging the law argue that Affordable Care Act must be completely repealed if the requirement that all Americans buy health insurance -- known as the 'individual mandate' -- is found to be unconstitutional. AFP PHOTO/MLADEN ANTONOV (Photo credit should read MLADEN ANTONOV/AFP/Getty Images)
UNITED STATES – MARCH 27: Rep. Michele Bachmann, R-Minn., speaks during the Tea Party Patriots rally protesting the Affordable Care Act in front of the Supreme Court as the court hears arguments on the health care reform bill on Tuesday, March 27, 2012. (Photo By Bill Clark/CQ Roll Call)
UNITED STATES – MARCH 27: Tea Party Patriots supporters hold signs protesting the Affordable Care Act in front of the Supreme Court as the court hears arguments on the health care reform bill on Tuesday, March 27, 2012. (Photo By Bill Clark/CQ Roll Call)
Ronald Brock moves his anti-Obamacare sign as protestors, press, and passersby wait for decisions in the final days of the Supreme Court's term, in Washington, Wednesday, June 25, 2014. The court has yet to announce its finding in Sebelius v. Hobby Lobby Stores. The chain of arts-and-crafts stores does not want to provide insurance coverage for certain forms of contraception that it finds objectionable on religious grounds. The justices ruled Wednesday that a startup Internet company has to pay broadcasters when it takes television programs from the airwaves and allows subscribers to watch them on smartphones and other portable devices.The justices said by a 6-3 vote that Aereo Inc. is violating the broadcasters' copyrights by taking the signals for free. (AP Photo/J. Scott Applewhite)
Protestors block traffic near the White House in Washington, Thursday, June 5, 2014. In response to President Obama’s decision to delay the deportation review he ordered from the Department of Homeland Security, United We Dream protested near the White House to highlight the urgency of the administration acting now. (AP Photo/Susan Walsh)
Carlos Padilla of Seattle, Wash., holding flags, and other protestors block traffic near the White House in Washington, Thursday, June 5, 2014. In response to President Obama’s decision to delay the deportation review he ordered from the Department of Homeland Security, United We Dream protested near the White House to highlight the urgency of the administration acting now. (AP Photo/Susan Walsh)
Demonstrators display signs during a protest on West Florissant Avenue in Ferguson, Missouri on August 18, 2014. Police fired tear gas in another night of unrest in a Missouri town where a white police officer shot and killed an unarmed black teenager, just hours after President Barack Obama called for calm. AFP PHOTO / Michael B. Thomas (Photo credit should read Michael B. Thomas/AFP/Getty Images)
Pakistan protesters from the Jamaat-e-Islami party gather around a protester dressed as US President Barack Obama effigy during a pro-Palestinian demonstration against Israel's military campaign in Gaza, in Karachi on August 17, 2014. Indirect talks between Israelis and Palestinians for a long-term truce in Gaza resumed on August 17, 2014, with just over a day left before a temporary ceasefire is set to expire, a Palestinian official said. AFP PHOTO/Rizwan TABASSUM (Photo credit should read RIZWAN TABASSUM/AFP/Getty Images)
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"They are going to extend the subsidies in some manner," Antos said. "I don't know how they are going to do it, but they are going to find some way."

The Affordable Care Act is one of the most politically divisive U.S. laws, opposed by many Republicans. Party lawmakers have fought in particular against its requirement that all Americans have health insurance or pay an annual penalty, and say they have plans to replace the law if the subsidies are ruled out.

HOSPITALS

Without a legislative fix, however, policy experts and Wall Street analysts expect hospitals will take the biggest hit, as they bear the brunt of costs for patients who must be treated but can't pay their own medical bills. Hospital associations said an increase in such costs could "devastate" some of their members, according to a brief filed with the Supreme Court.

When Obamacare was conceived, hospitals were so confident that newly insured patients would increase their revenues that they agreed to $269 billion in cuts to the government's Medicaid and Medicare health plan reimbursement over 10 years.

"It was a quid pro quo, with hospitals agreeing to these reductions in return for coverage of more people," said Kevin Brennan, executive vice-president for finance at Geisinger Health System in Pennsylvania, which relies on HealthCare.gov.

Geisinger offers an insurance plan through the Obamacare exchange and estimates that 80 percent of the 22,000 people who hold those polices receive subsidies.

Pennsylvania is one of a handful of states that plans to set up its own exchange if the Supreme Court rules against the subsidies, and has said it could be ready for 2016.

Data from publicly-traded hospital operators show their costs for treating uninsured patients have dropped since Obamacare took full effect in 2014.

In the first half of that year, admissions of "self-pay" patients, who are almost always uninsured and unable to pay the full bill, fell 14.7 percent at Community Health Systems, 6.6 percent at HCA Holdings, 6.5 percent at Tenet Healthcare Inc, and 9.3 percent at Universal Health Services, according to an analysis by consultants at PwC.

Drug companies like Pfizer and Merck & Co and medical device makers such as Medtronic agreed to new taxes in exchange for the expected increase in paying Obamacare customers. The bet has paid off: Pharmacy benefits manager Express Scripts Holding Co estimates that each Obamacare patient now accounts for an average of $79 per month in prescription drug spending.

That works out to roughly $6.1 billion a year for the 6.4 million people whose subsidies would be eliminated.

Not all of the $6.1 billion would dry up, since drug spending by the uninsured is not zero, said Rand Corporation economist Christine Eibner, who has studied healthcare utilization by Obamacare patients. "On average, people will not fill as many prescriptions" if losing their subsidies causes them to drop their insurance, she said.

Insurers will see a more limited hit to revenue if the subsidies are thrown out, largely because Obamacare customers are only a small percentage of any single health insurer's total business. At the nation's largest insurer, UnitedHealth Group, for instance, about 1 percent of its 46 million members are receiving subsidies that are at risk.

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