What Governors Are Saying About King v. Burwell

Last week’s ruling in King v. Burwell affirmed the provision of tax-subsidies through the federally-facilitated marketplace (FFM), a decision which may have affected over 6.4 million Americans currently receiving subsidies in the 34 states that have opted for the FFM model. The ruling has asserted the place of the Affordable Care Act (ACA), with state leaders continuing to play a critical role in determining how to implement the law most beneficially for the citizens of their states. Statements issued by governors in light of the ruling hint at the future direction of potential reforms across states. Read More

As documented in this NASHP chart, 14 governors have released statements supporting the ruling, with comments emphasizing how the ruling improves access and continuity of coverage and lowers uninsured rates. Ten governors struck a more neutral tone, stating that the decision maintained the current status of coverage. Sixteen governors clearly opposed the Court’s ruling, with comments calling for an overhaul or repeal of the Affordable Care Act and suggestions to replace the law with options to give states greater flexibility and employ market-based reforms.

In addition to weighing in on the ruling, several governors used this platform to advocate for related health care priorities. Governors in Alaska, Missouri and Virginia called for the legislature to pass Medicaid expansion; while those in Michigan and New Hampshire drew attention to alternate coverage expansion plans. Governors in New Hampshire, North Carolina, South Carolina, and Wyoming called for a focus on state flexibility and options to assure affordability and access to care for their citizens. Several governors from states operating state-based marketplaces (SBM) (Connecticut, Idaho, Kentucky, Nevada, and Rhode Island) said the decision affirmed that that the SBM was an appropriate marketplace model to benefit the citizens of their states.

The ruling underscores that the ACA was built on a foundation of state innovation and experimentation; similar opportunities await as governors, along with other state leaders, debate future reforms in their states.

NASHP will continue to track state activity around the King v. Burwell decision and support state leaders as they develop and advance reforms. If you have feedback or more you’d like to add to our chart, please email ccousart@nashp.org.

