2018 MIDTERM ELECTION

Time: D H M S

PA/DE: Good News (maybe): 343,000 people MIGHT not be screwed by King v. Burwell after all (maybe)

It appears that at while most of the 34 states on the federal exchange have spent the past 5 months wandering around aimlessly, at least two of them did pay attention last November when the Supreme Court, to the astonishment of anyone with an ounce of sanity, agreed to take up the King v. Burwell case.

Tom Wolf, the newly-elected (Democratic) Governor of Pennsylvania, announced back in March that yes, he would absolutely push to "establish" a state ACA exchange in the event of a King plaintiff win, and earlier this week he made good on this by formally submitting an application to the HHS Dept.:

Pennsylvania became the first state Tuesday to publicly put in motion a back-up plan to protect its federal health insurance subsidies in the event the Supreme Court dismantles a key part of President Obama’s health care law.

It's important to note that on the surface, nothing would appear to change for those actually enrolling...because Pennsylvanians would still be routed through HealthCare.Gov for the process, just like Oregon, Nevada and New Mexico already are (even though they technically have "established" their own exchanges, legally speaking):

Tuesday evening, Democratic Gov. Tom Wolf announced the state this week had submitted an application to the federal government to take over the state's federal exchange. The move would allow Pennsylvania residents to continue to receive federal subsidies towards purchasing health insurance if subsidies on the federal exchange are invalidated by a ruling in the King v. Burwell case expected later this month.

If this were to go through as planned, tax credits (and therefore, in most cases, the actual policy coverage) for over 325,000 Pennsylvanians would be spared in the event of a King plaintiff win. Beyond that, several hundred thousand additional PA residents would be spared massive rate hikes.

There's one little problem, of course:

Pennsylvania would also need the approval of its GOP-led legislature if it wanted to set up its own exchange.

(sigh) Oh yeah, there is that...

Things look more positive in Delaware, which is the only state completely controlled by Democrats which hasn't already set up their own exchange (presumably because their population is so small it'd be tricky to cover the cost of doing so; see Vermont, Rhode Island and Hawaii's financial woes as examples):

Facing a possible Supreme Court ruling on Obamacare that could cost residents millions of dollars in subsidies to buy health insurance, Delaware has put in motion a plan that could protect the state from the effects of such a decision.

Rita Landgraf, Delaware's health and social services director, confirmed to TPM Wednesday that the state has filed a "blueprint" to the federal government to take more responsibility for its Obamacare exchange to blunt the potential effects of a pending Supreme Court ruling in King v. Burwell.

Currently Delaware's exchange is a state-federal hybrid-run marketplace, but this week Delaware submitted what Landgraf called a "plan for a plan" to move to a federally-supported state-based marketplace.

The good news is that as DE is fully Democratically-run, there shouldn't be any political issues here. The bad news is that the state has only about 18,000 people currently receiving federal tax credits anyway. Don't get me wrong, every person pulled out of this quagmire is a good thing, but 18K out of 6.5 million isn't much to cheer about in the big picture.

Besides, there's still the remote possibility that only the states which fully run their exchanges (i.e., the 14 with their own website platform, etc) could end up being ruled "kosher" by the Court. The odds of that are pretty slim (even the plaintiffs are pretty much giving a pass to NV/NM/OR), but you never know.

If that were to happen, then PA, DE and OR/NM/NV along with every other state would have to set up the entire exchange from top to bottom to be considered "established by the state"...and that would be a truly unholy nightmare, due to the time and expense which would be involved.

So, to summarize, I'd say that assuming the SCOTUS rules for the King plaintiffs:

  • Delaware has about a 95% chance of being OK
  • Pennsylvania has about a 50% chance of being OK (either the GOP legislature will stop being jackasses or they won't)

As for the other 32 states, my own state of Michigan seems like a likely prospect; Gov. Snyder has already said he'd push for it if necessary and at least one Republican state Senator has gone on the record as saying he'd be ok with it...but they haven't actually done anything yet.

Beyond that, there's been a whole lot of fuss and bother over the past few weeks...but little else.

Anyway, assuming that both the PA and DE plans go through as hoped without legal challenges, bla bla bla, that'd be about 343K people crossed off the casualty list...leaving another 6.16 million or so twisting in the wind...