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Enrique Gonzalez, 22, (L-R), Janet Regalado, 21, and their nine-month-old daughter Kayleen Gonzalez pose for a photo after signing up for health insurance at an enrolment event in Commerce, California March 31, 2014. U.S. President Barack Obama's embattle
Last week's split decisions by federal appeals courts on the Obamacare subsidies are rippling down through the states. A three-judge panel on the D.C. Circuit ruled that the law says that subsidies should only be available to customers in states that created their own exchanges under the law, while in a second case the Fourth District Court ruled that the law intended for everyone in all the states to be eligible. Not knowing which way the case will wind up, governors in states that base their exchanges on the federal system are working to protect the insurance subsidies that have provided millions with affordable health insurance.
Among the 36 states, the level of federal involvement varies. That means states see gray areas to work with, if they want to, though the ultimate decision about their status would likely hinge on additional court decisions and determinations by the Obama administration.

For example, two states, Idaho and New Mexico, had intended to set up their own exchanges but turned to the federal government to handle their technology in May 2013. The Obama administration has described them as "federally supported state-based" exchanges and often issues data on their behalf, in which it groups them with the other 34 states with "federally facilitated" exchanges.

Two other states, Nevada and Oregon, are currently considered to be among the 14 "state-based" exchanges, but have had technological problems and are now looking to the U.S. to operate their technology for the coming year.

Idaho, Oregon, and Nevada have all issued statements saying that they run state-based exchanges, that the technology might be borrowed from the federal government, but the actual administration of the exchanges is what matters, and that it is done by the states. That's the argument also made by Delaware and to varying degrees as well by Arkansas and Illinois, where there are strong pushes from the legislatures to move ahead on establishing fully state-run exchanges. That's because the political ramifications are potentially very big.
“It becomes health reform for blue states,” said John Holahan, an author of the Urban Institute report. “In the rest of the country you don't have health reform.” […]

“If the end result is if you live in New York you get (subsidies) and if you live in Georgia you don't, I don't think that's politically palatable,” said Kevin Wagner, a political science associate professor at Florida Atlantic University. “You start hitting middle-class people, and they vote.”

Republican governors in Florida, Georgia, Maine, Pennsylvania and Wisconsin are all up for re-election this November and all to varying degrees foes of Obamacare. For a few of them who have refused Medicaid expansion, their opposition to the law has already proven to be a campaign issue. Add in the loss of insurance to a huge chunk of people who have had it for this year—and many more people being deliberately hurt for political purposes—and you've got some serious election-year fallout.

Originally posted to Joan McCarter on Mon Jul 28, 2014 at 07:29 AM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (36+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Mon Jul 28, 2014 at 07:29:41 AM PDT

  •  taking away something people already have is a (12+ / 0-)

    lot more difficult than getting it in the first place. I understand that the total population getting insurance through the exchanges is not too large, but for every single person it would be a real big deal. Voters who are strongly committed are much more potent than those for whom an issue is just one more issue.

    “Conservation… is a positive exercise of skill and insight, not merely a negative exercise of abstinence and caution…” Aldo Leopold

    by ban nock on Mon Jul 28, 2014 at 07:50:48 AM PDT

  •  Relax (10+ / 0-)

    We knew the ACA threatened Republicans ability to scamming millions of republican voters. Once people get a taste of success like the ACA, they can't be easily seduced by Republican's lies.

    If you honor our worthiness to receive quality healthcare, make a commitment to vote on Tuesday, Nov 4, 2014 for Democracy.

  •  3 judgements for to 1 against... (3+ / 0-)
    Recommended by:
    bufffan20, CWinebrinner, TofG

    which means; Republi-cons win!?!? Folks, that's as defeatist as it gets.

  •  Brainwrap made a point a few weeks ago (10+ / 0-)

    that you could easily consider it to be "state run" if the state owns the domain for the website that people access, even if they contract out the rest to partners, and even if they happen to have the federal government as a partner.

    Of course, states that really want to screw their people still could, if that decision holds.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Mon Jul 28, 2014 at 09:16:49 AM PDT

    •  Still could, and will. (6+ / 0-)

      BTW, does anyone know if a US House member has proposed a straightforward amendment to the law, to clarify that federally-run sites are included?  It'd be interesting to see the tortured path such legislation would take.  First, no committee would take it up straight, because everything is controlled by Rs.  Second, if one did take it up, they'd do so only to convert it to another ObamacareSucks law.

      But imagine if there was actually a House of Representatives that cared about the citizenry.

      I am become Man, the destroyer of worlds

      by tle on Mon Jul 28, 2014 at 09:38:26 AM PDT

      [ Parent ]

  •  Can a state "contract" the federal stite (2+ / 0-)
    Recommended by:
    Losty, Brainwrap

    to provide their "state-based" site?

