Later this month, the Supreme Court will issue its ruling in King v. Burwell, a case that could have far-reaching effects on American health care. The Court will decide whether the Affordable Care Act (otherwise known as Obamacare) allows the government to provide subsidies for purchasing insurance in the 34 states, including Pennsylvania, that rely on, the federally-facilitated marketplace.

In Pennsylvania, the Wolf Administration has announced that it will move forward with a supported state-based marketplace in the event that the Supreme Court takes away tax credits from people in state like ours. This is a commonsense approach that will protect hundreds of thousands of Pennsylvanians, who could otherwise lose their health insurance.

How would a state-based marketplace work? Pennsylvania would lease the computer platform to keep its well-functioning infrastructure in place rather than starting again from scratch. This will not only save money, but also streamline the transition. The state's Insurance Department would then assume responsibility for oversight, selection, and certification of plans sold on the marketplace, which would meet the unique needs of our state.

What about the cost? While the initial federal funding available to states to establish marketplaces is gone, an assessment on insurers remains in place — and it can be used to fund Pennsylvania's marketplace, without enacting any new taxes. Currently, Pennsylvania insurers pay to participate in the federally facilitated marketplace, and these funds support the marketplaces in all state. With a state-based marketplace, assessments on Pennsylvania insurers would stay in Pennsylvania.

A state-based marketplace will shift control, oversight and, importantly, accountability, from the federal government to the state. This puts Pennsylvania in a position to innovate, design, and support a marketplace that gives working families, individuals and small businesses the best chance to obtain robust, quality, affordable health care choices year after year.

More than nine million Americans will lose insurance subsidies next year if the Supreme Court rules against them, and of those nine million, two-thirds will become uninsured. That includes nearly 350,000 people in Pennsylvania who stand to collectively lose nearly $79 million. On average, each person who enrolled in a plan through would lose $227 each month, resulting in a 177% increase in monthly premiums — and for most, the forced choice to drop coverage.

This wouldn't just hurt those individuals who have to give up coverage — it would also hurt their communities, and especially, their local hospitals. The Affordable Care Act reduced uncompensated care payments to hospitals on the assumption that there would be fewer uninsured patients. A ruling against the subsidies would leave them with smaller payments but fewer patients with insurance. The court would be leaving it to Congress to deal with these consequences — a polarized, gridlocked Congress that has voted more than 50 times to repeal the health care law entirely

Nearly 500,000 Pennsylvanians are eligible for the ACA's subsidies. That's why it's so critical that the legislature and Governor Wolf unite to act quickly to establish a state-based marketplace if the Court moves to strip away this financial help. The economic security of working families, the stability of our insurance market, and the health of our community hospitals all hang in the balance.