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Mixed signals from the Supreme Court have states on edge about the future of health insurance subsidies for millions of Americans. And a summer decision from the justices leaves little time for backup planning. Many governors, especially Republicans, want the federal government to craft a contingency plan and at least one governor — in Pennsylvania — is pursuing a state exchange, which would make sure his state was able to receive the subsidy. (Kennedy, 3/5)

Justice Samuel Alito ’s suggestion that the Supreme Court could delay for months the impact of a decision to gut the health law revives the possibility that at least a dozen states could take action to limit the effect of such a ruling. Justice Alito’s remarks came Wednesday during oral arguments in a case that seeks to halt the use of tax credits to offset the cost of insurance premiums for residents in about three dozen states that don’t operate their own insurance exchanges and use the federal HealthCare.gov site instead. Challengers in the case argue the law allows the tax credits only for insurance buyers in states with their own exchanges—currently just 13 states. (Radnofsky and Bravin, 3/5)

During oral arguments before the U.S. Supreme Court Wednesday in King v. Burwell, Justice Samuel Alito suggested that there is a relatively simple fix to the problem of residents in up to 37 states that haven't established their own exchanges potentially losing access to premium subsidies. Alito is correct in the hypothetical sense. ... But realistically, the logistical, financial and—perhaps most crucially—political hurdles would so significant that few states seem capable of overcoming them. (Demko, 3/5)

As the nation awaits a Supreme Court ruling on Obamacare, lawmakers in many states are moving ahead with a range of Affordable Care Act bills, some of which seek to bolster the law and others that are bent on derailing it. The Supreme Court case, King v. Burwell, focuses on subsidies paid to millions of Americans who bought health insurance through exchanges set up under the Affordable Care Act. At issue: whether subsidies issued through exchanges operated by the federal government are legal. By the end of June, the justices are expected to issue a ruling, which could either uphold the law as it now operates or strike down those subsidies for good. (Schulte, 3/5)

Hospitals are just beginning to hash out contingency plans as the waiting begins for the U.S. Supreme Court to decide whether to end insurance subsidies in most of the country. Some of the financial gains that hospitals have experienced from having a greater number of insured patients may be erased if the court rejects the use of subsidies for individuals who purchase health plans from the federal exchange. (Evans and Kutscher, 3/5)