The court could rule any day in a case seeking to overturn the federal Affordable Care Act, and the consequences are significant for Massachusetts in the case of Texas v. United States in the U.S. Court of Appeals for the Fifth Circuit, according to a new analysis.

If the ACA is overturned and Massachusetts is able to reestablish its 2006 coverage programs, state spending would need to rise by $731 million while federal health care funding would shrink by $1.4 billion per year, even if the federal government agreed to the funding arrangement that made coverage expansions possible under the 2006 law signed by former Gov. Mitt Romney, the Blue Cross Blue Shield Foundation of Massachusetts concluded. Without the federal funding arrangement, the state would face a $1.7 billion increase in its own spending to stand by its 2006 coverage expansion.

A second scenario explored by researchers assumes Massachusetts is not able to reestablish the subsidized coverage programs created by the 2006 law. Under that scenario, 375,000 people would lose health insurance coverage and the state's uninsured rate would rise from 3.5 percent to 10.2 percent of the non-elderly population, according to the brief, which was released Tuesday morning. The state would lose $2.4 billion in federal aid under this scenario, and health care providers would see a surge in demands for care from uninsured patients, creating stress on the system.

Researchers based their findings on a model developed by the Urban Institute using cost and coverage data from MassHealth, the Massachusetts Health Connector and the Center for Health Information and Analysis. The foundation says the case may ultimately be decided by the U.S. Supreme Court.

The case looms as a major wildcard for all states, and in Massachusetts the outcome could also have significant impacts on the state's ability to afford the major K-12 education investments agreed to under a seven-year law and the major long-term investment under consideration for public transportation. - Michael P. Norton/SHNS | 12/17/19 9:46 AM