WASHINGTON — Sometime before the end of the month, the Supreme Court is likely to issue its ruling in King v. Burwell – a case that will decide whether health insurance premium subsidies for moderate- and middle-income Americans will continue to be available in all states, or whether they will be withdrawn from the 34 states that deferred to the federal government to run their insurance marketplaces.

There is ample reason to believe that the Supreme Court will rule for the government and allow the subsidies, offered through the Affordable Care Act, to continue nationwide. Abundant court precedent makes clear that statutory interpretation requires an examination of the whole statute and its context, and this makes it likely the court will continue subsidies throughout the country.

But the Supreme Court is often unpredictable. If it does the unexpected and rules against the Obama administration, Congress will have to step in and save these subsidies that are so critical for more than 6 million Americans – about 61,000 in Maine.

To show the extent of the damage, Families USA has drawn a map that shows, by congressional district, how many people in Maine and the other 33 affected states would lose their subsidies if the court eliminates them. (To see the map, go to FamiliesUSA.org and click on the banner at the top of the page.)

The map clearly shows this should not be a partisan issue. Some 4.2 million of those who would lose tax credits live in congressional districts with Republican representatives, while 2.1 million live in Democratic districts.

In Maine, the 61,000 residents who would lose coverage are split fairly evenly between Democratic U.S. Rep. Chellie Pingree’s 1st District and Republican U.S. Rep. Bruce Poliquin’s 2nd District.

This means it is in the interest of both parties to act quickly on their constituents’ behalf, because ending these subsidies would cause premiums to skyrocket, with the potential to destabilize both the insurance and the health care industries.

Here’s what could happen if subsidies vanish in federal exchange states like Maine.

In the Pine Tree State, the average per-person monthly premium for subsidized insurance is $93 versus $425 without a subsidy, according to a report this spring by the U.S. Department of Health and Human Services.

Without subsidies, many healthy people would find that the cost is too steep, and they would drop their health insurance. Sicker and older people would also find the premiums are very high, but they would be less likely to end their coverage.

The inevitable result is that insurance pools would disproportionately be filled with people needing significant care, rates would skyrocket and an insurance “death spiral” would occur, causing premiums to continuously rise.

The American Academy of Actuaries summed up what would happen in a report released last month.

“An immediate or near-term elimination of federal premium subsidies would cause massive disruption in the individual market,” according to the report. “Potentially millions of people would drop coverage, and the average costs of those remaining would soar. Insurers could face solvency concerns, especially for those whom exchange business is a relatively large share of their book of business.”

Hospitals and other health care providers would feel the weight of this as well. Estimates indicate that the millions who would become uninsured because of a ruling against the federal government would result in $12 billion in uncompensated medical care in 2016 alone.

With an adverse decision, we would be headed back to where we started before the Affordable Care Act, when, according to the Census Bureau, about 46 million Americans – about 147,000 in Maine – went without health insurance, largely because they couldn’t afford it.

The people the ACA has helped know it has set this nation on the right course toward the goal of affordable, high-quality health care for all. It is imperative that the Supreme Court recognize this, too, and uphold premium tax credit subsidies for residents of every state.

But if not, Congress must step in.

— Special to the Press Herald