This Health Affairs article discusses a very interesting development from the SCOTUS ruling on Medicaid expansion.
The ACA requires those eligible for Medicaid to obtain Medicaid. They are ineligible to obtain health insurance subsidies, even if they are willing to skimp and save in order to purchase insurance rather than participate in the inferior coverage program of Medicaid. This is because the subsidies are more expensive for the federal government.
Now, if states choose not to expand Medicaid eligibility — more people will be eligible for HI subsidies –paid for 100% by the federal government, vs. Medicaid where the states have to pitch in. If states fail to set up state exchanges, it is still not clear if the federally operated exchanges can even legally provide the subsidies, although the IRS is currently acting as if they can.
Just one more mess that needs to be cleaned up.