Five months later, true implications of King v. Burwell FINALLY sinking into skulls of some state admins
2018 MIDTERM ELECTION
Time: D H M S
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.
Anyway, let's suppose that #1 and #2 are squared away. Against all odds, the Republican governors and legislators of these states get their heads out of their asses and actually approve all of the above.
That leaves #3: Time. Even if everything was streamlined and fast-tracked (and lord knows that's unlikely), it would still take substantial amounts of time to do all of this.
According to consulting firm Leavitt Partners (via the Center for American Progress), it would take up to 18 months for a state to set up their own "full" exchange (website/platform et al). Using the "HC.gov piggyback" method which I'd imagine most states would go for (again, assuming it's allowed), it might take less time--perhaps 6 months or so from the point that such legislation is passed and signed.
And that's the problem. Again, as the CAP notes:
A ruling in June would be only months before open enrollment for 2016 begins in October, leaving little time for states to act.
Of the states that would lose tax credits, only eight have legislative sessions that extend beyond June. Because states need to have the legal authority to set up a marketplace—and because most governors do not have the statutory authority to act on their own—state legislatures would need to act.
In other words, even if the various state legislatures and/or Governors wanted to go ahead and slap something together, almost all of them would have to do so BEFORE the Supreme Court ruling.
That is, they'd have to start RIGHT NOW...and even then it would be awfully tough timing.
One bit of good news, I suppose: The start date for 2016 Open Enrollment has been pushed back since I wrote this...by all of 2 weeks (to November 1st). So, y'know, there's that, anyway.
However...legislators "acting quickly"??? On something which actually serves a useful and potentially necessary purpose??? I dunno, man...sounds like a stretch.
Speedy and decisive legislative action is usually reserved for things like, say, forcing a woman in a vegetative state to remain on life support against the express wishes of her husband and anyone with a shred of human decency.
Anyway, now it's Memorial Day Weekend, and the Supreme Court King v. Burwell announcement is just 5 weeks away.
Well, guess what? The Hill's Sarah Ferris has a very nice scoop today:
A number of states are quietly considering merging their healthcare exchanges under ObamaCare amid big questions about their cost and viability.
...Others are contemplating creating multi-state exchanges as a contingency plan for a looming Supreme Court ruling expected next month that could prevent people from getting subsidies to buy ObamaCare on the federal exchange.
Awesome!! I guess I owe all these states an apology--apparently they really have been quietly working behind the scenes to prepare for the worst-case scenario in time for the Big Announcement, right???
The idea is still only in the infancy stage. It’s unclear whether a California-Oregon or New York-Connecticut health exchange is on the horizon.
Oh. Never mind.
Most Republican state leaders have avoided talking about how they would respond to a decision against the use of subsidies on the federal exchange. Behind the scenes, however, many are anxiously contacting states that run their own exchanges.
“In the last seven business days, I’ve probably had seven to 10 states contact me about contingency plans,” Wadleigh said, though he declined to disclose the names of states he’s been talking to. “You can imagine the political backlash that would be if the names got out.”
The last 7 business days?? The GOP-run states waited until mid-May to get off their keisters and start asking questions?
Well, y'know what, guys? You wouldn't have to be quite so "anxious" if you had actually listened to people warning about it 4 or 5 months ago (or nearly a year ago, actually).
To clarify, I'm hardly the only one who's been sounding the warning bell on this. Many reporters, legal experts, insurance experts, actuaries and healthcare professionals have long been warning anyone who would listen about the potential danger and how important it is to not just move, but move quickly to avoid disaster in the event that the Court rules for the King plaintiffs. The problem is that few were listening (or if they were, they somehow thought this happening would be a good thing).
I should also clarify that I'm not taking shots at the states which already have their own exchanges set up considering working together; that makes perfect sense, especially for smaller states such as Vermont and Rhode Island which may not have enough of an enrollment pool on their own to make it cost-effective.
However, the states on the federal exchange have known (or should have known) that this was a distinct possibility since at least last November 7th, when the Supreme Court, against all common sense, agreed to take on the case.
(sigh) Well, better late than never, I suppose. And this "regional exchange" idea sounds just as reasonable as any of the other workaround or alternate plans which anyone (including myself) has come up with so far.
In fact, this also brings up another potential idiocy of the King v. Burwell case.
Let's suppose that the SCOTUS does rule for the plaintiffs, and the federal exchange becomes effectively a ghost town.
Let's suppose that against all odds, all 34 (or 37?) states on the federal exchange manage to bind together into perhaps a half-dozen regional exchanges with 5-6 states participating in each, thus saving the Affordable Care Act from the Republican Party's best efforts to destroy it.
Let's say that, a year or two down the road, a couple of these regional exchanges decide that, in the interests of further cost savings, it makes sense to merge into a larger "regional" exchange, followed by mergers of the others, until you're down to 2-3 regions.
At that point, logic would dictate that if working together promotes better economy of scale and efficiency for 10-15 states, it should be even more economical and efficient if they merged together into a single "regional" exchange, right?
Why yes, that sounds like a grand idea! Of course, at that point it wouldn't make much sense to keep calling it the "Mid-Atlantic Exchange" or the "Southwest Exchange"; it would probably be better for branding and marketing purposes to give it a simple, catchy, easy-to-remember name.
Like, say, "Healthcare.Gov", perhaps.
That domain would likely be available at a pretty cheap rate, I should think; it's not like it would be being used by anyone else or anything...