With the U.S. Supreme Court decision on King vs. Burwell, the subsidies are staying as the Justices ruled in favor, voting 6-3, for upholding the subsidies.  Naturally, the impact of the decision won’t be immediately felt, but here are five ways you will benefit from King vs. Burwell decision.

The Subsidies are Staying

The most obvious, and most powerful, takeaway of the King v. Burwell decision is that the subsidies are staying in force. Millions of Americans no longer have to worry about continuing their health insurance policies without assistance on the cost. The subsidies will continue to make health insurance affordable and well within reach. But retention of subsidies is not only beneficial for the people, but for the healthcare industry as well. Let’s see how.

Health Insurance Premiums Will Continue To Be Affordable

Other than the regular yearly increase in the cost of Obamacare health insurance plans, premiums should not be going up anymore. Plans are just starting to submit their plan premiums for open enrollment 2016. However with the few that have already been submitted and published, it looks like any increase will be minimal.

Quality of Care is Expected to Go Up

Without subsidies, the health insurance industry was looking at a high rate of uninsured. More than that, hospitals and doctors were worried about uncompensated care and the money spent on people without health insurance. Available statistics show that states were looking at $12 Billion in uncompensated care for the uninsured. Now, with subsidies intact, the states and hospitals can breathe easy and focus on what they can delivery – improved care quality and efficiency. With covered health insurance and a healthy insurance pool, hospitals and doctors need not worry about these challenges, and they can continue to invest their money in improving care quality for Americans.

More Choice in Health Insurance Plans

Continuing the trend of Obamacare plans, enrollees will continue to see better health plans at competitive prices on the marketplaces. With subsidies intact, health plans no longer need to worry about imbalanced risk pools and challenges in the market. They can strive and thrive with the current setup, and that requires introducing new, better health plans that can grab the attention of customers. So if you have been waiting to change your health plan for something better, this open enrollment should have some nice offerings that are right up your alley.

Increased Stability in Healthcare System

The American healthcare system, for the amount of money spent on it, is not impressive, and the health insurance industry admits that. Now that the subsidies are staying, there are a lot of other avenues where attention will be focused. How will that affect you? Well, you would experience a drop in healthcare costs, prescription drug costs, and improved care quality for the same dollar amount spent, and all of this will result from the stability in healthcare system brought about by Obamacare and its subsidies. Over time, the impact of Obamacare would be visible in your daily healthcare services and how you use health insurance, precipitated through a stabilized healthcare system.

King v. Burwell, the case that is causing sleepless nights to Obama administration, Health Plans, and Consumers with Obamacare subsidies, may have yet another implication that could skew premium increases across the nation for everyone. No matter which way the Supreme Court ruling goes, the health insurance premiums are set to rise drastically next year and that’s going to impact everyone, including people who are not availing subsidies from the exchange. The reason is simple – the Supreme Court decided to entertain the King v. Burwell argument and the decision on the same will not be disclosed before late June.

In King v. Burwell, the plaintiffs have moved the Court against a particular verbiage in the law that, according to plaintiffs, does not allow the federal government to issue health insurance subsidies to consumers from states which have not established their own health exchange. Under this challenge, 34 states that are using the federal exchange cannot legally provide subsidies to their citizens. On the other hand, the administration says that in the context of the entire law, this challenge holds no basis and the intention behind framing the law was to provide subsidies to states that are providing health insurance through the federal marketplace.

The federal appellate courts agree with this argument of the Obama administration and the same sentiment was echoed in Fourth Circuit Court of Appeals in Richmond last year, establishing the subsidies as legal in the 34 states that are using the federal marketplace to provide ACA coverage to citizens. However, when the Supreme Court decided to hear the case, it got a lot moreserious. Now, with Supreme Court deciding to disclose the decision by late June, health insurance plans are in a state of confusion, as they need to submit their health insurance premium rates for 2016 by then. For preparing these premium rates, health plans need to figure in an important factor – what happens if the plaintiffs prevail?

State Exchange

A lot of people who are using subsidies to pay for their health insurance would, obviously, no longer be able to do so. Naturally, this might cause a large number of people to drop their coverage. The highest probability is that the healthy, young people will be the ones that drop coverage, as they will feel coverage isn’t necessary. Once that happens, the percentage of older, sicker people will outmatch the percentage of young, healthy people. To keep the scales balanced, health insurance firms will be left with no other option but to raise premiums to compensate for the larger unhealthy pool.

