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King v. Burwell: the GOP is scrambling for a plan today, but the plaintiff has one

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The Supreme Court will rule this month on King v. Burwell, a case arguing that Obamacare's insurance subsidies are illegal. A decision in favor of President Obama's health-care law could solidify its place in history — but one against would throw the insurance expansion into chaos.

Up until the ruling, Vox will be collecting each morning the most important news, commentary, and thinking about what could happen — and what it means for the Affordable Care Act.

No King decision, more waiting — Despite a furiously churning rumor mill, the Supreme Court did not issue a King ruling Monday, leaving us plenty of free time to obsess over what it might rule in the near future. Also more time to be annoyed at Larry Kudlow, who made our morning much more stressful than it needed to be.

Y'all ready for this? And by y'all, I mean Republicans — Brian Beutler argues that a legal victory for Obamacare challengers could be a disaster for Republican candidates. He's writing about the possibility of the Supreme Court saying the language in Obamacare is vague and therefore the courts must defer to the government's interpretation. More from Beutler:

If the government wins in this way it will create a new conservative litmus test for Republican presidential candidates. If elected, will you shut down the subsidies? I suspect most of the candidates will yield to pressure from the right and promise to do precisely that.

Robert Pear also reports that Republicans are becoming increasingly worried about the "enormously complex" challenge of building an Obamacare alternative, should the Supreme Court strike down Obamacare's subsidies.

The GOP won't fix Obamacare for free. Sam Baker and Dylan Scott at National Journal summarize their list of demands.

States have four ways to react to a ruling against Obamacare, experts at Leavitt Partners (run by former Health and Human Services Secretary Michael Leavitt) argue.

King plaintiff not worried, has backup insurance paid for by the government The New York Times interviewed David M. King, who is not especially worried about the outcome of the case:

But Mr. King said that he was not really worried about the outcome of the case, King v. Burwell, because as a Vietnam veteran, he has access to medical care through the Department of Veterans Affairs.

If he wins, Mr. King said, "the left will blow it out of proportion and claim that eight million people will lose their health insurance." But he said lawyers had assured him that "things are in play to take care of the problem."

Lots of other Obamacare enrollees, however, don't have another insurance plan to fall back on. More here from the Huffington Post.

Via Jonathan Cohn: two-thirds of Obamacare enrollees who would lose tax credits live in Republican districts.

(Oprah voice) You get an exchange, and you get an exchange The Obama administration has given three states — Pennsylvania, Delaware, and Arkansas — conditional approval to build state-based exchanges in 2016. Maine is also trying to build a fix. That means that three of the 34 states using have taken initial steps toward building some type of escape hatch for a scenario in which the Obamacare challengers win.

How hard is it to actually build health insurance exchanges? I talked to Peter Lee, executive director of Covered California, about that when he was here in Washington last week. He runs the country's largest insurance marketplace and says that, technology-wise, it's definitely possible to build a website where people can shop for insurance by open enrollment next fall.

What's hard to do is build up the infrastructure: get a marketing campaign in place and hire all the people to sit at a call center, and those types of things. That's where he's not totally sure other states could get going on time.

"We'll share strategies," Lee says, "but in the end, the ACA isn't self-implementing. And there are parts that just don't scale."

Map of the day

Read more about it here.

Card of the day

Q&A time: send me your questions! Have a question about the King decision? Email me at And in the meantime, here's one that turned up in my inbox last week: "If the Supreme Court decides against subsidies, what happens next for subsidy recipients? Do sick patients get thrown out of hospitals right away? Or the next month? Or do they still receive treatment but just have to declare bankruptcy later?"

Patients will not get thrown out of hospitals. Obamacare enrollees have presumably already paid their premiums through the end of June, which means they have coverage for the rest of this month. Insurers won't be able to rescind that.

When, exactly, the subsidies would disappear in a ruling against Obamacare is largely up to the justices. They could decide to let their decision take effect immediately, meaning that whenever an Obamacare enrollee's next bill is due, he or she would no longer get financial help.

Or the justices could recognize the disruption this would cause, and decide to stay their ruling for a few months. Justice Antonin Scalia hinted at this idea in oral arguments, but we won't know how the court wants to navigate the issue until they issue the decision.

That's all until next time. Well, except for this.