Did the King v. Burwell ruling squash state-based exchanges?

State-based health insurance exchanges may have met their demise, according to The New York Times. Following Thursday's Supreme Court decision in the King v. Burwell case to uphold subsidies on federal exchanges, states running their own exchanges may be wondering, 'Why bother?'

The Patient Protection and Affordable Care Act allows states to build their own health insurance marketplaces so state insurance regulators could continue to manage markets and to allow for maximum flexibility and control, according to the report. However, building and managing a marketplace is a major technological and logistical undertaking, not to mention expensive.

Now that consumer access to federal subsidies has been solidified, no matter if states operate their own exchanges or not, states are even less incentivized to build their own, The New York Times reported.

As it is, many states are struggling. Hawaii's exchange is crumbling, Vermont's isn't looking great, and Massachusetts and Maryland had to start from square one this year, according to the report. Attempts in Nevada, New Mexico and Oregon all failed to stand on their own in the first year.

For now, 14 states operate their own exchanges. That number may dwindle if difficulties persist for states with their own marketplaces.


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