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One thing they didn't seem to consider was whether Alabamians would be able to receive subsidies to make their health insurance more affordable if the state defaulted to a federally operated exchange, according to documents and interviews with principal figures in the debate.
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The federally operated exchanges will go live at 8 00 a.m. EDT Tuesday, another Health and Human Services official told reporters.
A "hospitable" interpretation would have treated federally and state operated exchanges as equivalent for subsidy purposes, so as to avoid bringing down the federal exchanges.
The consequences for those in Alabama and 33 other states who get health insurance from federally operated exchanges could be dire.
If the Supreme Court rules that the government cannot continue providing subsidies to folks in the states with federally operated exchanges, the uninsured rate undoubtedly will go back to what it was in 2013 if not higher.
Starting next week, many Americans who buy individual health insurance policies will see big increases in premiums — 25% on average for those who shop at the federally operated exchanges established by the 2010 Affordable Care Act.
It would allow subsidies to continue in states using federally operated exchanges until September 2017, but it would deny them to anyone in those states who doesn't already have a subsidized policy.
At issue is a brief phrase contained in the Affordable Care Act -- "exchange established by the state" -- that the plaintiffs contend limits subsidies to health insurance exchange marketplaces set up by states like California, Idaho and New York, not the federally operated exchanges in most of the states, including Florida and Texas.
Euronext, which operates exchanges in five European countries, also illustrates the importance of a common language.
Ms. Sebelius told states they had until Feb. 15 to file applications to operate exchanges "in partnership with the federal government".
In big Democrat-run states that are running their own insurance exchanges, such as California and New York, and in states like Illinois and Michigan that are operating exchanges in partnership with the federal government, the prognosis is pretty good.
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