A spokeswoman for Gov. Martin O'Malley says that even if the Supreme Court strikes down the federal health care mandate, Maryland might continue setting up its health benefit exchange, subject to resources approved by the General Assembly.

"We’ll have to see what happens; if the mandate is struck down, I think we're in a really good place because we've taken some really good steps," O’Malley spokeswoman Raquel Guillory said Monday.

The Supreme Court is expected to issue its ruling Thursday on President Obama’s landmark — and controversial — 2010 Patient Protection and Affordable Care Act.

Maryland already has received more than $34.4 million in federal grants to help establish its health benefit exchange, which is part of about $13.7 billion in federal funds that have gone to state and local governments, according to analysis by the Kaiser Family Foundation.

The exchanges are to create a virtual marketplace, including private insurers, where individuals and small businesses could compare and buy insurance plans.

The federal law calls for states to establish the health benefit exchanges by 2014 or participate in a federal exchange.

Even if the Supreme Court strikes down part of the law, legal experts have said it is not clear whether the federal government would try to take back money.

The Affordable Care Act already is benefiting some Marylanders, including seniors who are getting prescription drugs because of federal aid tied to the law, young adults who can continue to be insured under their parents’ health plans, and high-risk patients who otherwise would not be able to get insurance, Maryland’s Health Secretary Joshua Sharfstein has noted.

Legislation signed into Maryland law this year requires the Maryland Health Care Reform Coordinating Council to select the state’s benchmark for plans in the exchange, which must comply with state and federal laws by Sept. 30.

The new Maryland law also establishes requirements for health insurance carriers that want to participate in the exchange, and requires the establishment of “navigator” programs for small group and individual markets. The navigator programs are aimed at reaching people without health insurance and making it easy for them to determine whether they qualify for plans, and to move from one plan to another as needed.

Maryland is among 14 states and the District of Columbia that have established or are in the process of establishing exchanges.

Eighteen states are studying options; 14 states have taken no significant action; three states have decided not to set up exchanges; and Arkansas is planning a partnership exchange.

mhyslop@gazette.net