Question: What are the immediate results of yesterday’s Supreme Court ruling on state exchanges?

Answer: The SCOTUS decision puts a lot of pressure on those states that have not done much to get their exchanges started while hoping the ACA would be declared unconstitutional. Now, they are under severe time constraints to implement an exchange. Many states will be left with no alternative to a federally run exchange. States must also decide whether to accept the Medicaid expansion program and will probably decide along party lines - many Republican dominated states choosing not to. The development of the California Exchange is way ahead of the curve relative to other states and will most surely continue with Medi-Cal expansion. So, other than a sigh of relief, no changes in California.