World Blog by humble servant. Johnnie Ellington II February 5, 2015 · Nonetheless, only 14 states and the District of Columbia established state-based exchanges and even some of those (Oregon and Nevada) are backing out for 2015. In the remainder of states with exchanges, the federal government, not the state governments, established the exchanges. These tax subsidies for low-income Americans are only available, through an Exchange established by a State under section 1311 of Obamacare. Federal exchanges are set up under Section 1321 of Obamacare – not Section 1311. Hence, the administration still wants to provide subsidies, even though the law doesn’t appear to authorize the handout. And there lies the problem to be decided by the Supreme Court. You would figure with a 7ft high bill, they would have got at least that correct. American healthcare has been morphing from a function of a humanitarian society into a revenue stream for healthcare profits. Drug, medical device companies, hospitals, and insurance companies, are all in the business for profits and they all supported Obamacare because their profits would rise – not fall. Then there is the legal profession that controls Congress. There is no prayer in hell of lawyers instituting caps on tort claims that drive insurance rates even higher. Doctors will often order tests they do not feel they need just to cover their ass against the lawyers. In effect. we have transformed healthcare in the U.S. into an industry whose goal is to be profitable not some humanitarian pursuit as the Democrats claim. We have to call a spade a spade and stop pretending this is about caring for anyone. Obamacare was upheld by the Supreme Court as a tax, not as a social program.