However, there is a quick solution, the American Academy of Actuaries suggested that the HHS should allow health plans to submit two potential rates – one if the subsidies stay intact and other if the subsidies are scrapped. In that case, two sets of insurance premiums will be available, and that might have a better impact on the mechanics for next year. However, in case the administration does not take this route, most health insurers are expected to prepare for the worst by excluding insurance subsidies in their calculation of market dynamics and presenting health insurance premiums that will be much higher.

No matter which way Supreme Court decision goes, health plans will mostly prepare for the worst and present premiums that will be higher for everyone, even for those who were exempt from subsidies in the first place.

March 4 was an important date for everyone connected with King v. Burwell, which is practically the entire nation. People with subsidized health insurance are waiting with baited breath for the decision that could take away subsidies that make their health insurance affordable. Republicans are leaving no stone unturned to turn the tables in their favor and the Obama administration is bracing up for what could be an acid test for the workings of the law. On March 4, the Supreme Court heard the arguments from both sides on the King vs. Burwell case, and the Court will be meeting again soon to continue further.

The argument presentation on March 4 saw a lot of action around interpretation of the law, the context of those fateful 6 words, and the disposition of participating Supreme Court judges on the presented issues. Let’s take a look at the 4 important things to know after the verbal argument round of King v. Burwell.

  • The primary theme of the arguments was that of federalism and unlawful coercion of states. Justice Anthony Kennedy, considered the strongest federal favoring judge on the panel, was all about the impact this case will have on the subsidies available to millions of Americans. Justice Anthony Kennedy’s primary concern was whether the scrapping of crucial subsidies to millions of Americans on the basis of a misconstrued, misinterpreted phrase in the law functioned as an unlawful, unconstitutional coercion on States. In simpler words, Kennedy felt that it would be unconstitutional for the Congress to put this pressure on States, in turn making them lose their health insurance subsidies, when other better means of handling those six words are present.
  • Context and understanding of the law as a unit was the prime theme for the State. The Defendants cited that the Court needs to view the law as a whole to understand the overall program and direction of the law while ruling on the case. Justice Elena Kegan used hypotheticals to break the case and cite that the text in question has a context, and to establish and use that context, granular understanding of the whole law is essential.
  • In the war over context and understanding of the law, Justice Antonio Scalia and Justice Samuel Alito were completely opposed to a unified view of the law. Justice Scalia wanted to view the contested statement in absolute isolation, without corrupting it with the working of the remaining law. Similarly, Justice Alito was of the opinion that the law still works without federal subsidies to the states without exchanges, and the statute will still make sense without those subsidies. Both the Justices wanted to move the context to only those four words in isolation, without taking into account what they mean in reference to the whole law.

State Exchange Lease

The panel of judges will battle on the lines of context, and by the looks of it, the conservative judges might decide to side with the government on this. It will be mostly about avoiding the chasm that will open up if the Court kills the subsidies. For now, it seems that the scales are slightly tilted in favor of the Obama administration.

Over the years, Republicans have made numerous attempts on the life of the Affordable Care Act, some of which have been partially successful. Medicaid expansion was one instance where Republicans succeeded in removing the mandate of expansion, which ultimately resulted in the formation of a coverage gap in states that did not expand Medicaid. Other attempts, fortunately, were primarily unsuccessful. However, now with Republicans in full control of the U.S. Senate, a new repeal and replace attempt is brewing, and the GOP has another alternative to replace the law that has connected 16.4 million people to affordable health insurance.

With King v. Burwell, Obamacare might lose some potency without its trademark subsidies, and Republicans will choose this time to present some major changes as a part of its Repeal and Replace campaign. Let’s find out what the latest alternative is about.

1)  End of Individual and Employer Mandate – With the repeal, Republicans want to end the Individual health insurance mandate and Employer mandate. With this, individuals would no longer be required to have health insurance and employers would no longer be required to offer coverage under the law.

2)  Introduction of Consumer Protection in the System – With the replacement law, the concept of consumer protections under Obamacare will be retained. As per these protections, there will be a guaranteed renewability of their coverage, adults up to 26 years of age would be able to stay on their parent’s plan, and there will be no lifetime limits. Currently, Obamacare limits the cost ratio between younger and older consumers at 1:3, but the Republican alternative will increase this to 1:5. Although that will result in increased premiums for older people, younger people will have a reason to enter the insurance markets at lower health insurance premium.

