A Supreme Court decision is expected by the end of the month in King v. Burwell, a challenge to the Affordable Care Act that argues subsidies for health insurance should only be available in states that set up their own insurance marketplaces, or exchanges.
If the court rules against the Obama administration, millions of people in states using the federal exchange could lose their subsidies.
Enter entrepreneurs, who think they’ve found a way to help states set up exchanges almost immediately. Sanjay Singh is one of them. He’s CEO and co-founder of hCentive, a tech start-up that supplies the software for state health care exchanges. hCentive helped Kentucky and New York set up their exchanges. They’re two of the more glitch-free state marketplaces.
Singh is a political junkie and a techie. He got immersed in hearings on the Affordable Care Act, and read through the nearly 1,000-page bill. It was the first bill he ever read. And then Singh made a bet – he established hCentive before the Affordable Care Act even became law. Now he’s making another bet. If the Supreme Court rules that people in states using the federal exchange to buy their insurance aren’t eligible for subsidies, he’ll be ready with what he’s calling an “exchange-in-a-box” — a ready-made answer for states that suddenly need to build their own marketplaces.
“You can take what has been already built, package it in a way that a state can use it, almost out of the box,” Singh says.
He says hCentive’s exchanges-in-a-box can be up and running in under six months. Singh says there wouldn’t be any big, up front down payment. States could pay hCentive a percentage of the fee they charge to insurers. But there is one giant unknown for Singh: politics. Twenty-six state legislatures won’t even be in session this summer.
“How will a state even decide it wants to do an exchange-in-a-box?,” says David K. Jones, an assistant professor at the Boston University School of Public Health. “How will they get the legislation passed? Will it require a governor being brave enough to do an executive order?”
It’s hard to tell how Republican governors who’ve opposed the law would react. Some campaigned hard against the Affordable Care Act, and government involvement in healthcare. But Singh thinks they may be more open to a private-sector solution, like his exchange-in-a-box. And some observers say Singh may be onto something.
“If I’m a governor in one of the red states, I’m going to be concerned about making some kind of arrangement with the federal government to basically run my exchange,” says Joel Ario, the first director of the federal exchange, now managing director at Manatt Health Solutions. “But I’m going to be more open to a private company.”
So Sanjay Singh, the political junkie, could bridge a political divide — and make a profit in the process.