State King v. Burwell Roundup: Illinois, Mississippi and...Oklahoma??

Hot on the news that HHS Secretary Sylvia Burwell decided to channel the Bridgekeeper from Monty Python & the Holy Grail ("Right! Off you go then!!") when it came to Pennsylvania and Delaware's "state-based exchange" requests, here's what's going on in three other states facing possible tax credit loss from an adverse King v. Burwell decision:

ILLINOIS: Hospital group says Illinois could lease Healthcare.Gov

A hospital group in cash-strapped Illinois says the state might be able to set up a health insurance exchange at a lower cost by "leasing" the federal government's technology, an option that could appeal to as many as 34 states where subsides could be jeopardized by an unfavorable U.S. Supreme Court decision.

In a memo written for Gov. Bruce Rauner and state lawmakers and released to The Associated Press, the Illinois Hospital Association says it anticipates the federal government "will be developing a leasing fee" for states to use as the backbone for their own insurance exchanges. It also lists an alternate possibility of renting an exchange system from another state that has its own, such as Connecticut or Kentucky.

..."We as an association are ready to work with the legislative leaders and certainly the administration," said Illinois Hospital Association President and CEO Maryjane Wurth. "We hope we have the governor's support to figure this out."

Rauner, a Republican who took office in January, hasn't discussed what his approach would be if the Supreme Court rules against subsidies. "The governor's office will take appropriate action depending on how the Supreme Court rules," said Rauner spokeswoman Catherine Kelly.

"Leasing" sounds pretty much like exactly what both Delaware and Pennsylvania are planning, but whatever; the key point is that the ultra-right wing governor, Bruce Rauner, would presumably have to agree to doing so.

Meanwhile, in Mississippi, the state insurance commissioner has a slightly solution (h/t to Louise Norris for calling my attention to this story):

The Mississippi Insurance Department has developed a proposed contingency plan  in case the U.S. Supreme Court invalidates federally run health-insurance exchanges in 36 states, including Mississippi.

Insurance Commissioner Mike Chaney said Thursday in an interview with the Mississippi Business Journal that the replacement would protect the federal tax credits that would otherwise be lost to about 100,000 Mississippians. That would make coverage more expensive or unattainable.

...Chaney made two subsequent efforts to establish a state exchange, but after [Mississippi Governor] Bryant ruffled feathers in a letter he sent at the end of 2012 to  Washington, D.C., officials that said that he “didn’t want the state to have anything to do with the Affordable Care Act. Period. And that he thought that he was the proper authority to say no, which is debatable because he is not the elected insurance commissioner. And I chose just not to fight with him,” Chaney said.

...Now Chaney says he has sent the contingency plan to Bryant, Lt. Gov. Tate Reeves and House Speaker Philip Gunn. The plan will not move forward on the replacement for the exchange unless there is a consensus between the four state officials — and then only if there is a ruling adverse to the federal government.

It would entail funneling federal money through the existing Mississippi Comprehensive Health Insurance Risk Pool Association to private insurers, said Chaney.

I don't know understand much about state high-risk pools, but this sounds like it could get awfully messy both legally and process-wise. Seems like it'd be a lot easier to simply do what Delaware, Pennsylvania and (possibly) Illinois are doing to me.

Finally, this isn't quite a King workaround, but there's a really strange King-related story out of Oklahoma this evening; see if you can make sense of it:

It is a health insurance program heavily subsidized by the government that allows individuals to buy coverage they couldn’t otherwise afford.



The program is called Insure Oklahoma, and some state Republican officials — particularly Gov. Mary Fallin — have embraced it in the past few years and pushed the Obama administration to keep it alive.

A few years ago, however, some of the same Republicans defending it now voted against the program.

Attorney General Scott Pruitt, Lt. Gov. Todd Lamb, former Senate GOP leader Glenn Coffee and Oklahoma Republican Party chairman Randy Brogdon cast votes against either its creation or expansion or both when they were members of the Oklahoma Senate.

Created by Democratic Gov. Brad Henry and the Democratic Legislature in 2004, the program is now threatened by the Affordable Care Act, the health-care law created by a Democratic president and Democratic Congress.

And if the U.S. Supreme Court strikes down the Affordable Care Act’s system of tax subsidies this month, about 8,000 Oklahomans who had coverage through Insure Oklahoma but were forced into the federal program could be hurt — again.

...Insure Oklahoma was created to help small businesses offer health insurance to their employees.

The state uses a pot of money from the national settlement with tobacco companies, along with Medicaid money, which is a mix of federal and state funds. The employer and employee also pay a portion of the premiums.

Confused yet?