WASHINGTON Officials in several Republican states that balked at participating in President Obama's health care initiative are revisiting the issue amid mounting panic over a possible Supreme Court decision that would revoke federal insurance subsidies for millions of Americans.
The discussions taking place in state capitals across the country are part of a flurry of planning and lobbying by officials, insurance and hospital executives and health care advocates to blunt the possible impact of a court ruling.
The justices hear arguments about the matter this week. If the court sides with the plaintiffs, who argue that subsidies are not allowed in the 34 states that opted against setting up their own insurance marketplaces, the ruling could spark an immediate crisis. People could see their insurance bills skyrocket or be forced to abruptly cancel their health insurance.
At least six states where Republican leaders had refused to set up state marketplaces under the Affordable Care Act are now considering what steps they might take to preserve the subsidies being paid to their residents.
Efforts to try to hold on to the subsidies are even under consideration in South Carolina, which supported the challenge now before the Supreme Court. South Carolina Gov. Nikki Haley, a Republican, said her state might consider setting up a marketplace, though it is unclear how such a proposal would fare in the staunchly conservative state.
We're going to start in this next week working on some things statewide, Haley, one of the health law's fiercest critics, said late last week.
A total of nine states now have bills under consideration to set up their own marketplaces, according to the National Conference of State Legislatures, though in some cases these efforts began even before the court accepted the subsidies case.
Lobbyists for insurers, hospitals and consumer groups are alerting legislators in some states to what they call the potentially disastrous consequences if the subsidies are suddenly revoked. In Pennsylvania, for example, hospitals and insurers are trying to coax the Republican-led Legislature to back a state marketplace if immediate action is needed to preserve the subsidies.
But there are enormous logistical and financial barriers to setting up a marketplace this late in the game, experts say. The states that have their own marketplaces took several years to set up the websites, contract with insurance companies and establish call centers. They did so with the help of hundreds of millions of dollars in federal grants that are no longer available.
Insurers are gaming out who is going to drop coverage, and how quickly, if the subsidies dry up. The companies have begun devising strategies to hold on to these customers. Insurers that did major hiring to handle the new business resulting from the marketplaces are figuring out whether layoffs might be needed.
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