"The terms ‘adequate’ and ‘affordable’ are very much subject to interpretation," Epstein said. "What is adequate and affordable for one person may not be for another.  And it almost certainly doesn’t mean that those with pre-existing conditions have to be charged the same as those without."

If states fell short, Epstein said Washington regulators could try to hold their feet to the fire and press them to do better with their federal money, but "we can anticipate a whole lot of litigation." And even a win for Washington might not mean much in practice.

"Folks who are sick and need health insurance coverage now don’t have the luxury of time to let these legal debates play out," Epstein said.

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