Which states can make themselves immune to a subsidy ruling?


Now that the U.S. Supreme Court has decided to hear a case challenging the legality of Affordable Care Act subsidies, many states are looking into options that would make them immune to a potential ruling invalidating subsidies, reported Governing.

The seven states in the best position to make changes are ones running a partnership health insurance exchange with the federal government--Arkansas, Delaware, Illinois, Iowa, Michigan, New Hampshire and West Virginia. That's because the most important, and obvious, step states can take is to establish their own exchanges, since subsidies for state marketplaces aren't being questioned in the King v. Burwell case, FierceHealthPayer previously reported.

The process of shifting a federal marketplace to a state-run exchange is no walk in the park. For example, even states operating a partnership exchange haven't established governing boards or made subsidy eligibility determinations for themselves, Timothy Jost, law professor at Washington and Lee University, told Governing.

States such as Delaware say they're ready to take on the challenge of completely running their own marketplace. Delaware has started actively certifying its exchange plans and handling most of the operations required by a traditional state exchange. Delaware exchange officials, then, just need formal status, which they intend to seek after receiving authorization from state regulators.

Meanwhile, Illinois Gov. Pat Quinn (D) wants the legislature to approve a state-based exchange before the newly elected governor takes over in January. Quinn faces an uphill battle, needing a supermajority in a short veto session to receive the authorization.

In Iowa, state Sen. Pam Jochum (D) is trying to pass a bill authorizing a state-run exchange before the session ends. So far, Republican opposition has blocked past efforts by Jochum and fellow Democrats, Governing noted.

To learn more:
- read the Governing article

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