Legal challenges are giving states and their governors more power to run healthcare insurance coverage programs, an unintended result of the ACA, reports the National Journal.
In 2012, the Supreme Court ruled that states can decide whether they will chose to expand Medicaid. Last month, in Halbig v. Sebelius, two appeals courts reached conflicting decisions about Affordable Care Act subsidies, and whether consumers purchasing plans on the federal exchange can get financial assistance.
If the subsidies case makes its way to the Supreme Court and is upheld, striking down financial assistance in more than half of the states, millions of low-income Americans might not be able to afford coverage.
What's more, governors in states on the federal exchange must then decide to either switch to a state-run exchange and keep the subsidies, or stick with the feds and risk allowing their residents to lose their insurance, notes the National Journal.
The Halbig ruling, if it stands, could cause an estimated 7.3 million people to miss out on $36.1 billion in subsidies, according to a recent report from the Urban Institute, notes the article.
"There's a question of whether the individual market would be stable in states without subsidies," Larry Levitt, a senior vice president at the Kaiser Family Foundation, told the National Journal.