JAMA Network October 14, 2021
The Affordable Care Act (ACA) envisioned a seamless system of health coverage. All people who are poor and near poor would be covered by Medicaid, and those with incomes above that who do not have access to employer-provided health benefits could buy private insurance in the ACA marketplace with subsidies to help make it more affordable.
The Supreme Court had other ideas.
In the 2012 decision that upheld the constitutionality of the requirement to get insured or pay a tax penalty—which has since been repealed—the court threw a curveball (or, maybe more aptly, a knuckleball) on Medicaid. It ruled that states could not be required to expand Medicaid to everyone with incomes up to 138% of the poverty level (currently...
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