3)  A System of Default Enrollments will be Introduced – States will have the option of initiating default enrollments for people who are eligible for tax credits under the proposed law. This would ensure that uninsured will have a default enrollment without going through the cumbersome exchange process, but would not be mandated to have insurance because there will be no Individual Mandate.

4)  State Managed Risk Pools for Uninsured – For people who decide to go uninsured, state run risk pools will take care of insurance coverage. These risk pools will be high risk, no certainty pools and people will have no assurance on coverage options and cost of coverage. The premise of this risk pool is an adequately funded program that will ensure coverage for the uninsured.

State Exchange Lease

5)  No More Non-Discrimination on the basis of Preexisting Conditions – A major aspect that could result in the undoing of this new potential replacement, preexisting health conditions will feature in insurance premiums again, and people could face high insurance premiums or no coverage if they do not meet certain requirements if they have a preexisting condition. If a person is continuously insured for at least 18 months, he can get affordable insurance even with preexisting conditions, but otherwise, people could be looking at high insurance premiums if they suffer from a chronic ailment.

6)  Affordability through Balance in Risk Pools – Through inculcation of preexisting medical conditions back in the risk pools, Republicans want to have a stable risk pool where people with preexisting medical conditions will not jack up the prices for those in search of affordable coverage. By having a state-run uninsured pool, the Republican alternative further solidifies this mechanism of keeping insurance costs in check by having continuous coverage. With the proposed tax credits, covered in the next part of this post, consumers should be able to have health insurance in the ballpark of available credits. With this move, Republicans ensure continued affordable coverage in the absence of Obamacare.

These initial replacement aspects demonstrate that the Republicans are looking at balancing the risk pools by moving out the unhealthy people and bringing in healthier people. Although this looks good on paper, it is not entirely reassuring, especially considering the fact that state-run risk pools won’t be ready for the burden, and insurance costs are not just governed by a balance between young and old. In the next part, I will cover the proposed tax credits by Republicans and their potential in replacing Obamacare subsidies.

While the arguments in the U.S. Supreme Court were primarily about the context, the individual meaning, and the impact of the challenged words, the focus was primarily the impact that would result if the Court were to rule in the favor of the plaintiffs. Lost subsidies, additional pressure for states to build exchanges, and necessity to raise the health insurance premiums are just a couple of major things to think about. Fortunately, most of these instances show that the Justice panel is inclined toward keeping the subsidies intact and shooting down the lawsuit.

6) Why create Federal Exchange at all? – Liberal justices collectively asked what was the purpose of having a federally facilitated marketplace when the administration did not intend to provide subsidies and tax credits, and, moreover, why would health insures sell on it? The Justices believed that there were no benefits available through the federal exchange if the subsidies were removed, and trapped plaintiff advocate Michael Carvin on the statements he made in 2012, when he cited that without subsidies, health insurers will have no reason to sell their products on the exchange. The premise behind this was simple – the federal exchange was created to provide subsidies to states that did not have their own exchange.

7) Plaintiffs lost key ground in their arguments – Amid this argument of “why have a federal exchange at all,” plaintiffs lost key ground in their discussion with the panel. Plaintiffs have argued since the beginning that the Obama administration failed to see the state side of things in their rollout of the law. They did not evaluate how many states wanted to go with the ACA marketplace method, and that’s why they included the “established by the state” clause into the law. This would indirectly motivate states to establish local exchanges if they wanted to have subsidies. However, this key ground was lost in the wake of the question that why did the administration federal marketplace at all.

8) On the other hand, Justice Samuel Alito felt that the case was crystal clear – For Justice Alito, the case looked simple enough – the plaintiffs are right and the statute of the law does not allow the administration to provide Obamacare subsidies to states without exchanges. Had the administration wanted that to happen, they would have used language used in other sections of the law, such as “exchange established under the act” or “established within the state.”

9) The Chevron Doctrine could be useful here – If the ambiguity in the case is maintained, the U.S. Supreme Court might refer to the Chevron Doctrine under the 1984 case of Chevron v. State, that set the precedent that a government agency could resolve the ambiguity. However, Justice Antony Kennedy felt that having an individual agency and its director decide the future of millions of dollars of subsidies is not prudent, and that the proponents of federalism should rethink how they want to approach this. Further, if that happens now, it’s not hard to imagine that an opposition government can take the same approach to kill the subsidies in states without their own exchange.

10) Jonathan Gruber was ignored in the stream of arguments – Fortunately for the Obama administration, Jonathan Gruber, the man who defected from the Obama camp after working on the economics of the law, was ignored in the whole argument.

