Many experts believe state-level health exchanges are here to stay. However, Politico reports that some state officials worry that if the individual mandate is struck down, healthy people could avoid buying policies and premiums for everyone else could skyrocket, putting them in a bind.
St. Louis Beacon: Some Health Reforms Will Continue No Matter What Supreme Court Says About The Affordable Care Act
Though efforts to set up a health insurance exchange in Missouri have failed so far, the concept is regarded nationally as one of many Affordable Care Act measures that will take root and thrive ... Among those betting on the survival of some form of insurance exchange and a few other measures that are expected to result in a sea change in health care access and delivery is Christopher Condeluci, who was tax counsel for the Senate Finance Committee during the period when the health reform legislation was crafted (Joiner, 4/28).
Politico: States Could Be In A Bind On Mandate
If the Supreme Court strikes down the health reform law's individual mandate, the states at the forefront of implementing the law could find themselves like Wile E. Coyote in the Road Runner cartoons: racing ahead only to discover there's no ground underneath their feet. These states were all counting on the individual mandate to make health insurance exchanges viable — because without a requirement for most people to buy coverage, there's a chance that healthy people could avoid paying into the system, making premiums skyrocket (Feder and Millman, 4/29).
In related news, the White House is reportedly eyeing a loophole in the law -
Politico Pro: W.H. Watches For Small-Business Dodge
The Obama administration may be laying the groundwork to close a loophole in the health reform law that some worry could undermine the small-group market. The administration requested comment Friday on whether regulations are needed to prevent small employers from becoming self-insured in order to get around some Affordable Care Act rules. Historically, only large employers have decided to self-insure. That’s largely because small employers could find themselves bankrupt if just one of their employees fell seriously ill. But now, there’s a growing market for stop-loss insurance with low "attachment points" — meaning it starts paying the costs after employers have paid only a small amount out of their own pockets. And these policies could make it possible for large numbers of small employers to exit the small-group market and the rules that will apply to it under the ACA (Feder, 4/27).