Congress could easily amend the law to prevent these consequences. Alas, partisan gridlock makes such legislative action unlikely. A Supreme Court decision disallowing the tax credits would threaten the law’s survival.
So would the election of a Republican president in 2016, given the virtually unanimous GOP opposition to the ACA. A Republican president would almost certainly seek to scale back, repeal or dismember the ACA—either directly or by empowering each state to modify the law. Allowing each state to go its own way would violate a fundamental objective of the ACA—to assure that all Americans, wherever they live, have access to insurance on similar terms.
Thus, despite having reached the age of 5, the ACA continues to live on a precipice. Nonetheless, I think the law will survive. More than 25 million people already enjoy insurance coverage as a result of the ACA. Even more will be covered by January 2017, when the next president takes office.
All major elements of the health care system—insurers, hospitals, doctors and drug and device manufacturers—have an interest in continuation of the ACA. This alignment of forces suggests that Obamacare will survive current threats.