    "Drudge: soundslike sludge, islike sewage."
    (-7.25, -6.72)

    by gougef on Mon Jul 28, 2014 at 09:17:11 AM PDT

  •  "some serious election year fall-out" (2+ / 0-)

    one would think...

    people who vote against their own interests - more than likely the hate factor - which r's exploit and rely on gleefully

    "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

    by Sybil Liberty on Mon Jul 28, 2014 at 09:19:20 AM PDT

    •  Sybil (2+ / 0-)
      Recommended by:
      TofG, Sybil Liberty

      you are so right. it pisses me off when friends of mine are against everything Obama has done even helping them.
      1 freind recieves ss,foodstamps for his child (mom died) .
      His unemployment has stopped yet Pa. is still processing his claims in case the repigs cave on it without paying for it.
      but my friend will not call out his party for it?? And he will vote Repig ,believes faux nonews is the only "real" news station.
      i can show him proof how his party is destroying his life but he is not interested.
      Its really sad.

      In all affairs it's a healthy thing now and then to hang a question mark on the things you have long taken for granted." Bertrand Russell (1872-1970)

      by lippythelion69 on Mon Jul 28, 2014 at 12:11:31 PM PDT

      [ Parent ]

  •  sounds like the 2014 Issue just presented itself (1+ / 0-)
    Recommended by:
    Nicci August

    Nice and easy.

    If the DCCC can't campaign on this?

  •  Here's my question: (13+ / 0-)

    The majority of people in anti-Obamacare red states have thus far been willing to forego Medicaid expansion (even if it hurts them) as a fair price to pay to punish Obama.  Thus far, they have voted against their own interests just for spite.  If this lawsuit turns out to rob them of healthcare subsidies that blue state constituents enjoy, will they continue to accept being screwed just to satisfy their racist, xenophobic anti-Democratic fervor?  Or will the worm turn?

    "It ain't right, Atticus," said Jem. "No, son, it ain't right." --Harper Lee, To Kill a Mockingbird

    by SottoVoce on Mon Jul 28, 2014 at 09:22:07 AM PDT

  •  I hope this would finally get people off their (3+ / 0-)
    Recommended by:
    bufffan20, CWinebrinner, VPofKarma

    tuckuses and to the polls to vote out those politicians who would let tax money from red states flow to blue states to pay for health care for people in those states.

    I also bet there are some position papers already crafted on what to do with the windfall of money to the federal government if they're going to not have to supplement health insurance to red state or federally run exchange states.  They certainly wouldn't invest it in health care - it's probably going to be used to fund more tax breaks for CEO's.

    •  Therein Lies the Problem... (3+ / 0-)
      Recommended by:
      ColoTim, lippythelion69, triplepoint

      Tax money does not flow from Red States to Blue States...

      The Blue States tend to have more highly educated and better paid workers, whose tax dollars have been supporting the Red States for years...

      As much as those in the Red States talk about Welfare and I Made That, the reality is they have been feeding at the teat of the Blue State Taxpayers...

      "Do you realize the responsibility I carry?
      I'm the only person standing between Richard Nixon and the White House."
      ~John F. Kennedy~

      -7.5,-5.8

      by Oldestsonofasailor on Mon Jul 28, 2014 at 10:34:50 AM PDT

      [ Parent ]

      •  The way I understand it, people are paying taxes (0+ / 0-)

        to fund these health care supplements.  If people in the states that have set up their own exchanges (almost exclusively blue states) are the only ones able to have their policies funded, these states are going to receive funding from the other states.  The red states will lose money they would otherwise keep because the funds won't be coming back to them for their own residents who would otherwise be receiving money for the policies.

        This is the same issue with the medicaid expansion - red state governors refused it (which the crafters of the ACA didn't expect they could - thanks USSC) so the money for the medicaid expansion, which is coming from everyone around the US, is only going to those states that expanded medicaid - and in addition, since the medicaid funds were expected to be flowing to all the states, other programs were ended because the medicaid funds were expected to fill the money pots of those other programs.  Because medicaid expansion was refused, but those other programs were stopped, the hospitals and providers in red states are out money they otherwise would have received.  The only reasons for that are politics and hating the black president.

      •  One BIG Reason Blue Tax Money Flows to Red (3+ / 0-)

        With all the Republican control of government these past 30 years, they've dictated the closure of military bases in Blue States and kept ones in Red States open. Another really big cause is other defense monies flowing to the shipyards in Mobile, just recently awarded contracts to build the next generation of destroyers. The old shipyards in the North aren't being awarded anything like that, not even close.

        Remember when Toyota decided to relocate their plant to Canada from Mississippi when they could find enough literate workers they could train to do the work? Remember Toyota even resorted to using comic books in an effort to train these people but it was all to no avail so off they went to Canada.

        Now think on this, this is the state and presumably the same workforce who will now be building mission critical ships for the US navy. Do you see anything wrong with this picture?

        In any case, Blue States are being punished heavily for not being Red States and supporting all the military bases and contracts in those Red States is coming from Blue State Taxpayers' pockets. This is just one more way Pukes prove they're unfit to govern.

        "Those who fail to learn from History are doomed to repeat 11th grade"

        by Dave925 on Mon Jul 28, 2014 at 11:35:20 AM PDT

        [ Parent ]

  •  Keep your hands off my Romneycare (6+ / 0-)

    First, Boehner's gonna sue to make Obama enforce the ACA. Now Republicans are scrambling to create state exchanges to keep the subsidies for their citizens.

