King v. Burwell: Impact on states

King v. Burwell Supreme Court case: What you need to know [Special Report]

By Dori Zweig

Even though the Supreme Court will decide the fate of the subsidies, many industry experts believe it's not up to the courts to rewrite the statute. As a result, he 37 states using the federal exchange may need to take matters into their own hands and establish state-run marketplaces.

There are a few options that could present themselves to states should this happen, according to a recent report from the Leavitt Partners, FierceHealthPayer previously reported:

  • The Centers for Medicare & Medicaid Services may let states use the platform but require them "to assume or retain ownership and control of all other marketplace functions."
  • States could form partnerships with other states to build an exchange.
  • States could adopt a multi-tenant shared service technology model. This so-called "Marketplace as a Service" would give states more autonomy than a regional partnership, the report mentioned.

It's possible the situation could be rectified. However, while an exchange appears to be just a website on the surface, it's far more complex. Setting up an exchange requires a huge investment of both time and resources. States also must consult with stakeholders, grant exemptions from the individual mandate to obtain coverage, operate a program that helps individuals navigate the site and certify qualified health plans.

Many governors are taking a wait-and-see approach. "We declined to operate a state exchange along with a majority of other states," Indiana Gov. Mike Pence, a Republican who is weighing a 2016 White House run and supports the repeal of the healthcare law, said during last week's National Governors Association winter meeting, FierceHealthPayer previously reported. "Right now we're just evaluating what our options are depending on what the Supreme Court decides."