State	Governor (Political Affiliation)	Quote	Health Insurance Marketplace Model*	Medicaid Expansion Status
AK	Walker (I)	“We are pleased so many of our friends, family and neighbors will be able to continue to receive health care. Now it’s important that we continue to work toward Medicaid expansion, so more Alaskans can receive the health coverage they need.” More…	FFM	No
AL	Bentley (R)	“I, as a physician, have always believed, that the Affordable Care Act is deeply flawed and does little to help improve the health of our citizens.” More…	FFM	No
AR	Hutchinson (R)	“We will continue our work…to find innovative solutions for Medicaid and healthcare reform. I am convinced now more than ever that we need to proceed with caution to measure the costs to the taxpayers and the reliability of the outcome as we consider the potential of a state exchange.” More…	SPM	Yes¹
AZ	Ducey (R)	“[The ACA] isn’t the right plan for Arizona or for America, and it should be replaced.” More…	FFM	Yes
CA	Brown (D)	“Because of this ruling, health insurance continues to be accessible to every American, making our entire nation healthier and more prosperous.” More…	SBM	Yes
CT	Malloy (D)	“Today reminds us why we’re so proud to have built the best exchange in the nation…we embraced the Affordable Care Act, celebrated healthcare reform, and stood for progress by helping insure over 250,000 Connecticut residents.” More…	SBM	Yes
DE	Markell (D)	“For the more than 19,000 Delawareans who qualify, the federal subsidies are critical in helping to make health insurance more affordable. And we know that coverage is an important component in connecting Delawareans to care.” More…	SPM	Yes
FL	Scott (R)	“It’s a bad law. It was supposed to reduce health care costs and health care costs have gone up.” More…	FFM	No
IA	Branstad (R)	“The increasing costs of healthcare due to Obamacare red-tape and burdensome regulations have already led to tighter budgets for Iowa families….Obamacare continues to be unaffordable, unsustainable and unpredictable.” More…	FFM	Yes¹
ID	Otter (R)	“Due to the wise and prudent course set by the governor and Legislature to ensure Idaho implemented our own state-run exchange, Idaho would not have been directly impacted by the court’s decision in either direction.” More…	SBM	No
IN	Pence (R)	“ObamaCare must be repealed and states must be given the flexibility to craft market-based solutions focused on lowering the cost of health care rather than growing the size of government.” More…	FFM	Yes¹
KS	Brownback (R)	“Kansans will continue to suffer higher health care costs….We are hopeful that Congress and President Obama’s administration will provide states the needed flexibility in finding Kansas solutions to our health care challenges.” More…	FFM	No
KY	Beshear (D)	“The U.S. Supreme Court’s decision…reaffirms that, from the very start, we did the right thing for the more than 500,000 Kentuckians who have qualified for healthcare coverage through kynect since January 1, 2014.” More…	SBM	Yes
LA	Jindal (R)	“The debate will continue because the law has failed to accomplish its prime objective: Containing health care costs.” More…	FFM	No
MI	Snyder (R)	“Our focus can now center on securing the second waiver for our Healthy Michigan Plan, which has been an outstanding success. ” More…	SPM	Yes¹
MN	Dayton (D)	“We need a period of stability now where we can improve upon the system that’s been established. I really hope the critics will recognize now that this is the system has been enacted. It’s federal law, and we’re going to work to make it better.” More…	SBM	Yes
MO	Nixon (D)	“Today’s ruling…removes all doubt that the ACA is and will remain the law of the land. There are no more excuses for continuing to send our tax dollars to other states and denying 300,000 working Missourians the opportunity to access affordable health care coverage through Medicaid expansion.” More…	FFM	No
MS	Bryant (R)	“Mississippi was right…not to willingly entrench Obamacare by establishing a state-based exchange, and I will continue to resist any efforts that attempt to shove Obamacare deeper into this state.” More…	SBM	No
MT	Bullock (D)	“Forty thousand Montanans can now be sure they will not lose their health insurance or have their taxes increased in order to maintain coverage.” More…	FFM	Yes¹
NC	McCrory (R)	“[W]e must build a North Carolina-based reform plan that focuses on healthier patients at a cost taxpayers can afford. We must give doctors, hospitals and all health care providers the flexibility to provide their patients the highest quality care possible.” More…	FFM	No
ND	Dalrymple (R)	“This is what we anticipated when the Legislature decided to utilize the federal exchange. The Affordable Care Act is law and we expected it to be applied equally in all the states.” More…	FFM	Yes
NE	Ricketts (R)	“Today’s decision…allows Nebraskans to keep the health insurance premium subsidy provided under Obamacare. This decision maintains the status quo and does not appear to have any impact on the functionality of Obama’s healthcare law.” More…	FFM	No
NH	Hassan (D)	“We need to keep building on the new competition in our health insurance marketplace to continue making coverage more affordable and more accessible for all of our people and businesses. [I]t’s crucial that we also maintain our commitment…and eliminate the remaining uncertainty in the market by continuing our business-backed, bipartisan health care expansion plan.” More…	SPM	Yes¹
NJ	Chrstie (R)	“State means state, not the federal government. This decision turns common language on its head. Now leaders must turn our attention to making the case that Obamacare must be replaced.” More…	FFM	Yes
NV	Sandoval (R)	“[W]e have remained confident that the thousands of Nevadans who rely on our Silver State Health Insurance Exchange would not be impacted…. We remain committed to state control of our marketplace and assuring affordable health plans are available to reduce the number of uninsured Nevadans.” More…	SBM	Yes
OH	Kasich (R)	“The law has driven up Ohio’s health insurance costs significantly and I remain convinced congress should repeal and replace it with something that actually reduces costs.” More…	FFM	Yes
OK	Fallin (R)	“The American people need Congress to use its powers to move the country towards constructive, market-oriented solutions that empower families, provide flexibility to states, improve health and reduce the cost of health care.” More…	FFM	No
PA	Wolf (D)	“I am extremely pleased with the Supreme Court’s ruling in King v. Burwell. As a result of this decision, roughly 382,000 Pennsylvanians will keep their much-needed assistance to help them afford health care.” More…	FFM	Yes¹
RI	Raimondo (D)	“Last year, thousands of Rhode Islanders took advantage of almost $70 million in tax credits to gain the coverage they need to live healthy and productive lives. I applaud the Supreme Court for ensuring these benefits won’t be taken away from Americans across the country.” More…	SBM	Yes
SC	Haley (R)	“In South Carolina, we will continue to work around [the ACA] as best we can, finding better ways to make health care more affordable and give patients more choices.” More…	FFM	No
SD	Daugaard (R)	A spokeswoman for Gov. Dennis Daugaard, a Republican, said the state doesn’t have to change its approach to the federal health law since the court upheld the subsidies.	FFM	No
TN	Haslam (R)	“So while philosophically I did not agree with the ruling, in terms of the smoothness of the market and people being able to obtain insurance in a predictable way, it’s good.” More…	FFM	No
TX	Abbott (R)	“Today’s action underscores why it is now more important than ever to ensure we elect a President who will repeal Obamacare and enact real healthcare reforms.” More…	FFM	No
UT	Herbert (R)	“Ultimately, we are a nation of laws and I will continue to work diligently to maximize state flexibility within the legal parameters.” More…	FFM	No
VA	McAuliffe (D)	“This historic decision is a victory for the 286,000 Virginians who will now keep affordable health care that is essential to economic success. It is also a clear sign that now is the time to drop cynical efforts to prevent families from accessing care that will make their lives better.” More…	FFM	No
VT	Shumlin (D)	“This is very good news for the 6.4 million Americans who were in danger of losing their affordable health care coverage….We are making progress to deliver the services Vermonters expect through Vermont Health Connect. We have insured nearly 20,000 Vermonters who previously did not have insurance, and now Vermont has the second lowest rate of uninsured in the nation.” More…	SBM	Yes
WA	Inslee (D)	“I applaud the Supreme Court for upholding this landmark law that is helping so many people here in Washington state and across the nation. The Affordable Care Act has helped more than 730,000 Washingtonians find affordable care, and more than 300,000 of those had been uninsured.” More…	SBM	Yes
WI	Walker (R)	“Today’s ruling means Republicans must redouble their efforts to repeal and replace this destructive and costly law.” More…	FFM	No
WV	Tomblin (D)	Gov. Earl Ray Tomblin’s “appreciates” a U.S. Supreme Court ruling letting 28,000 West Virginians keep receiving federal subsidies for health insurance plans bought from a federal marketplace. More…	SPM	Yes
WY	Mead (R)	“Simply stated, this ruling maintains the status quo. It will still be necessary for Wyoming to develop its own path forward for better health care access and better health care for our citizens. I will continue to work with the Legislature on these important issues.” More… https://www.wvva.com/story/29412364/206	FFM	No

*Health Insurance Marketplace Models
FFM = Federally-Facilitated Marketplace
SPM= State-Partnership Marketplace
SBM= State-Based Marketplace
¹States have expanded Medicaid through an alternative expansion. For more details, please see this StateRefor(u)m chart.

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