The Supreme Court could trigger an ObamaCare death spiral

But to balance out all the sick people that those provisions help, the law creates inducements for healthy customers to buy insurance. The biggest one is the tax credits that are available on a sliding scale to middle-income Americans. And there’s the individual mandate: Anyone who can afford insurance and doesn’t sign up will face a tax penalty. Taken together, those provisions help people with limited means afford insurance premiums, and they serve to discourage people from waiting until they’re already sick to buy insurance.

Upset that balance, and the policy structure will become broken.

If the Supreme Court rules that the tax credits can only be awarded in certain states, insurance will become immediately unaffordable for many people getting the subsidies. About 87 percent of people in the affected states qualify for some kind of subsidy, and, in some cases, the subsidy covers the entire cost of the insurance premium. The ruling will also effectively knock out the mandate, since the law says that no one can be punished for failing to have insurance if none is affordable.