Embedded in the premiums in Obamacare, smokers face very different tax rates depending on where they live. Although there are risk-based reasons for why smokers would face higher premiums, the rates in some states cannot be justified with economic arguments.
To the extent that individuals enroll in high deductible plans until they get sick (and then migrate to more generous plans), the efficiency gains under the current Obamacare design are likely to be small.
Some say that today’s decision maintains business as usual for Obamacare, taxpayers and consumers. The Supreme Court upheld the subsidies (also known as the Premium Tax Credit) to consumers in the 34 states that rely on the federal exchange.