Concerns that the Patient Protection and Affordable Care Act (ACA) may be struck down by the court have prompted many states to take precautions to protect their citizens who are at risk of losing coverage or valuable patient protections. Some states have enacted legislation codifying key parts of the ACA, yet only three states have codified the ACA in its entirety. Other states have passed laws that will go into effect only if the ACA is struck down, while several state governors have taken administrative actions to protect consumers, such as ordering state agencies to uphold the protections of the ACA.
Though these policies offer some protection, they may be inadequate to ensure that consumers have become accustomed to the ACA’s protections over the last decade. Arguably, one of the most difficult challenges that states would encounter if the law is struck down is the cost of care. States, insurance companies, and insureds are dependent on federal funding whether it be through Medicaid expansion, marketplace tax premiums, or subsidies. Additionally, protective state laws would not govern any employer-based health insurance plans since the state laws are preempted by the Employee Retirement Income Security Act (ERISA).