If the Supreme Court rules next spring against insurance subsidies in states that have refused to run their own marketplaces, these states will face a decision with implications for millions of people who’d suddenly lose subsidies: Do they cave and set up their own health insurance marketplaces, after all?
When most Republican-led states rejected the chance to set up their own marketplaces, or exchanges, two years ago, many offered a few similar reasons: They didn’t want to do anything that can be viewed as helping to implement the Affordable Care Act, it would be too expensive to run and they didn’t see any difference between state and federal control. That last factor suddenly changes if the Supreme Court rules against subsidies in federal-run exchanges.
The latest Obamacare case accepted by the Supreme Court on Friday revolves around whether the Congress intended for residents to receive financial assistance to purchase health coverage in states that didn’t set up their own insurance marketplaces, or exchanges. Subsidies in state-run exchanges aren’t at stake in the case, King. v. Burwell.