Recently, Maryland lawmakers created the State’s first health insurance exchange as a State nonprofit, reacting to a U.S. Department of Health and Human Services mandate. Lawsuits filed in federal district courts resulting from HHS’s requirement will eventually find their way to the U.S. Supreme Court, which will rule on the requirement’s constitutionality.

“States really have to tell the feds what they’re going to do in some detail by the end of next year,” said Ballard Spahr partner Brian M. Pinheiro. “They really need to be up to speed in a really tight turnaround time, and that’s against the background of the court cases. If the individual mandate is not constitutional, that’s going to unravel some pieces of this.”