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The Supreme Court ruled that the individual mandate is constitutional due to Congress’s power to tax. The Court did, however, make the Medicaid expansion a choice for states. To date, only about half of the states have chosen to expand Medicaid. In states that have not expanded Medicaid, many low-income residents are stuck without affordable coverage options.
More recently, in June of 2015, the Supreme Court once again ruled on the constitutionality of the Affordable Care Act. This time, the Court focused on just one sentence of the law. Those who filed the lawsuit believed that a literal reading of the law suggested that the federal government did not have the authority to offer subsidies through federally-operated exchanges. While New York uses a state-operated exchange and would not be spared from potential negative consequences, consumers in states with federal exchanges could have lost access to financial assistance if the Court ruled in favor of those who filed the suit.