The future of many state-run health insurance exchanges hangs in the balance ahead of Thursday’s expected Supreme Court ruling on the constitutionality of the Patient Protection and Affordable Care Act, known as Obamacare.
Several states have already passed state laws creating their own exchange programs, which will not be affected by the ruling, but other states have signed on with the federal system.
Brett Graham, who directs the health exchange practice at Leavitt Partners, told The Daily Caller that both the Supreme Court ruling and the November election might influence states’ decisions on how to proceed with their exchanges.
“There’d be a few states that would still have the funding [if Obamacare were entirely struck down],” Graham said. “They would just keep pushing forward. Those would be … the states which received some of their early innovator grants, the large dollar grants that were set forth to be able to do create programs that theoretically were going to be used by other states to follow.”
Washington, California and Maryland are among the few states that Graham said would likely continue on with exchange programs even if the Supreme Court rules Obamacare unconstitutional.
“There would be only a handful that would go forward, because most of the states fall into the bucket, which is, they’re going forward because there is a requirement to do so in order to both comply with the law and also have the mechanism to be able to distribute the subsidies,” Graham said.
But if Obamacare survives Thursday’s Supreme Court decision, more states will join the federal exchange program, Graham added.
“I think if that happens, all those that are currently moving move, and many that are sitting on the sidelines start to get in because at least one more thing has happened that they can’t point to and say, ‘gotta wait for the Supreme Court,” Graham said.
“Some of those states that haven’t acted yet will say, ‘Well, there’s still another shoe to drop and that’s the election and they may hold out.’ But because the election is in the first part of November, and states have to make their determination of what they’re going to do and make that known to HHS by the 16th of November, there really isn’t a whole lot of time.”
Many unknowns remain concerning the implementation of the health exchange system, including the potential problems raised by the projected influx of many new patients into the health care system.
Those making up to 400 percent more than the poverty line are eligible to participate in the health care exchange program established by Obamacare and purchase government-subsidized health insurance plans. Many people, therefore, may choose to opt out of their employer-provided insurance plan to enter the exchange, adding pressure to the existing health care system.
“If you throw 15 percent in the system, it’s logical to assume that if those 15 percent of increase of people use the system similar to how the other people do, then all of a sudden the existing physicians and facilities will have demand that will increase,” Graham said.
The exchange system is designed to offer a cheaper health plan for the more than 32 million uninsured Americans who cannot afford health coverage. The system creates a public forum for these individuals to sell or exchange their health insurance and purchase federally subsidized insurance policies.
“Unless you increase the amount of physicians and facilities, there’s many places that won’t have the the time and schedule to see those people, and that’s a real challenge.”
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