Pennsylvania Keeps the Door Open

It is official, Pennsylvania has given notice that it may choose to switch to a state operated exchange, should that be necessary to preserve subsidies after a potential ruling adverse to these subsidies through the federally facilitated exchanges under King v. Burwell.

The letter leaves open whether or not this is something Pennsylvania will do as well as the terms of a potential jointly operated exchange. Of course, all exchanges (federal or state) are jointly operated in the functional sense, since the back of the house operations have to merge state-specific Medicaid enrollment standards with nationalized standardized federally operated exchange applications and subsidies.

On one level, I just don't get it. Every exchange, to a certain extent, is state operated and federally operated. Yes, even Missouri's (as of this date Missouri has not withdrawn from original Medicaid, though it has declined to expand Medicaid under the ACA, having seen fit to have expanded it under earlier expansions, however).

One possible post-Burwell anti-subsidies through the FFE possibility could be that other states announce and then implement hybrid exchanges.  But isn't that what they already are functionally?

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