Anyone should note that the language of the ACA is not so nitpicking as some plaintiffs and some courts have made it appear. Section 1311 is way more clear than a bell:
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AMERICAN HEALTH BENEFIT EXCHANGES.—
(1) IN GENERAL.— Each State shall, not later than January 1, 2014, establish an American Health Benefit Exchange (referred to in this title as an ‘‘Exchange’’) for the State that—
(A) facilitates the purchase of qualified health plans;
(B) provides for the establishment of a Small Business Health Options Program (in this title referred to as a ‘‘SHOP Exchange’’) that is designed to assist qualified employers in the State who are small employers in facilitating the enrollment of their employees in qualified health plans offered in the small group market in the State; and
(C) meets the requirements of subsection (d).
(2) MERGER OF INDIVIDUAL AND SHOP EXCHANGES.—A State may elect to provide only one Exchange in the State for providing both Exchange and SHOP Exchange services to both qualified individuals and qualified small employers, but only if the Exchange has adequate resources to assist such individuals and employers.
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The overriding meaning of the act is established in (1) IN GENERAL.
In General, there are legally required to be state exchanges. Anything else is a modfication. Usually, any modification refers back to the legal intent of what is required. If there is an opt out of the manner of management responsibility for the exchange, then anyone rational would likely conclude that all enrollees in ACA have done so through the legally required state exchanges.
"Crow, James Crow: Shaken, Not Stirred!"
(History of White Eyes, funny marks on loose leaf, already known to Lands of Many Nations!)
________________________________________________________________
AMERICAN HEALTH BENEFIT EXCHANGES.—
(1) IN GENERAL.— Each State shall, not later than January 1, 2014, establish an American Health Benefit Exchange (referred to in this title as an ‘‘Exchange’’) for the State that—
(A) facilitates the purchase of qualified health plans;
(B) provides for the establishment of a Small Business Health Options Program (in this title referred to as a ‘‘SHOP Exchange’’) that is designed to assist qualified employers in the State who are small employers in facilitating the enrollment of their employees in qualified health plans offered in the small group market in the State; and
(C) meets the requirements of subsection (d).
(2) MERGER OF INDIVIDUAL AND SHOP EXCHANGES.—A State may elect to provide only one Exchange in the State for providing both Exchange and SHOP Exchange services to both qualified individuals and qualified small employers, but only if the Exchange has adequate resources to assist such individuals and employers.
_______________________________________________________
The overriding meaning of the act is established in (1) IN GENERAL.
In General, there are legally required to be state exchanges. Anything else is a modfication. Usually, any modification refers back to the legal intent of what is required. If there is an opt out of the manner of management responsibility for the exchange, then anyone rational would likely conclude that all enrollees in ACA have done so through the legally required state exchanges.
"Crow, James Crow: Shaken, Not Stirred!"
(History of White Eyes, funny marks on loose leaf, already known to Lands of Many Nations!)
