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+ {"source_url": "https://www.wsj.com", "url": "https://www.wsj.com/articles/as-court-case-imperils-affordable-care-act-some-states-prepare-contingency-plans-11571650207?mod=hp_lista_pos4", "title": "As Court Case Imperils Affordable Care Act, Some States Prepare Contingency Plans", "top_image": "https://images.wsj.net/im-118786/social", "meta_img": "https://images.wsj.net/im-118786/social", "images": ["https://m.wsj.net/video/20191017/101819howtomeditate/101819howtomeditate_167x94.jpg", "https://content-thumbnail.cxpublic.com/content/dominantthumbnail/79ce9148d567c81c93b6f6e3082ad73c7eda5dc7.jpg?5dae863a", "https://images.wsj.net/im-118445?width=620&size=1.5", "https://content-thumbnail.cxpublic.com/content/dominantthumbnail/afd2642bb101df3d1e47b2f251b1f8547556e849.jpg?5daee491", "https://content-thumbnail.cxpublic.com/content/dominantthumbnail/2027656d8b58ecb7d9e6c8395cd0edbebcfd70bf.jpg?5dae9552", "https://m.wsj.net/video/20191016/101619golf/101619golf_167x94.jpg", "https://images.wsj.net/im-119053?width=111&height=62", "https://si.wsj.net/public/resources/images/S1-DV928_np_con_D_20191021072421.jpg", "https://images.wsj.net/im-118786/social", "https://images.wsj.net/im-119093?width=111&height=62", "https://images.wsj.net/im-118851?width=111&height=62", "https://s.wsj.net/public/resources/images/B3-FG244_INFLUE_C_20191018172347.jpg", "https://content-thumbnail.cxpublic.com/content/dominantthumbnail/c20412658fde8e776e773a27a969c605c4536280.jpg?5daed73e", "https://m.wsj.net/video/20191017/101719opvideastiseast4/101719opvideastiseast4_167x94.jpg", "https://content-thumbnail.cxpublic.com/content/dominantthumbnail/222051bfa2fc89544702f6b614882941789331be.jpg?5dae8905", "https://m.wsj.net/video/20191019/101919brexitvote/101919brexitvote_167x94.jpg", "https://content-thumbnail.cxpublic.com/content/dominantthumbnail/5d83e1b3f66ab99ed0d2ac06a4cb8676e6dcd045.jpg?5daed767", "https://content-thumbnail.cxpublic.com/content/dominantthumbnail/41986f4a57554828de0ccee18dabd23e034e906f.jpg?5daeccb1", "https://content-thumbnail.cxpublic.com/content/dominantthumbnail/8119faff608249b2a5f493821a62f9a3ef8dd88c.jpg?5dae5490", "https://content-thumbnail.cxpublic.com/content/dominantthumbnail/ba1927b92e5ae9960629560c33f0b40d33949cea.jpg?5daedaf5", "https://m.wsj.net/video/20191018/101819wildfireinsurance/101819wildfireinsurance_167x94.jpg", "https://content-thumbnail.cxpublic.com/content/dominantthumbnail/0d09f4ee7cfa48604cb281b83c36587074a9563a.jpg?5daee3e0", "https://images.wsj.net/im-119236?width=111&height=62"], "movies": [], "text": "A federal appeals court decision that could strike down the Affordable Care Act as soon as this month has rattled officials in several states who are pursuing legislation to preserve some coverage in the absence of any Trump administration contingency plan.\n\nLawmakers in states including Louisiana, Nevada, New Mexico and California have passed bills or are reviewing action aimed at dealing with the fallout if the ACA is overturned. Many of these lawmakers are also facing re-election campaigns this fall in some of the very states that brought the lawsuit.\n\nPlans include giving subsidies to insurers that cover high-cost consumers, possible emergency legislative sessions to address sudden coverage gaps, and regulations that prevent people from being denied coverage even if the law is no longer in effect.\n\nThe state initiatives reflect growing angst over the possible ramifications of a decision that could ultimately end health coverage for more than 20 million people.\n\nA three-judge panel of the Fifth U.S. Circuit Court of Appeals heard oral arguments in July in a lawsuit driven by 18 GOP-led states seeking to invalidate the law. The Trump administration has largely sided with the states.\n\nThe judges\u2019 questions during the arguments suggested they could rule against upholding the ACA, legal experts said. A ruling would likely be stayed, and the case is expected to be taken up by the Supreme Court, pushing the timeline for a final decision into 2020 or beyond.\n\nHealth and Human Services Secretary Alex Azar said in an interview Friday that because the ruling is likely to be stayed, there is no reason for concern now.\n\n\u201cOur message is to keep calm and carry on,\u201d he said.\n\nHe added that should the makeup of Congress change after next year\u2019s elections, lawmakers could revisit an ACA replacement, although the Republican-controlled House and Senate couldn\u2019t agree on a new health plan in the early months of the Trump administration.\n\n\u201cA lot of what we\u2019d support would depend on the political climate at the time,\u201d he said.\n\nSHARE YOUR THOUGHTS What do you think states should do to prepare in case the ACA is struck down? Join the conversation below.\n\nBut some lawmakers risk being portrayed as jeopardizing coverage if they don\u2019t push bills to enshrine parts of the ACA, especially its protections for people with so-called pre-existing conditions. Lawmakers are also acting now because of the time it can take to get legislation passed.