11) The U.S. Supreme Court ruling could be delayed in a way that helps everyone – Although the Court’s decisions are implemented immediately, there was a suggestion from Justice Samuel Alito that talked about issuing the decision in June but delaying its implementation until the end of the tax year. That way, the decision’s impact can be minimized by giving states, health insurers, and people additional time to get things in order. Insurers would be able to manage their offerings by taking the decision into account and people would be able to manage their finances in the absence of subsidies.

The U.S. Supreme Court will be announcing its decision on King v. Burwell in late June, and there are some rumblings that the decision might be delayed. For a decision that influences health plans across the country, affects 34 states without health exchanges, and burdens millions of people in affected states with a renewed health coverage challenges in the absence of subsidies, this delay in decision could probably be a bigger challenge than the decision itself. While it is still not clear which way the wind would blow, the discussions and arguments presented to the court on March 4 gave clues to how the case might turn out.
Some states have already started thinking about their contingency plan, and with powerful healthcare technology that overcomes the perennial challenges of traditional state exchanges, a solution might be possible. However, it’s imperative to know how this is going to shape up. Here are 11 instances from Supreme Court discussions that give a glimpse into how the panel of judges might take this ahead.

1)    Judges were concerned about the Standing of the Plaintiffs – When the arguments were being presented, the starting concern of Judges was the Standing of Plaintiffs. Justice Ruth Ginsburg picked up a recent news mention that insinuated that the Plaintiffs might not have the right to file this suit because some of them had access to other insurance, and this very access challenges their standing in the case. While Plaintiff attorney Michael Carvin assured the Court that at least one plaintiff had standing, the administration suggested that the Panel might want to recheck that part.

2)    Justices Interpreted the Contested Four Words Themselves – Since the whole argument is about those four words “established by the state,”,Justice Stephen Beyer interpreted these words to show Michael Carvin that they have treated these words too narrowly while filing this suit. Stephen Beyer then explained that the idea was to have a federally operated exchange that functioned as a close equivalent of a state operated exchange to provide tax credits to people in states that did not build their own exchange. It was clear what the law was talking about, and this misconstrued interpretation was not helping the system in any way.

3)    Justice Elena Kagan Reinforced the Idea of Interpretation of Text as a Whole – In a similar fashion, Justice Kagan suggested that the plaintiffs should reevaluate their argument by viewing those words in context of the entire law, and not in isolation. The federal exchange was a fallback mechanism for those states which did not establish their own exchange, and that’s what the entire law suggests. Isolating a section of text to build an argument that refutes the meaning of the law as a whole was not making the cut for Justice Elena Kagan.

4)    Federalism Ruled the Roost at the Arguments – Citing unconstitutional actions that might result from the suit, Justice Anthony Kennedy clearly demonstrated that it would be wrong if the Courts used the plaintiff’s argument of verbiage in the law and ignored the complete picture of the subsidies. With so much at stake and so little time to curb the damage that might result, it would be entirely wrong to deliver a decision that unconstitutionally coerces states to build an exchange to safeguard their health insurance subsidies. The idea was to support the law and the federal-state exchange relationship that was originally suggested by ACA.

5)    Intention vs Execution turned out to be a major problem – The argument of federalism supports that the Obama administration always intended to have federal exchanges as a fallback mechanism for states which did not establish their own exchange. However, Justice Scalia was more concerned with the execution during the writing of the statute. Justice Scalia said that this might not be the intended statute, but it is definitely the statute that was delivered in written, and for that, he was in favor of slamming the subsidies. Scalia also mentioned that since the statute was rushed, it was never properly evaluated, and that this should go back to the Congress for rework if they wish to avoid the consequences resulting from an absence of subsidies in the market. It was very clear that Justice Scalia was in favor of the plaintiffs.

In the next part of this series, I will cover the remaining instances that will give a closer look at how King v. Burwell might end for the involved parties.

Like it or not, King v. Burwell is moving ahead, and the U.S. Supreme Court heard arguments from both  sides on earlier this month. A lot of attention has been devoted to the case, with each side presenting its case. So much attention for six words – the ACA is comprised of 381,517 words and, if you count the additional regulations the word count jumps to 11,588,500. So this is a real life example of the power of words.

As per the plaintiffs in King v. Burwell, the language of the ACA only allows those states that have their own exchange to provide premium tax credits to citizens shopping through the exchange. For 37 states who are using the FFM, the law does not state anything about the insurance subsidies, and as a corollary, the ACA is illegally providing insurance subsidies to those shopping through the Federal Marketplace. If the Supreme Court rules in favor of the plaintiffs, all these people will lose their insurance subsidies unless their state builds an exchange and has it live by November 1, 2015.

