More than 90,000 health care consumers in Maine and New Hampshire, the only New England states that do not run their own health insurance exchanges, will continue to receive government subsidies now that the Supreme Court has upheld a key element of the Affordable Care Act.
Lower- and middle-income consumers in those states compare plans and purchase health insurance through an online marketplace run by the US government. In the four other New England states, including Massachusetts, insurance exchanges are run by state government.
If the challenge to the Affordable Care Act had succeeded, consumers in states that rely on the federal exchange would have lost tax credits that help make insurance affordable. The court’s 6-3 ruling Thursday means those subsidies remain intact.
Maine state Senator Geoffrey Gratwick, who is a physician, unsuccessfully sponsored a bill to create a state exchange as a hedge against a Supreme Court decision that might have dismantled subsidies.
“This brings tears to my eyes,” Gratwick, a Democrat, said. “I have too many stories of patients who fell through the cracks.”
Gratwick said that given the political makeup of Maine — with Republican Governor Paul LePage ardently opposed to the Affordable Care Act — there is no longer “any impetus whatsoever” for a state-based exchange. LePage’s office did not return a call seeking comment.
Earlier this year, New Hampshire state Representative Ed Butler tried to establish a state-run exchange, but that bill failed because other lawmakers didn’t want to act before the court’s decision, the lawmaker said.
“They felt my bill was trying to solve a problem before the problem was there,” Butler, a Democrat, said. “I don’t know what the state’s response would have been had the court decided differently. . . . But I can’t imagine that we would abandon those people that benefit from insurance coverage.”
Butler said New Hampshire’s reliance on the federal marketplace works reasonably well, and the state sees no need to add the cost of establishing a state-run exchange.
The Massachusetts Health Connector served as a model for the federal exchange. Jason Lefferts, a spokesman for the state’s marketplace, said a state-run exchange is clearly the best thing for people in Massachusetts. The state exchange gives people subsidies on premiums beyond the federal tax credit, Lefferts said.
“As we have learned in Massachusetts, financial assistance to consumers helps make health insurance affordable and provides health access for individuals and families who need coverage,” Amy Whitcomb Slemmer, executive director of the advocacy group Health Care For All, said in a statement.