    Cripes, i take a little trip and end up in bizarro world. What's next Ted Cruz moving back to Canada?

    Can't wait for them to take complete credit for the ACA and Romney to run for President championing his visionary healthcare reforms.

    There is no Planet B, no spare Earth in the trunk. This is the only world we have. So stop screwing it up.

    by BobBlueMass on Mon Jul 28, 2014 at 09:26:01 AM PDT

  •  funny to... (2+ / 0-)
    Recommended by:
    BelgianBastard, hadrons

    see Elliot Cutler griping about this...he has about as much room to complain about LePage as Nader does about Dubya.

    "It's almost as if we're watching Mitt Romney on Safari in his own country." -- Jonathan Capeheart

    by JackND on Mon Jul 28, 2014 at 09:26:25 AM PDT

  •  It seems hard to believe that (0+ / 0-)

    an unexpected impact of this ruling will be to get some of those red states to actually embrace more responsibility for Obamacare. But already that seems like what's happening.

    The whole definition of what is a state-based exchange and what isn't seems impossible for even the Supreme Court to determine consistently and it wouldn't surprise me if it all comes down to what a state calls it.

    Want a progressive global warming novel, not a right wing rant? Go to www.edwardgtalbot.com and check out New World Orders

    by eparrot on Mon Jul 28, 2014 at 09:29:42 AM PDT

  •  What if the DC Court decision on ACA wins? (11+ / 0-)

    What if only state exchanges can get the subsidies?

    The federal government could easily sell the exchange to any state wanting to buy it, then get a contract with the state to operate it for the state. It becomes a state exchange and the subsidies continue to flow.

    This would not be difficult. The federal exchanges are already designed for each state they operate in anyway. All it would require would be a few intergovernmental accounting transactions, a change in ownership registration, and Bob's your uncle.

    Oh, and put a new home page on the state portal listing the state ownership. It's exactly what would happen if the state had built it themselves and hired contractors to do the work of building and operating the exchange.

    The US Supreme Court has by its actions and rhetoric has ceased to be legitimate. Whiskey Tango Foxtrot - over

    by Rick B on Mon Jul 28, 2014 at 09:46:59 AM PDT

  •  When the Republicans were celebrating the decision (7+ / 0-)

    last week I wondered when they would realize this. If the federal subsidies are illegal and only blue states have state exchanges, then, seems to me, this program would turn into a giant wealth transfer to the blue states.

  •  I don't know if this somewhat related, but I fo... (5+ / 0-)

    I don't know if this somewhat related, but I found it funny how the Republican mayor of Belhaven NC walked to Washington to protest the hospital getting closed. I think he should have walked to Raleigh instead.

  •  HIT them NOW and HIT them HARD!!! If only Dem's... (7+ / 0-)

    HIT them NOW and HIT them HARD!!! If only Dem's would all spin this like Maine "ALL FOR ONE (ACA HEALTHCARE SUBSIDIES) AND ONE FOR ALL!!! I am not usually someone that elects FEAR as a driver but I know for a fact (since I have a new lease on life, thanks to Obamacare subsidies and health insurance) if I heard over and over they (GOP) were taking it away every news channel every Dem for the next months like they (GOP) push their spin machine...people would come out to vote. Taking away my subsidy is no less than taking my healthcare and I care about that as much as my mother does her MEDICARE!!!

  •  Prediction: This is going to fail spectacularly (1+ / 0-)
    Recommended by:
    VPofKarma

    Dammit Jim, I'm a lawyer, not a grammarian. So sue me.

    by Pi Li on Mon Jul 28, 2014 at 10:20:23 AM PDT

  •  She would've started a newspaper, but (3+ / 0-)
    Recommended by:
    Dave925, VPofKarma, lippythelion69

    she still can't figure out what it is.

    Wanting to own a gun is an immediate indicator that you should be the last person to have one.

    by pollbuster on Mon Jul 28, 2014 at 10:32:48 AM PDT

  •  How hard would it be... (1+ / 0-)
    Recommended by:
    TofG

    ... for the federal exchange web site to be copied onto another server (or servers)? I think it could be safely assumed that a state-specific site wouldn't need to have as much hardware as the full-blown federal site. The existing software would be edited slightly to have a front page specific to each state that's currently relying on the current federal site. The Feds could lease that site back to each state for $1 or some tiny fraction of the federal subsidy money.

    I would be completely amazed if the current federal site wasn't comprised by a slew of virtualized systems organized as a load-balanced server farm. Take some of those virtual servers and reassign them to a state-specific exchange server running the edited copy of the federal system. You shouldn't have to hire additional administrators to take care of the new state servers; any set of administrators worth their salt should be able to take on the responsibility of handling a few dozen new systems.

    I seriously doubt there's anything in the ACA that specifies just who hosts and supports the state exchange systems. (Though I do expect the House would fight to the death to prevent the Feds from spending of any money on doing this kind of modification.)

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