With Supreme Court arguments in the latest challenge to the Affordable Care Act just days away, a sense of impending crisis has hit state officials and patient advocates in many parts of the country. Many worry they have no good options.
If the justices rule in favor of the challenge, it would wipe out insurance subsidies for millions of consumers in nearly three dozen states that use the federal HealthCare.gov marketplace established through the health law.
Although consumers could still get aid in states that run their own marketplaces, officials in states that rely on the federal government fear they don’t have the time or resources to set up their own exchanges, even if they could overcome local political opposition.
“The recurrent nightmare for us is … ‘What do we do?’ “ Dr. William J. Hazel, Virginia’s health secretary, said at a recent conference in Washington. “We’re starting from zero. And all of those states like us will probably start at zero.”
The Obama administration, meanwhile, has provided states little guidance, a strategy many believe is calculated to pressure the Supreme Court not to sow chaos by invalidating the aid.
Congressional Republicans also have not advanced alternative plans to help states, though some senior GOP lawmakers say they might restore aid to consumers if the president agrees to change the health law commonly called Obamacare.
The marketplaces — now in their second year — allow Americans who don’t get health benefits at work to shop online among plans that must all offer basic benefits and cannot turn away customers, even if they are sick.
Americans making less than four times the federal poverty level — or about $94,000 for a family of four — qualify for subsidies to offset the cost of their premiums.
The law’s challengers argue that a strict reading of the statute makes those subsidies available only in states that established their own marketplaces, rather than having the federal government operate the marketplace for them.
The Obama administration, the law’s congressional architects and many outside legal experts disagree.
The justices are likely to decide the case in late spring. If they rule against the administration, nearly 90 percent of health plan enrollees in 34 federal marketplace states — an estimated 7 million people — would lose aid.