If the Supreme Court rules against the government in King v. Burwell, an additional 5.6 million people could lose health coverage in the 20 states that have a federally-facilitated health insurance marketplace and have not expanded Medicaid, according to a new report by the Urban Institute and Robert Wood Johnson Foundation. That’s on top of 4.2 million residents who will be uninsured in 2016 because these states have opted not to expand Medicaid eligibility under the Affordable Care Act, the report estimates. Unless Medicaid was expanded and the marketplace assistance replaced, these states also would forgo an estimated $721 billion in federal spending over the next 10 years, the report adds. “States that have not expanded Medicaid have the most to lose in the King v. Burwell decision if they are not already running their own marketplaces, because people with incomes between 100% and 138% of the [Federal Poverty Level] would not get any assistance in affording health care,” the report states. “The adverse effects of both not expanding Medicaid and losing access to financial assistance for marketplace coverage would affect state residents, health care providers, insurers and state governments.” For more on the impact of these and other health coverage issues, visit www.aha.org/coveragematters.