The Supreme Court announced it would hear King v. Burwell. In short this case is a challenge to the ACA, protesting the subsidies granted to people buying policies through a federally managed exchange. Those people live in the 36 states that didn't create their own exchange, states that did set up an exchange wouldn't be impacted.
I've seen a lot of teeth gnashing about what would happen if the courts upheld this challenge. People argue that it would undo the ACA because without subsidies people wouldn't be able to afford policies, and the resulting adverse selection would kill the market. I think those arguments are entirely correct. I also think that's not something worth spending a lot of time worrying about.
If the challenge is upheld, states have an obvious and easy remedy. They can create an exchange. It doesn't need to be a big complicated web site, it just needs to meet whatever certification threshold the feds set. And so long as the President is a Democrat that threshold will likely be low.
States may opt not to do this, they might prefer having more uninsureds and less access to health care. That sucks if you live in such a state, but I don't feel sorry for you. Collectively, the people in your state empowered asshole Republicans to run it. That has consequences, and those consequences aren't any secret. An earlier Supreme Court ruling (by Republicans) gave states the right to turn away free money and keep a large segment of their adult population uninsured. About half the states, overwhelmingly red ones, took the court up on the offer. So it's known that Republicans would rather shit on a poor family than help them. Republicans who reject exchange subsidies are merely extending that treatment to the middle class.
That sucks for people on the receiving end, but it sucks no worse than for the low income population. Why should the middle class be treated better? Why is it a bigger problem that people with incomes between 1.33 and 4 times federal poverty level can't get insurance than people with lower income? Is cancer worse if you make 40 grand a year instead of 15? Does heart disease care what's in your wallet?
I just don't see it. King v. Burwell isn't a problem for the ACA, it's a problem for the people living under Republican governance. Sorry, but you shouldn't order a turd sandwich if you don't want to eat one.