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Congressional District-Level Data Show Potential Damage of King v. Burwell

By Ben D’Avanzo,


The pending Supreme Court ruling in King v. Burwell puts 6.4 million consumers across the country at risk of losing their health coverage. We have released new data broken down by congressional district that detail the number of consumers who would be affected if the justices rule against the government.

The case challenges whether residents in the 34 states where the federal government runs the health insurance marketplace can continue to receive premium tax credits through the Affordable Care Act (ACA). Our series of 34 state-specific infographics shows that, in each congressional district, there are thousands of consumers who rely on premium tax credits to afford their health insurance.

Data show that southern congressional districts have some of the highest numbers of residents at risk of losing premium tax credits

While all states and districts in our series would see an impact if the Supreme Court decides to strip premium tax credits, these data show that some states would be disproportionately affected. For example, at 1.3 million, Florida has the highest number of enrollees receiving tax credits of any of the states with marketplaces run by the federal government:

  • District with the highest number of residents who could be affectedFlorida’s 25th congressional district in the Miami suburbs, represented by Rep. Mario Diaz-Balart (R), contains the largest number of consumers in the country who stand to lose their premium tax credits: 95,000 people.
  • District with second-largest number of residents at risk: The next district in the country with the most residents at risk is Florida’s 27th district, represented by Rep. Ileana Ros-Lehtinen (R): 86,000.
  • State with the second-highest number of residents at risk: With 832,000 relying on tax credits, Texas ranks as a state that could be hit hard by a ruling against the government. The congressional districts making up and surrounding cities like Houston (250,000) and Austin (100,000) have some of the highest numbers of residents receiving tax credits in the country. The Texas congressional district with the most to lose is the 9th, in southwestern Houston, represented by Rep. Al Green (D): 36,000.
  • North Carolina and Georgia contain several districts that are among those with the highest number of consumers who would lose their tax credits, and very likely, their health insurance.
  • Elsewhere in the country, the congressional districts in the metropolitan areas of Chicago and Philadelphia have 154,000 and 147,000 residents, respectively, who could lose tax credits.

Many consumers currently receiving premium tax credits could be forced to drop health insurance

In 2015, consumers enrolled in ACA coverage received an average monthly premium tax credit of $272. If the justices decide residents in the 34 federal marketplace states are not eligible for that financial assistance, their monthly premium payments could increase substantially. In most cases, consumers would be unable to afford the increased price of their insurance and would be forced to drop coverage.

Data derived from 2015 HHS enrollment figures

The data for the infographics were compiled from zip-code level enrollment figures from the Department of Health and Human Services, adjusted for how many enrollees actually paid premiums (“effectuated enrollment”) and the percentage of enrollees receiving tax credits. These data reflect those who would be directly harmed, though we believe the resulting chaos in the health care system will likely threaten the health coverage of millions more.

While we are confident the court will recognize the need to uphold the premium tax credits and rule in favor of the government, these infographics demonstrate the danger if it chooses to ignore the intent of the ACA’s drafters and the language of the law itself and strip consumers of their access to affordable insurance.

Help spread the word about the potential damage done in your community by sharing these graphics and personal stories