If Supreme Court strikes down ACA subsidies, states could step in

If the U.S. Supreme Court rules next year that the Affordable Care Act subsidies aren't legal, it could make health insurance unaffordable for millions of consumers. But could states "save" the healthcare reform law?

The high court agreed last week to hear a case challenging the legality of federal subsidies, which could dramatically impact the future of healthcare reform. At issue is whether Congress intended to allow subsidies for consumers shopping on the federal health insurance exchange in addition to state-run marketplaces.

"There are workarounds," Timothy Jost, a law professor at Washington and Lee University, told Bloomberg News.

The most obvious step that states can take is to establish their own exchanges--subsidies for state marketplaces aren't being questioned in the case. Although the midterm elections last week ushered in more Republican governors who are opposed to the ACA, they would still have to tell millions of consumers who are now receiving subsidies to pay the money back.

To help persuade states to establish and operate their own exchanges, the Obama administration would likely implement various incentives. The Department of Health and Human Services "will have lots of incentives to make this painless for states, and considerable legal flexibility to do so," Nicholas Bagley, an assistant law professor at the University of Michigan who specializes in healthcare law, said in July, Bloomberg noted.

To learn more:
- read the Bloomberg News article