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Millions of Americans could lose Obamacare subsidies under a Supreme Court ruling this month, but many in the GOP don’t need their votes anyway.

That’s a major political calculus for Tea Party Republicans, who are likely to resist any efforts to extend the subsidies, even temporarily. They’re much more worried about angering their base by appearing to concede to Obamacare than whether a handful of constituents lose their subsidies.

Relying on any system to continue requires that such a system is sustainable. If it is not,
then, as the late economist Herb Stein has said, “it will stop.” In stopping, however, such a
system will impact those who rely on it and assume that it will continue.

The American Action Forum recently assessed the plausible effects of a ruling for the plaintiff in the Supreme Court case, King v Burwell, concerning the legality of subsidies in the federally-run health insurance exchanges implemented under the Affordable Care Act. At the time of writing, the most up-to-date number for enrollees at risk of losing a health insurance subsidy was 7.7 million. But this week, the Center for Medicaid and Medicare Services released an update to enrollment figure that counts effectuated enrollment, which includes only households that have paid an insurance premium. As generally expected, roughly 15 percent of individuals with “plan selections” did not pay a premium and become actually enrolled. In light of this most recent update, roughly 6.6 million individuals across 37 states are at risk of losing their subsidies.

If the Supreme Court later this month strikes down Obamacare subsidies in states with federal insurance exchanges, the narrative is simple: The health care law could be fatally crippled and marketplaces will fall into 34 simultaneous death spirals.

But what if Obamacare’s conservative challengers lose King v. Burwell?

If that question seems less sexy in a policy sense, that’s because it is. Essentially, if the Court decides the federal government is on the right side of the law, nothing happens; business continues as usual in all 50 states’ Obamacare exchanges. People keep their insurance as is.

But politically, an Obama administration win would mean volumes.

Just a few years ago, lawmakers in this left-leaning state viewed President Obama’s Affordable Care Act as little more than a pit stop on the road to a far more ambitious goal: single-payer, universal health care for all residents.

Then things unraveled. The online insurance marketplace that Vermont built to enroll people in private coverage under the law had extensive technical failures.

Washington has made a hash of health care. But that doesn’t mean that government should abandon the project of reforming our medical system. Those reforms are best carried out by the states. The federal government should provide states the resources and the opportunity to replace Obamacare with something better, something that is fair both to Julie and to those who are paying her medical bills.

The Supreme Court’s King v. Burwell ruling will make headlines whenever it arrives. It will also be genuine news to much of the country. The Kaiser Family Foundation’s Health Policy News Index, which tracks how closely the public follows health stories in the news, found that 59% of Americans have not been paying much or any attention to news stories about the case, and only 16% have been following very closely. That means that when the verdict comes the media’s first job will be to explain what the case was about.

The health law was designed to cover the poorest people by expanding Medicaid, the federal-state program for low-income people. But the Supreme Court made that optional. The result in states that didn’t expand Medicaid is a gap, where some people make too much money to qualify for Medicaid but not enough to qualify for insurance subsidies.

The Affordable Care Act is once again before the Supreme Court. This time it’s not about whether the government can force you to have health insurance or pay a penalty. It can. That is so “2012.”

Now, in the case of King v. Burwell, the meaning of six words in a thousand-page law is under scrutiny. Those words could determine whether millions of Americans can afford to buy health insurance.

After a passionate debate, the Florida Senate passed a bill Wednesday that would let a half million people use billions in federal dollars to buy health insurance, and added new measures to address criticism from the House, chiefly that the program would end in three years.

A majority of Republicans supported the controversial health care bill. Earlier this week, a state economist said the plan would save the state money. A top state health official warned it was unclear whether more or less people would gain coverage under the bill.