It’s even more ironic when you consider the size and impact these subsidies have on people and what would happen if all these subsidies were taken away, all because of six little words that make up the ‘controversial’ language of the law. Millions of people stand to lose their subsidies in near two third states, all because of six words. Since all of this is based on the pretext of words, what do linguists have to say on the matter? Do the plaintiffs have a strong case or are they simply making a mountain out of a molehill?

Linguists might be the most interesting to participate in the debate and unravel the linguistic applications of those six words that have launched this controversy. As per the language in the law, linguists think that the Obama administration has the upper hand in the case because of some simple rules of the English language.

As per the language of the controversial text, the law presumes that each state will have its own exchange. If a citizen shops through that state exchange, the state is legally allowed to issue premium tax credits on the basis of conditions laid out in the ACA. If, however, the state does not have an established exchange marketplace, the law does not explicitly state anything about the premium tax credits, it only talks about the case where the state does have an exchange. In simpler words, the federal government is neither mandated nor prohibited from providing premium tax credits to the state’s citizens. It is a matter of choice, and the administration can go any way about it. However, if the administration is providing tax credits in one state, it is obligated to offer the same in all states as per equal protection for all.

For understanding this, another linguist put forward a popular example of definite description problem to explain the situation. The problem states “the present King of France is not bald,” but this statement is ambiguous because the presumption of the statement, that there is a King of France, is not true as France is a Republic. Hence, the statement holds no value. Similarly, in King v. Burwell, the statement presumes that the state has an established exchange, and if that is not true, the subsidy clause is meaningless. The language of the law itself holds no restriction on the subsidies. On the other hand, if the lawmakers explicitly wanted to restrict the scope of subsidies to only those states who have their own exchange, they could have used ‘only when’ to limit the subsidies to those who shopped through the state exchange. Since the lawmakers did not do that, the federal government can choose to give subsidies or not, without any restriction. Naturally, no one can force the federal government to discriminate between two states over subsidies, and under equal protection, they need to provide subsidies for all.

It will be interesting to see how this plays out. All eyes are already looking toward June/July timeframe when the court is expected to issue its decision. Until then, I expect these aforementioned six words to be continuously debated.

On November 7, when the United States Supreme Court decided that it will hear the King v. Burwell case, the nation collectively gasped at the ramifications this hearing will bring to the reformed health market. [Side note: The Court will hear arguments on March 4, 2015] According to the King v. Burwell case, the Affordable Care Act’s language does not allow federal tax credits to be provided to people who bought health insurance from the federally facilitated marketplace. The 4.5 million people who bought insurance in 34 states, which utilized the federal exchange for their insurance needs are at the risk of losing the tax credits that connect these people to affordable health insurance.  However, that is not the only problem connected with this Supreme Court hearing.

Assuming that the United States Supreme Court decides that the federal exchange is not eligible to provide subsidies to people with insurance in those 34 states, what happens next? Logically, considering the amount of subsidies available to the states and people, most states will make a rush to have their health insurance exchange up and running before the Supreme Court ruling comes into effect. The general consensus is that the Court ruling will be announced in June/July timeframe. To support this movement from all these states, the HHS might allow some relaxation in rules about the establishment of the exchanges. By the time the Supreme Court passes this ruling, the states will still be a little late for meeting the 6.5 month conditional approval requirement before state exchange launch. Agreed, the HHS might relax these deadlines a bit, but it would still mean a lot of overhead for these states.

While considering that, let’s not forget that some of these states could not get their health insurance exchange up and running in the years they had before the rollout of ACA. Another more probable case would be states beginning their health exchange establishment plans, which could take somewhere around 6 months. What happens in these 6 months? Complete chaos. When the subsidies are dropped, some of the people with health insurance might not be able to pay their health insurance premiums. Due to nonpayment of premiums, most of them will stand to lose their health insurance in 30 days at the most. The health insurance plans will lose these customers and the subsequent market share. The people who retain their health insurance post this would be the ones who most need the health insurance. Naturally, with sicker, unhealthier people in the pools, health plans will run the risk of higher losses and lower profitability in the market. In an already competitive market, not every health plan will be able to bear the brunt of this onslaught, and some of them might succumb, leading to a destabilization of the insurance market. It will be likely the lose of subsidies will not immediate as that will render the market unstable.

