A Supreme Court decision due some time this month could return more than 60,000 Mainers to the ranks of the uninsured, placing their health and the economic stability of the state’s hospitals at risk.

If the court, in the case of King v. Burwell, rules that only those covered through state-based insurance exchanges are eligible for subsidies through the Affordable Care Act, then those in Maine and 33 other states that chose to utilize the federal exchange would lose their subsidies, and likely their insurance.

Lawmakers could avoid all that by passing a bill that is sensible and appropriate yet is still being delayed.

L.D. 1344 would establish a state-run exchange in Maine if — and only if — the federal exchange subsidies are struck down by the court, which is expected to rule by the end of June.

The bill passed through committee unanimously and through the House of Representatives with bipartisan support. However, a Senate vote may not be taken until after the Supreme Court vote.

But that would leave lawmakers in a reactive mode when the Legislature is likely to be out of session. If the court rules against the federal exchange, the state will have no immediate, solid answers, for no real reason.


That would be bad news for the estimated 60,939 Mainers who according to the Kaiser Family Foundation would have their insurance put at risk. Without the subsidies, they would see their monthly premiums jump from an average of $88 to an average of $425.

That would also be bad news for Maine hospitals, which would have to deal with an upswing in emergency room visits and charity care.

These effects would be echoed in each of the roughly 34 states now using the federal exchange.

Nationally, 6.38 million Americans — 80 percent of whom are working at least a part-time job — would be at risk of losing their insurance. Hospitals would lose an estimated $10 billion, with overall health care spending dropping an estimated $22 billion, according to the Urban Institute.

Even such a devastating possibility gets little traction in some states. Five Republican governors told Reuters earlier this year that because of their opposition to the ACA they would not create state-based exchanges under any circumstances.

These and other ACA opponents want to dismantle the law by any means necessary, and after losing a number of political and legal battles, the abolition of the federal exchange is their best chance, even if it does leave millions uninsured.

That obstructive, and destructive, thinking hasn’t surfaced in Maine. Even some conservative lawmakers who bitterly oppose the ACA see no gain in hurting tens of thousands of Mainers as part of a political strategy.

That’s sensible, as is passing a bipartisan bill that prepares for the worst. Lawmakers should enact L.D. 1344 sooner rather than later, so the state is ready to act as soon as the court issues its decision.

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