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As the Supreme Court prepares to hear oral arguments in its landmark case, King v. Burwell, it appears that the health insurance exchanges created under the Affordable Care Act that President Obama promised to expand and strengthen have been largely frozen in place through November. In fact, according to a study conducted by the nonpartisan Kaiser Family Foundation, enrollment in the markets are the same or close to the same as they were prior to the passage of the ACA in 2010. Even as premiums have skyrocketed and millions of consumers have been struggling financially, many in the health care industry have focused almost entirely on the coverage that remains after subsidies expire: the insurance that remains free or subsidized for those making less than 138 percent of the federal poverty level. The Kaiser researchers examined data from the insurance marketplaces as of January 1 of this year and found that among the 30 percent of those who could not receive a subsidy—or had signed up on any of the exchanges, rather than through the federal government—that number was slightly lower than the 27.9 percent of those who qualified for the premium subsidies that were in effect before the ACA, with 18.2 percent of all individuals not receiving any subsidies at all.

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The result is an unbalanced portrait of the marketplace, one that the industry claims is the result of the government not helping people or not offering them the health coverage they need. But while the government has played a central role in the health insurance status quo through the ACA, as a 2010 law, the law’s effects will depend not only on the law’s effectiveness as it relates to the health insurance markets, but also on whether it is still in effect as the courts consider the question of how much of the law should be upheld.

That balance is not what President Obama and the Congressional Democrats were hoping for when they drafted the ACA in 2010. While the law was billed as a bipartisan effort to improve the health-care system and reduce costs, many on the left believed it would be easy to cut subsidies for people making less than $46,000 and even more difficult on those making much more than that, particularly as the law would still allow those at an income that is not enough to qualify. This is a fair assessment, as many individual market insurance policies are quite pricey and many people cannot afford to purchase insurance, thus making a subsidy a necessary and welcome

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