2018 MIDTERM ELECTION

Time: D H M S

Note to 35* States Running off of HC.gov: My "Denny's Grand Slam" Solution is only TECHNICALLY easy, not LEGALLY so.

I'm filing this entry away in order to smack every damned one of these states--including the ones with Democratically-controlled governments--over the head with it 7 months from now when the Supreme Court is expected to rule on the King/Halbig case.

They're playing Russian Roulette with the lives--literally--of millions of people, sitting on their asses on the assumption that a) the SCOTUS will shoot down the King plaintiffs or b) if they do rule for the plaintiffs, they can slap something together with duct tape & chicken wire at that time.

Here's the thing, though: While I've been talking a lot about the technical ease in which my "Denny's Grand Slam" workaround could be done, I've been informed by several people (most notably Nicholas Bagley) that legally and procedurally speaking, it's a lot more complicated than that.

In other words, every one of the following states--along with the other 2 dozen not already running their own exchanges--should be running, not walking towards at least getting their ducks in a row in case SCOTUS lowers the boom...and instead, every damned one of them appears to have decided to twiddle their thumbs for the next 6 months or so:

NEBRASKA:

Nebraska should continue to let the federal government run the state's health insurance marketplace instead of creating its own, a state commission says.

The Nebraska Exchange Stakeholder Commission said in a report released this week that building a state-run marketplace would prove "difficult at best," given the lack of federal funding and problems some other states experienced with their systems.

The report comes one month after the U.S. Supreme Court agreed to hear a case that could jeopardize federal tax credits for states that use a federally facilitated marketplace. Nebraska is one of 27 states that declined to set up their own system.

...Commission chairman J.J. Green of Grand Island said the group opted for a wait-and-see approach while the case moves through the courts. Green pointed to states such as Oregon, which in October severed ties with a company it blamed for its botched marketplace.

ILLINOIS:

Legislation to establish a state-based health insurance exchange in Illinois failed to come up for a vote in the House before the Democratic-controlled Legislature adjourned for the year last Wednesday. That means Illinois won't be able to apply for $270 million in federal exchange development funds.

Republican Gov.-elect Bruce Rauner opposes Obamacare, making future action doubtful.

IOWA:

Roughly 24,000 Iowans stand to lose hundreds of dollars in annual assistance to pay for their health care, pending a U.S. Supreme Court ruling expected next summer.

The potential issue could be avoided if Iowa operated its own health insurance exchange rather than defaulting to the federal government’s. But that appears unlikely based on the comments of top elected officials, who continue to express concerns with the federal health care law.

NEW JERSEY:

One stumbling block could be Christie’s professed opposition to the ACA and his history of vetoing establishment of a state exchange.

But Jacobi noted that the circumstances could be different.

“The governor was opposed to the idea as it was initially proposed, but I don’t know whether the governor would be interested in … something that would qualify it as a state exchange but with less financial exposure to the state than the original proposal entailed,” Jacobi said.

ACA opponents in the state are likely to resist such a move. 

ARKANSAS:

Despite the high stakes, most states are taking a wait-and-see approach to the lawsuit, which is expected to be decided in June.

The only other state that has made moves to establish its own exchange is Arkansas. But there, a new anti-ACA Republican governor is replacing a pro-ACA Democrat.

MICHIGAN:

A representative for the Department of Insurance and Financial Services in Michigan, which also has a partnership exchange, said there has been no change in the state's plans concerning its exchange since the Supreme Court decided to take the King case. “We are reviewing the impact of the ruling, how it will impact Michigan consumers, but there is still a lot that is unknown at this point,” said Caleb Buhs, in a written statement.

Delaware, New Hampshire & West Virginia:

The most likely candidates to switch to a state-based exchange would seem to be the seven states, including Illinois, that operate partnership exchanges. Those states already take responsibility for some aspects of the exchange, such as overseeing outreach efforts. But they rely on HealthCare.gov for actual enrollments. Few of those states, however, appear eager to move forward with an exchange.

* I should note that there seems to be quite a bit of confusion as to just how many states would be screwed if the King plaintiffs do win. I've heard the number which are defined as legally having a "state-based exchange" ranging from 14 (CA, CO, CT, DC, HI, ID, KY, MD, MA, MN, NY, RI, VT, WA) to 16 (those 14 plus Nevada & Oregon, which ran their own sites last year but were moved to HC.gov this year), to 17 (those 16 plus New Mexico, which was supposed to run their own site but decided to take a pass the first 2 years), to 24 (those 17, plus AR, DE, IL, IA, MI, NH & WV which, as noted above, all have "Partnership" exchanges, whatever the hell that means).