In a state with its own exchange and where the ACA has drawn support, reaction to the court’s 6-3 decision has been largely favorable.
Officials in Washington state, which has largely supported the Affordable Care Act, welcomed the news Thursday of the U.S. Supreme Court’s decision upholding a key provision of the health-care overhaul.
“It’s as good of news as we could have hoped for,” said state Insurance Commissioner Mike Kreidler.
State Sen. Randi Becker, a Republican from Eatonville and chair of the Senate’s Health Care Committee, said she was also glad about the decision. “Now we don’t have to worry about people who need these subsidies having issues with it,” she said. “Other states were going to be really compromised. I’m glad this issue is settled.”
King v. Burwell challenged the ability of the federal government to provide tax credits that reduced the price of health insurance for lower-income Americans, but only in states that chose to have a federally run exchange.
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Because this state has its own exchange, Washington Healthplanfinder, the more than 124,000 residents receiving premium-reducing subsidies through the exchange would have continued to get that benefit. On average, insurance with a subsidy costs $174 a month per person in Washington, while unsubsidized insurance sold through the exchange cost $384.
“The best part about the decision is it eliminates some of the potential confusion,” said Bethany Frey, spokeswoman for the exchange. If the court had ruled against the subsidies, some in the state might have erroneously thought they would lose them, too.
Nationally, more than 6 million people in 34 states with federally run exchanges were at risk of losing their subsidies.
“That would have guaranteed that the sick people would have stayed (in the exchanges) and many of the healthier people would drop it, and you would have struggled across all of the states to raise rates fast enough to keep the insurance companies above water,” Kreidler said. “It was a recipe to see the individual and family plans in those states collapse.
“That was the part that made me nervous,” he said. “If you had that kind of chaos in the majority of states, why would you think the state of Washington would be immunized?”
Sooner or later, Kreidler said, Washington’s residents and exchange would have been affected by the disruption of the insurance market.
But even with a court ruling in support of the ACA, Healthplanfinder has struggles ahead. Like many state-run exchanges, it hasn’t found a clear path to financial stability. The Healthplanfinder technology is running more smoothly, but it has enrolled only 170,000 customers, falling short of this year’s goal of 213,000.
And state lawmakers are still debating how much funding the exchange will receive, with the Republican-led Senate calling for millions less than the Washington Health Benefit Exchange, which manages Healthplanfinder, says it needs.
“We need to be doing everything we can to make sure the Health Benefit Exchange is working as effectively and efficiently as possible, but our goal should be to reform and strengthen the exchange, not undermine it,” said Sen. David Frockt, D-Seattle, ranking minority member of the Senate Health Care Committee.
Now that the subsidies will continue for federally run exchanges, Washington could consider moving to the federal exchange as a potential way to save money.
One significant argument against such a move is Healthplanfinder is also the place to sign up for Medicaid. By combining individual insurance and Medicaid enrollment in one site, it’s easier to move between the programs as people’s incomes change.
“It really wouldn’t make sense for us to move to a federal marketplace,” Frey said.
Kreidler, who has been critical of some of the exchange’s missteps, said the state should keep it. “I strongly believe that’s the preferred course,” he said. “We have an opportunity to provide leadership to the federal government.”