States should not step in and establish their own exchanges if subsides are ruled illegal on the federal health care marketplace, a recent national study found, but industry experts say that is not the national consensus and point to the wording of poll questions to support the discrepancy.
The recent poll from the Foundation for Government Accountability (FGA), a group founded by Tarren Bragdon, former CEO of the think tank Maine Heritage Policy Center and a former Republican Maine legislator, found that only 22% of voters want states to establish their own exchanges if the Supreme Court rules only states can issue subsidies to purchase health care through a public marketplace.
The poll of 1,564 adults who voted in the November 2014 general election was limited to those in the 34 states that have not established their own marketplace. It also found if the Supreme Court rules subsides issued on the federal marketplace illegal, nearly half (46%) would blame Congress for poorly writing the law.
These numbers sharply contrast a March 20 poll by the non-partisan Kaiser Family Foundation in which 69% of respondents living in an FFM state said states should build their own marketplace if necessary.
Katherine Hempstead, a director at the non-partisan Robert Wood Johnson Foundation points to the wording of the questions in the FGA poll to possibly explain the 47% discrepancy.
In the FGA poll the question asks, If the Supreme Court rules the IRS overstepped its authority and that Obamacare subsides are illegal in 34 states, how should the states respond?
Kaiser words the question, If the Supreme Court rules that financial help is only available to people in states with state-run marketplaces, do you think states should create their own marketplace so people could continue to access financial help or do you think states shouldnt act on this issue?
Hempstead says it seems to her that the FGA poll is basically a push poll with lots of loaded language. The people conducting this poll are trying to figure out how to make people not want to establish a state exchange.
FGA has not respond to a request for comment.
What will happen?
Hempstead says that if the subsides are ruled illegal, the non-group market is too big to fail and there are too many people and dollars at stake for it to go down. Something will be worked out.
That fix, however, might not come from Congress, she adds.
I am not optimistic Congress can be the change agent, she says. I think the states and the [Centers for Medicare and Medicaid Services] are going to work something out. There is just too much at stake not to do that. But its not clear what it will be at this point.
In a recent blog post on the JAMA Forum, a collection of commentary by health policy experts, Kaisers Senior Vice President for special initiatives and Affordable Care Act expert Larry Levitt says that the important thing to understand about the King v Burwell case is that it does not (at least as its been argued before the Supreme Court) involve the constitutionality of the ACA. Rather, its a matter of statutory interpretation: did the Internal Revenue Service have the authority under the law to provide subsidies in all states?
That means with just a few strokes on the keyboard, Congress could clarify that subsidies should be provided to people in state-based and federal marketplaces alike, he adds. Such a swerve would avoid a catastrophe quickly and easily. But with many Republicans in Congress adamantly opposed to Obamacare, no one expects such a yield.
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