Obamacare authorizes subsidies for health insurance bought on an exchange “established by a state.” So far, 34 states have refused to establish such exchanges, and people in those states are signing up — or trying to, God bless them — for insurance and subsidies on the federal exchange.
Can people using the federal exchange get subsidies? A federal judge has refused to dismiss a case, Halbig v. Sebelius, arguing they can’t. Eventually, this will go to the Supreme Court.
If people in more than half the states can’t get subsidies, it’s going to be a disaster for them and for Obamacare.
The other disaster — and it’s already here, it’s not just a possibility — is that the statute doesn’t provide subsidies for people who qualify for Medicaid. You either get Medicaid or you pay full freight. But half the states have refused to expand Medicaid under the ACA, even though the federal government pays 100% of that expansion for three years and 90% thereafter. We’re talking about 8 million people who would qualify for expanded Medicaid not getting it. By upholding Obamacare as constitutional, but finding that states can refuse to expand Medicaid, the Supreme Court created the absurd situation where people making too much for Medicaid get subsidies, but their poorer brethren don’t. The most desperate are being denied.
When the ACA was drafted, it was just assumed that every state would expand Medicaid (since it would save states billions of dollars in paying for the uninsured) and would establish an exchange. The Dems believed that GOP governors and legislators wouldn’t cut off their noses to spite their faces. There’s a lot of red states with unattached noses.