Preventive medicine

When a vaccine for a serious illness is available, it's a savvy patient who steps up to be inoculated - more so if the immunization comes at little or no cost.

That health tip also applies to the personal and financial well-being of more than 4.5 million Americans with modest incomes living in 26 states, including Pennsylvania and New Jersey. They are relying on Washington for help purchasing legally mandated health coverage. But as the nation enters the second year of full implementation of President Obama's landmark health-care reform, they are at risk of losing the federal tax credits that bring their health policies within reach - the subsidies that put the affordable in the Affordable Care Act.

In response to legal challenges from the ACA's critics, a number of recent federal court rulings have determined that the subsidies are legal only in the states that run their own health-insurance exchanges. Since most states declined to do so and defaulted to the federal HealthCare.gov exchange, it's anyone's guess what will happen if, as is entirely possible, the U.S. Supreme Court ultimately agrees with Obamacare's foes.

Fortunately, there's a fix: Officials in federal-exchange states can get to work now on setting up their own exchanges. They should think of a state-run exchange as the vaccine that precludes the potential loss of insurance subsidies critical to the health of millions now receiving high-quality coverage under the ACA. There's even good evidence that state-run exchanges can be run more efficiently, with the savings passed on to the people buying coverage.

Millions of dollars in federal grants to pay for state exchanges are available until mid-November. With that deadline looming, it makes sense to act.

A complicating factor in Pennsylvania may be that given Gov. Corbett's long-standing reluctance to enact key Obamacare provisions, his administration will simply stand pat. But that would leave hundreds of thousands of Pennsylvanians vulnerable. It would also pass up even more federal aid on the heels of the funding lost due to Corbett's costly yearlong delay in expanding health coverage for the working poor under Medicaid.

The administration should recognize that a state-run exchange would be good medicine for Pennsylvania and much of the nation.