Among the 34 states that could be left hanging by the Supreme Court when it decides
King v. Burwell in the next few weeks, there are some that want to figure out how to fix it. Those are the states whose residents with Obamacare policies might lose their subsidies, if the court decides that the law does not allow the subsidies on the federal exchange. There are four states—Oregon, Nevada, New Mexico, and Hawaii—which ended up using a hybrid model when they ran into snags setting up their own exchanges. Those states could
provide a model.
Many health care experts see that as the best possible solution for states whose residents could be stripped of subsidies by the court later this month. The states declare that they're adopting a core component of Obamacare, thus preserving their eligibility for the subsidies. And they could seek HHS' approval to keep using HealthCare.gov for enrollment.
"It definitely is promising because it's a model in which the state would take on significant responsibility," said Trish Riley, executive director of the National Academy for State Health Policy. "But it would require work, certainly." […]
Nevada exchange Executive Director Bruce Gilbert said his state's system ended up being the best of both worlds. Nevada can control local elements of its marketplace while "the federal government is really good at providing infrastructure." […]
"I see huge value in the model that we're executing in New Mexico," exchange CEO Amy Dowd said, expressing optimism that other states could follow. New Mexico had set out to operate its own exchange and enroll people on its own, but changed course after encountering technical setbacks. They now have more than 33,000 people getting subsidies for their health plans.
That's fine, for the states that don't have asshole governors like Wisconsin's Scott Walker who flat out refuses to consider any fix, and South Dakota Gov. Dennis Daugaard who says it's a federal problem and so the feds have to fix it. Even if governors aren't assholes, there are Republican legislatures to overcome. That includes the legislature in Pennsylvania, which has already received the go-ahead from the feds to try to set up this kind of hybrid. Gov. Tom Wolf is set to go, but he has to sell it to his legislature.
Perhaps, if the Supreme Court does decide to gut the law, there will be so much outrage among the populace of these states that their lawmakers will be forced to act. Maybe. Somebody is going to have to do something, and the chances that it's going to be a Republican congress are mighty slim.