What happens if the King v. Burwell ruling goes against Obamacare?

As King v. Burwell is deliberated inside the Supreme Court, contingency plans continue to develop outside in preparation for whatever ruling comes.

The decision on the Affordable Care Act insurance subsidies could bring fire and brimstone or peace on earth, depending on which side you’re on. The reality will fall somewhere in the middle. Here’s how we see potential landscape shifts if the court rules that the law says individual states must have an insurance exchange for their residents to receive federal subsidies:

Congress could legislatively “fix” the four words being contested. If federal healthcare insurance subsidies are made available to individuals on any insurance exchanges, not just those “established by the state,” as the four contested words read, then those who had qualified before the Supreme Court case would be able to retain their standing after it.

Congress could “hold harmless” states that didn’t initially form exchanges. The path to an exchange could be smoothed, with the Department of Health and Human Services waiving or modifying the requirement that states secure approval for their exchanges at least 6.5 months before launch, a timeline that would otherwise jeopardize the ability of displaced enrollees to sign up for a new health plan in 2016.

States without exchanges might establish one that’s run by the federal government. The states would maintain the sovereignty several seek to protect, while still offering their constituents access to subsidy support.

States might arrange for other states to run their exchanges. Kentucky, for example, has put together a successful exchange that could be a resource for states without their own insurance exchanges.

Nothing happens. While at least 4 million are on expanded Medicaid and had coverage prior to the Affordable Care Act, inaction in the case of subsidy loss would cause a death spiral – in some cases, a literal one — for millions of Americans who would lose insurance coverage. The Kaiser Family Foundation estimates that in 2016, 13.4 million people would be enrolled in federally subsidized insurance. While Sen. Ben Sasse (R-Neb.) has proposed a Winding Down ObamaCare bill that would providing 18 months of gradually decreasing subsidies, the COBRA-like proposal would provide only a temporary solution to those who most need a permanent one.

What other potential outcomes do you see? Let us know in the comments section.