Insurance and health officials from across the U.S. gathered in Chicago in early May for a 24-hour secret meeting to discuss their options if the Supreme Court rules this month to restrict subsidies to residents in states that established their own health insurance exchanges, according to The Wall Street Journal.
Participants from 16 or 17 states attended the meeting at the O'Hare International Airport's Hilton hotel, which was organized by the Milbank Memorial Fund, a health policy foundation.
If the Supreme Court sides with the plaintiff in King v. Burwell, up to 8 million Americans in 34 states that use the federal government's HealthCare.gov site to purchase health insurance could lose their subsidies. Both supporters and opponents of the health reform law agree that a loss of subsidies for people who use the federally-run exchange would cause them to lose insurance, as well as a rise in premiums.
Insurance and health representatives worry it is unlikely most of the states using HealthCare.gov could set up their own exchanges quickly enough to maintain their residents' tax credits, participants of the meeting told The Wall Street Journal. Although some officials talked about other potential solutions, such as leasing an exchange from the federal government or a state that has one, the obstacles could be too complex to be successful.
Meeting participants indicated little confidence that their respective state governors, legislatures and insurance commissioners would all agree to establish an exchange if the Supreme Court rules in favor of King and eliminates subsidies in their states, and that they could accomplish this before the subsidies would disappear, according to the report.
"I really don't think, in my opinion, you could do it in 30 to 60 days," Bob Williams, the Mississippi Insurance Department's director of life and health, told The Wall Street Journal. "Like the other states that were there, it's not something we could just do overnight."
Consultants on the matter have suggested a few potential options, one being the federal government offer the technology behind HealthCare.gov to states that don't have their own exchanges. Another option is the creation of regional exchanges. However, several attendees voiced doubts that their governors or legislatures would agree to these options, as many strongly oppose the Patient Protection and Affordable Care Act as a whole.
In response, some supporters of the reform law are looking for new options, though they aren't completely confident they will work. One option is seeing if HHS could acknowledge that a state has established its own exchange by helping the federal government operate an exchange on behalf of the state.