Washington -- If the Supreme Court rules the federal health care bill's mandate unconstitutional, the Malloy administration may try to implement it in the state.
The Affordable Care Act will require most Americans, beginning in 2014, to obtain health insurance coverage or be subject to a fine.
But after three days of Supreme Court arguments on the Affordable Care Act this week, governors like Dannel Malloy are considering what they will do if the high court declares the individual mandate -- or the entire act -- unconstitutional.
Jeannette DeJesús, the governor's special adviser on health reform, said Thursday that Connecticut may implement its own requirement that residents buy health insurance.
"All options are on the table and (the mandate) would be one of the options on the table," DeJesús said.
(Malloy on Friday said he had no immediate plans to explore a state mandate, and he was unsure if the state constitution would allow one, should the U.S. Supreme Court strike down the federal statute.
"Everything's on the table," he said. "But if you're asking whether I'm proposing a state mandate, I am not proposing a mandate at this time and I'm not sure that we would ever do it.")
Connecticut is ahead of many states in implementing the Affordable Care Act, moving forward quickly on a requirement for a health insurance exchange that would help people buy affordable policies. The state is also counting on millions of dollars the act will provide the state to expand coverage to the uninsured.
DeJesús said she's confident the Supreme Court will find the health care act constitutional.
But she said the end of the Affordable Care Act's mandate, "would be a serious blow" to Connecticut's reform efforts.
"They would be much more incremental," she said. "But (the ACA) provided a road map."
During oral arguments at the Supreme Court this week, attorneys representing the National Federation of Independent Business and the 26 states that challenged the ACA were asked by the justices if states could impose health insurance mandates. They said those are constitutional even if the federal mandate is not.
Massachusetts is the only state with an individual mandate. Approved by the state legislature and signed into law by former Gov. Mitt Romney in 2006, Massachusetts' health care law requires nearly all residents to have a minimum level of health care coverage and provides free insurance for low-income residents.
That model could work in Connecticut, DeJesus said, but the state government is also looking at other options.
Jennifer C. Jaff, the executive director of Advocacy for Patients with Chronic Illness, said the idea of a state-based mandate is politically feasible.
"We are a state that has considered single payer for years," she said.
"Single payer" refers to a government-run health care system modeled after Canada's system. It is considered much more radical than the Obama administration's attempt to cover the nation's 40 million uninsured through the individual mandate, subsidies, expansion of Medicaid and a series of insurance reform.
"If the Supreme Court derails things, there would be tremendous support for something that would get us back on track," Jaff said.
But without federal help, Jaff said the Malloy administration would have trouble finding money to subsidize the premiums of those who can't afford insurance.
Ellen Andrews, executive director of the Connecticut Health Care Policy Project, said there would be "zero" support for an individual mandate in the state legislature.
"It was hotly debated (in 2009) and the legislature decided against it," she said.
Like Andrews, Juan Figueroa, president of the Universal Health Care Foundation of Connecticut, thinks there are other ways to cover the state's 400,000 uninsured.
One is to open the state insurance health pool to small businesses that can't afford to cover their employees. Another is to automatically enroll Connecticut residents in a health care policy when they visit a hospital or doctor, but allow them to opt out.
To Figueroa, the rejection of the health care act by the Supreme Court would "put a premium on state-based efforts."
But he said states should have never relied on the Affordable Care Act to solve all their health care problems.
"Putting all the eggs in the basket of federal reform is not a good thing," Figueroa said.