B. The Proposal Would Be Costly For Taxpayers
The MOOPL proposal not only would shift costs from wrongdoers to in-
nocent claimants, but from wrongdoers to taxpayers. Since health insurers
would pay for future medical expenses, insurance premiums would rise.129
The ACA provides government subsidies for those who cannot afford health
insurance premiums, with the subsidies tied to the cost of the second-lowest-
cost “silver” plan in their state.130 Therefore, as premiums for those plans
increased, the amount of taxpayer subsidies would have to be increased.131
This is especially noteworthy given the extent of the subsidies. For example,
they are available to individuals and families with incomes up to 400 percent
of the federal poverty level; in 2015, this would include a family of four with
an income of up to $97,000.132
The proposal also would conflict with the statutory rights of public programs such as Medicare to be reimbursed for their expenditures on care required to tort-related injuries.133 As noted above, claimants who require future medical care for their injuries are likely to be on Medicare and Medicaid
rather than to have private insurance.134 The less compensation that claimants
receive from tortfeasors for future medical costs, the less funds will be available to reimburse these programs. The drain on these programs would reduce
the health care resources available to those claimants, as well as elderly, poor,
and underserved individuals. As the North Carolina Supreme Court stated in
Cates v. Wilson, “between defendants who tortiously inflict injury and innocent taxpayers who fund programs such as Medicaid, we think it better that
the loss fall on the tortfeasor.”135
Finally, the proposal would impose greater costs on taxpayers by pushing
into poverty claimants whose future out-of-pocket expenses exceed their recoveries. The Kaiser Family Foundation reports that the inability to pay medical bills is a major cause of financial hardship:
129. See Rising Health Care Costs, AHIP, https://www.ahip.org/Issues/Rising-Health-Care-Costs.aspx (last visited November 16, 2015).
130. See BERNADETTE FERNANDEZ, CONG. RESEARCH SERV., R431137 HEALTH
INSURANCE PREMIUM CREDITS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT
(ACA) 9 (2014).
131. See AHIP, supra note 131.
132. 2015 Poverty Guidelines, U.S. DEP’T OF HEALTH & HUMAN SERVS. (Sept. 3, 2015),
133.Se e Reporting a Case, CTRS.FO R MEDICARE & MEDICAID SERVS., https://
Reporting-a-Case/ Reporting-a-Case.html (last updated October 1, 2015, 4: 56 PM).
134. See Fagel, supra note 14, at 4 (stating that “in most cases involving significant future
medical costs, it is . . . likely that the plaintiff would have lost their private health insurance
and gone on [Medicaid] or Medicare long before the resolution of their claim”).