The health care reform law was supposed to extend insurance to 32 million more Americans by 2019, but after the Supreme Court’s ruling it’ll be closer to 21 million, 16 million by a more conservative estimate. The Court decided that the Medicaid expansion provision of the law must be optional for the states, not mandatory as originally outlined. Those with incomes from 100%-400% of the federal poverty level (the poverty level is now $23,050 for a family of four) could qualify for sliding-scale subsidies to buy insurance on health exchanges. Subsidies are not available to those below 100% of the poverty level because it was assumed they would get Medicaid. It is now up to each state to decide to accept the government’s funds and expand Medicaid.