Following the Supreme Court’s decision in late June to uphold most of the two-year-old healthcare law, associations are among the parties interested in the states’ progress on two major implementation decisions: an expansion of Medicaid to cover roughly 15 million low-income individuals, and the formation of new insurance exchanges designed to help another projected 15 million consumers purchase private insurance.

While the administration works to develop additional regulatory guidance on certain new rules that go into effect in 2014, some states are putting off decisions on Medicaid expansion and the exchanges until after the November elections. Should Republicans capture the Senate and the White House, they will undoubtedly have a strategy for repealing the law that remains President Obama’s signature legislative victory.

Some Republican governors are also pledging not to expand their states’ Medicaid programs in accordance with the Affordable Care Act (ACA). While the Supreme Court affirmed most of the law’s provisions, it also ruled that the government can’t withdraw existing Medicaid funding from states that opt out of the expansion. States opting out could significantly undermine the administration’s aspirations for the law and the number of people it would insure.

ASAE has worked to see that nonprofit employers are afforded similar incentives to sponsor insurance plans for their workers as other small businesses, and that the administration and the states consider associations as possible “navigators” to the insurance exchanges.

ASAE has also asked the Department of Health and Human Services to include associations in its list of “stakeholder groups” for states to consult when creating an exchange.

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