CEO says launching a state exchange is 'very, very complex'

Kevin Counihan, CEO of, said states would not be able to immediately create their own insurance marketplaces if the Supreme Court rules in favor of the plaintiff in King v. Burwell in late June, according to The Hill.

Many observers of the King v. Burwell case have said states relying on the federal exchanges may be forced to create their own if the Supreme Court Justices rule in favor of King and determine only people in states with individual marketplaces are eligible for subsidies. According to The Hill, this will be even more likely if Republicans in Congress and President Barack Obama cannot come up with a solution to prevent the government from dropping subsidies for 7.5 million people in 37 states.

Creating a health insurance exchange is a "very, very complex activity" that cannot be completed in a few months, and exchanges created this summer would certainly not be ready for the next enrollment period beginning in November, Mr. Counihan said Monday during a day-long panel for health insurance exchange representatives.

Tim Jost, a professor at Washington and Lee University Law School and a proponent of the Patient Protection and Affordable Care Act, also discussed the complexity states face in creating exchanges.

"A marketplace is more than a website," he said during the panel. "There's a lot of stuff that an exchange is supposed to do."

These comments emphasizing the difficulty in setting up exchanges caution Republicans who have already begun drafting a response to King v. Burwell, which could transfer power to the states. However, it may not be possible to create a plan of action until after the Supreme Court makes its ruling at the end of June.

"I actually think it's a little silly for Republicans to try to put together a response at this point," Michael Cannon, health policy director at the CATO Institute told attendees, adding that Republicans don't yet know how the Obama administration will respond.

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