\n\n\u201cIf we\u2019re going to be upending and amending it, it needs to be done through Congress,\u201d said Democratic Colorado Gov. Jared Polis. \u201cThe lawsuit is just so much uncertainty. It could create great chaos in the system.\u201d\n\nColorado is pursuing the creation of an insurance plan, similar to a so-called public option, that would provide insurance to people on the individual market. The state would set the rates, which could help lower premium costs if the ACA ends.\n\nLouisiana, under legislation signed by Democratic Gov. John Bel Edwards, is seeking input through October on a replacement plan that would provide some coverage to people with pre-existing health conditions, said Frank Opelka, the state\u2019s deputy commissioner for life, health and annuity.\n\nThe legislation directs the state\u2019s insurance commissioner to set up a system known as a \u201chigh-risk pool,\u201d where insurers get subsidies for covering people with expensive medical conditions who are locked out of health insurance.\n\nLouisiana\u2019s Republican attorney general, Jeff Landry, joined the lawsuit from GOP-led states seeking to invalidate the ACA. Both the governor and Mr. Landry are running this year for re-election.\n\n\u201c \u201cOur message is to keep calm and carry on.\u201d \u201d \u2014Alex Azar, Health and Human Services Secretary\n\nThe prospect of losing coverage could prove unpopular with the electorate. Much of the coverage gains under the ACA came from the law\u2019s expansion of the Medicaid program, and more than 450,000 Louisiana residents covered under that expansion could lose their insurance. Many of the 90,000 people in Louisiana who have coverage through the ACA\u2019s individual exchange risk losing subsidies that help offset their premiums.\n\nIn Nevada, Democratic Gov. Steve Sisolak is fielding applicants for a patient-protection commission, directed under a bill lawmakers passed last year, that will make recommendations for protecting coverage if the ACA is eliminated. Like Louisiana, the state has 90,000 people who get insurance on the state\u2019s ACA exchange, and more than 210,000 residents in Nevada gained coverage through Medicaid expansion.\n\nDemocratic lawmakers in Texas, the state leading the lawsuit against the ACA, have weighed calling an emergency legislative session depending on when a decision comes down. The legislature passed a bill this year that would establish a temporary high-risk pool as a stopgap to provide some coverage if the ACA is overturned.\n\n\u201cStates should certainly be thinking about contingency plans,\u201d said Nicholas Bagley, a professor at the University of Michigan law school. He added that \u201ccoming up with reasonable contingency plans will take time.\u201d\n\nNewsletter Sign-up\n\nThe state actions are putting pressure on President Trump because he has yet to produce a health plan despite repeated promises to do so. The administration has been working on plans should the courts knock down the ACA or large parts of it, according to two people familiar with the discussions.\n\n\u201cWe\u2019re prepared for every scenario,\u201d a senior White House administration official said. \u201cWe have spent a lot of time and have prepared for various permutations.\u201d\n\nIn Congress, Sen. Chris Murphy (D., Conn.) has been pressing Republicans to present a plan in case the law is shot down. The conservative House Republican Study Committee has been working on a health plan that is expected to be released soon.\n\nMeanwhile, at least 11 states including Connecticut, Louisiana, Indiana, Maryland, Vermont and Washington have enacted laws that require insurers to provide coverage to people with pre-existing conditions or offer health plans that provide the same suite of benefits as those mandated by the ACA, according to a July report from Avalere, a health-care consulting firm.\n\nState budgets would be thrown into turmoil if the ACA ends because federal funds pay for most of the Medicaid expansion, as well as subsidies for roughly nine million people who buy their own insurance on the health law\u2019s exchanges. The federal government spent about $63 billion for Medicaid expansion in 2018, and states lack the funding to make up the difference.\n\nWrite to Stephanie Armour at [email protected]", "keywords": [], "meta_keywords": ["political", "general news", "society", "community", "health", "politics", "international relations", "domestic politics", "welfare", "social services", "politics & policy", "insurance", "non-life insurance", "medical insurance", "financial services"], "tags": [], "authors": ["Stephanie Armour", "Stephanie.Armour Wsj.Com", "Alex Azar", "Health", "Human Services Secretary"], "publish_date": null, "summary": "", "article_html": "", "meta_description": "A court case that could strike down the Affordable Care Act has rattled officials in several states who are pursuing legislation to preserve some coverage.", "meta_lang": "en", "meta_favicon": "https://s.wsj.net/media/wsj_favicon-16x16.png", "meta_data": {"viewport": "width=device-width, initial-scale=1.0, 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