health insurance exchange

As the Supreme Court edges closer to issuing an opinion that could deal a blow to the federal health exchange operating in more than 30 states, Democrats have sounded a warning to their colleagues on the other side: Be careful what you wish for.

It will be up to state officials and Congress to help consumers who can't afford health insurance if the Supreme Court strikes down health law subsidies for millions of Americans, Health and Human Services Secretary Sylvia Burwell.

"The critical decisions will sit with the Congress and states and governors to determine if those subsidies are available," Burwell told the House Ways and Means Committee on Wednesday.

The politics of the Affordable Care Act in the state of Louisiana aren't subtle: The law isn't popular.

The state was part of the lawsuit to strike down Obamacare in 2012; it didn't expand Medicaid and has no plans to. Louisiana also didn't set up its own marketplace to sell health insurance.

The Affordable Care Act requires all Americans to get health insurance or pay a penalty. To help coax people to buy a health plan, the federal government now subsidizes premiums for millions of Americans.

The Supreme Court heard arguments Wednesday in a case that could end Obamacare subsidies for policyholders in a majority of states, including Texas, Florida, Illinois, Pennsylvania and Ohio. If the court sides with the plaintiffs, it would mean millions of people could no longer afford health insurance.