David Dayen has Obamacare / ACA summarized in a sentence. He’s been doing excellent work on the implications of the Supremes’ decision to sort of uphold it when individuals have to pay, but to let states opt out at will.
About that last, he’s pointed out repeatedly that there really is no reason to assume all states will go along with the Medicaid expansion because it’s free federal money. The career Democrats’ are taking it for granted that hospital lobbyists will twist Republican governors’ arms to take the cash already. But the hospital lobbyists “don’t sound confident about their magical powers of persuasion”
States can also opt out of the federally administered medical insurance exchanges and force their defunding. That would leave millions of very poor people without even the access to Medicaid that they have now and no access to the new subsidized-and-expensive insurance exchanges.[Update, Jul 7: the Urban Institute has a pdf with more detail.] Democrats don’t seem to expect much voter pressure about these issues. Again, “like the Medicaid expansion, Democrats are hoping that the industry will force these governors to comply, or force the appropriations through at the federal level.”
The crumbs that reach actual people from Obamacare are good, but they are crumbs. People aren’t going to get excited about crumbs. What’s interesting is that the Democrats know perfectly well who’s getting the loaf and who might actually push.
This persistent hope on the efforts of industry to force compliance actually tells us quite a bit about the Affordable Care Act itself.