Next month, the Supreme Court will decide whether Obamacare enrollees in states that did not set up their own exchanges will continue to have access to federal subsidies.
If the Court rules against the administration in the high-stakes case of King v. Burwell, an estimated 9.8 million could become uninsured in states that rely on the federal exchange, Healthcare.gov, says a new study from the Urban Institute and the Robert Wood Johnson Foundation (RWJF).
The report estimates that in the event of such a ruling, the 20 states that did not set up their own exchange or expand their Medicaid programs under the Affordable Care Act would lose an estimated $721 billion in federal funding over the next decade.
Under the ACA, the federal government funds state Medicaid expansion fully for three years, then at 90 percent thereafter. When the law was originally passed, all states were mandated to expand their Medicaid programs.
However, a 2012 Supreme Court ruling gave states the right to opt out of the expansion. Twenty-one states have decided not to expand their programs, with many of their state lawmakers citing cost issues as the number one reason for not expanding.