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States could forestall King v. Burwell outcome, but it won't be easy

Politics, finances and time stand in way of states building insurance exchanges

Ever since the Supreme Court announced last month that it will hear the case of King v. Burwell to determine the legality of the Affordable Care Act's subsidies, there's been a lot of speculation as to how the ruling will play out.

If, in fact, the high court rules that only states running their own insurance exchanges can provide financial assistance to residents, it's possible millions of low-income Americans could lose the subsidies that help them afford their health insurance.

States could offset this outcome by building their own state-run exchange, suggests The New York Times. Of course, that's easier said than done.

"Anyone who thinks you can just snap your fingers and you've got a state exchange is just wrong," Timothy Jost, a law professor at Washington and Lee University, told The Times.

On the surface, an exchange appears to be just a website, but it's far more complex. Setting up an exchange requires a huge investment of both time and resources, according to the New England Journal of Medicine.

Every state marketplace must be able to 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, notes NEJM.

The seven states in the best position to set up their own exchanges--Arkansas, Delaware, Illinois, Michigan, New Hampshire and West Virginia--run their existing exchanges as a partnership with the federal government. Delaware already has started actively certifying its exchange plans and handling most of the operations required by a traditional state exchange, FierceHealthPayer previously reported.

But it's possible the aforementioned states won't even want to run their own exchanges because of politics, according to NEJM. Due to this year's midterms, many states will face a Republican-controlled legislature--and many Republican governors oppose state-run exchanges.

If states want to set up shop, they better act quickly. The deadline to apply for federal grant money that goes toward operating an exchange has already passed--and, by law, all state exchanges must be able to support themselves financially next year, adds The Times.

For more:
- here's the NYT piece
- read the NEJM article

Related Articles:
Courts, not Congress, will decide if ACA gets dismantled
Which states can make themselves immune to a subsidy ruling?
King v. Burwell: SCOTUS decision could change everything--or nothing
U.S. Supreme Court will hear King v. Burwell