Oct 22, 2019 - Health

States working on ACA backup plans before federal court case decision

Pro-ACA protestors.

Pro-ACA protestors. Photo: Erik McGregor/Pacific Press/LightRocket via Getty Images

States are beginning to make contingency plans in case the courts strike down the Affordable Care Act, WSJ reports.

Yes, but: There's only so much they can do.

Where it stands: As we all wait for the 5th Circuit Court of Appeals to hand down its ruling, and then for the likely appeal to the Supreme Court...

  • Colorado is looking to its state-level public option, still under formation, as an ACA fallback.
  • Nevada has formed a commission to look for ideas.
  • Louisiana is working on a plan to establish a high-risk pool for sick people.

The catch: Even setting aside the fact that this is only a small handful of states, even the most motivated blue state probably couldn't make up for the total loss of the ACA.

  • They could not deliver themselves a federally funded Medicaid expansion, for starters, and would have to raise an awful lot of revenue to replace the premium subsidies on the ACA's exchanges.
  • States would face their own drawn-out political battles if they wanted to re-impose the ACA's protections for pre-existing conditions and the accompanying rules that give the coverage mandate teeth.

And that's just the ACA's coverage expansion: States definitely couldn't fill the ACA's shoes on Medicare policy, biosimilars approval or the host of other programs that would fall by the wayside if the law is ultimately struck down.

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