Other than these, there is another parallel thread running along. It’s not yet certain whether a state with an outer shell that utilizes the functionality of healthcare.gov internally qualifies as a state established exchange, and the HHS plans to make use of this. In 7 states, the HHS is planning to recognize the partnership exchanges, exchanges which are managed by the State but run jointly with the federal government, as state-based exchanges that are eligible for providing tax credits to enrollees. However this partnership would only makes really help the 7 states, the remaining 27 states are still nonplussed about how to proceed.

And then there is the case of ‘state innovation waivers’. Under these waivers, if a state offers similar, affordable coverage under an alternate plan, they are allowed to circumvent a few primary ACA requirements, such as having an exchange or offering premium tax credits, without losing the federal funding they are eligible for under the ACA. However, the concept of waivers does not kick in before 2017, and until then, the residents of these states will be in a coverage gap without any premium tax credits for residents, assuming that the challengers win the case.

Ultimately, amid all these threads and ideas, the Obama administration, the health plans, and the state authorities are in a state of clamor without any certainty of their future. In case the challengers in King v. Burwell win, it could mean a whole lot of consequential changes for Obamacare that could ultimately rob it of its potency.  It is definitely going to be interesting to watch!

It was just announced that on March 4, 2015, the United States Supreme Court will hear augments regarding a controversial piece of text in the Patient Protection and Affordable Care Act that could remove the availability of subsidies in states which decided to go with a federally facilitated marketplace.

The case is based on a selective piece of text in the Act highlighting the availability of insurance subsidies in only those states which established their own state exchanges. In case the United States Supreme Court rules in favor of the challengers, as many as 4 million people could lose health insurance subsidies across 37 states which opted for the federal marketplace.

In response to this, the Obama administration has made it clear that it was never their intention to limit the health insurance subsidies to only those who were shopping through state exchanges. The CBO, too, established that the tax credits will be available nationwide, and inculcated this cost while estimating the overall impact ACA will have on the federal budget. The appellants, on the other hand, are fixated on a four-word phrase ‘established by the state’ for exchanges that allow subsidies in the form of tax credits to people buying a health plan off that exchange. As the Court hears the case and prepares to pass a verdict, some states are already working to circumvent this situation and, thus, keep their subsidies intact.

States like Delaware and Illinois are already leading the way with a complete response plan. The state of Delaware plans to implement a technical workaround that will prevent them from losing their insurance subsidies. Illinois, on the other hand, is trying for a legislative fix that would connect them to the subsidies.

Delaware’s Workaround

Out of all other states, Delaware’s case is pretty interesting. Back in 2010, Delaware decided that its small size would hinder its ability to build a state exchange. Delaware did side with the federal insurance exchange, but state officials are confident that they will not lose the subsidies as they are in control of a ‘Delaware version’ of the federal insurance exchange, which is almost like having a contractor managing the state run health insurance exchange. If the court agrees with this definition of the state-based marketplace, Delaware will be in a favorable position and will be allowed to retain its subsidies.

If this option works out for Delaware, it will set a precedent for other states to follow suit. However, having this legislative change in their favor will be a tough nut to crack, and Delaware might not be able to make this technical workaround.

State Partnerships with Federal Insurance Marketplace

Aligned with the definition of state insurance marketplaces, some other states have a ray of hope that will allow them to retain the subsidies. Six states, other than Delaware, are in control of some aspects of the federal insurance marketplace for their state, such as controlling the available health plans. In such situations, the states can be said to be in a partnership with the federally run marketplace, and hence might help them retain the subsidies through a legislative fix that recognizes these partnerships as state managed marketplaces. Illinois is one such state.

However, the problem with this legislative fix is that out of these six states, Illinois, Iowa, Michigan, and Arkansas will have Republican governors next term, and they are highly likely to shoot down this partnership theory. To avoid that, these states will need to make their move under the current administration.

Road Ahead

The road ahead is wrought with challenges, as even the fixes at hand have a low probability of working out. In case the United States Supreme Court removes the availability of these subsidies, states will be left with only the option of creating a state-based marketplace. States like Virginia, Pennsylvania and Mississippi are disgruntled over the fact that they are about to lose subsidies, while Delaware and Illinois are contending that their partnership with the federal marketplace should be enough for qualifying them for subsidies. The best possible outcome of the whole case would be a resounding rebuttal of Appellants arguments and retention of Obamacare subsidies across the federal exchange participant states.