State insurance regulators heard more about their Patient Protection and Affordable Care Act (PPACA) premium tax credit emergency rescue options this week in Phoenix.
The Health Care Reform Regulatory Alternatives Working Group, a panel at the National Association of Insurance Commissioners (NAIC) for states that are not fond of PPACA, brought in two experts Sunday, to a session at the NAIC’s spring meeting, to brief them on King vs. Burwell (Case Number 14-114).
That’s the case that hinges on whether PPACA lets an exchange set up by the U.S. Department of Health and Human Services (HHS) offer the PPACA health insurance premium subsidy tax credits.
PPACA says, directly, that a “state-established” PPACA exchange can offer the tax credits, which are helping more than three-quarters of private exchange plan buyers pay their premiums.
PPACA does not explicitly say whether the HHS exchanges can offer the tax credits. HHS officials argue that the omission is an oversight. The plaintiffs in the case say that the omission was intentional, and that only a “state-established” exchange can offer the tax credit.
See also: King vs. Burwell: Does PPACA bully the states?
No one knows for sure whether the Supreme Court will hand down any substantive ruling on the case.
Some say a Supreme Court ruling that limits or eliminates the ability of the HHS exchanges to offer the tax credit this year and in 2016 could devastate some states’ individual major medical markets, by leading to huge market changes after insurers have already filed 2016 rates.
Court watchers have been trying to figure out what exactly states that have avoided running PPACA exchanges themselves might have to do to have an exchange that is “state-established” enough to keep the tax credit program going, at least on a limited, emergency basis, if the Supreme Court rules against HHS.
Joel Ario of Manatt Health Solutions gave the working group members a general update on the King vs. Burwell case and possible repercussions.
The other speaker, William Schiffbauer, talked about what a state has to do to have a “state-established exchange,” and why simply giving HHS a formal invitation to provide exchange services, along with a hug and a box of chocolates, is not enough.
For a look at some of what speakers said a state has to do to have a state-established exchange, read on.
1. Get HHS Secretary Sylvia Mathews Burwell and her people to act fast.
Ario, the original PPACA exchange construction chief, said states could probably still set up their own state-based exchanges for 2016, as long as they and HHS act quickly.
Under the current HHS rules, blueprints for 2016 state-based exchanges are due June 15, 2015, but “most requirements are operationally based and not rooted in statutory requirements,” Ario says in a slidedeck. “HHS could make wholesale changes in this process.”