Top Obamacare Official Looks Ahead After Supreme Court Ruling

The U.S. official overseeing Obamacare said on Friday she has not seen any indication that states will back away from running their own health insurance marketplaces now that the Supreme Court has validated the federal insurance exchange.

Sylvia Burwell, secretary of Health and Human Services, also said she expected enrollment in both the state and federal health insurance exchanges established under the 2010 Affordable Care Act — called Obamacare — to decline from 10.2 million currently to 9.1 million by the end of 2015. That was the number her department had originally set as a goal for 2015.

Speaking with reporters in her office, an upbeat Burwell said now that the Court has upheld the law, she is ready to build on the five-year-old program’s progress by continuing to expand Medicaid, which makes benefits available to low-income people.

Obamacare survived a major legal test on Thursday when the Supreme Court upheld the law’s tax subsidies, which help millions of Americans pay for health insurance.

The plaintiffs contended the law’s authors only intended the subsidies to be paid to consumers on state-based health exchanges. The court rejected that argument, confirming the subsidies were also legal in 34 states now relying on the federal website,

“We’re going to work with states that want to do state-based exchanges. We’ll do federal exchanges where there aren’t those,” Burwell said.

Asked if some states might give up operating their own exchanges and let residents shop for insurance on the federal website, she said: “I don’t think we have seen any indication of that, but we’ll see.”

Thirteen states and the District of Columbia have established their own exchanges where consumers can find insurance. Some state exchanges have had technical and logistical challenges as well as financial difficulties.

Burwell said she expected Obamacare enrollment to decline to 9.1 million by year’s end for a combination of reasons. Some people will get insurance through new employment, others will marry and go on their spouses’ coverage, and some may not be able to pay their premiums, she said.

She said she learned the administration had won the Court ruling on Thursday as she walked down the hallway of her department and heard a cheer. Then she asked her team: “Are we sure?”

“It was very emotional … It was just such a moment of, you know, as I said, relief,” Burwell said.

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