Swing states' uninsured will be biggest losers if Obamacare is struck down

Patients wait in line at the Remote Area Medical clinic (Lucy Nicholson/Reuters) If the Supreme Court fulfills most analysts' expectations and strikes down the Affordable Care Act, about 22.4 million who would have gotten health insurance will stay uninsured. The states that will have the largest populations of uninsured will be in the swing states, according to new data from Avalere Health.

Florida, North Carolina, Ohio, Virginia, Pennsylvania and Michigan would each see more than 500,000 people lose access to Medicaid or subsidized private insurance.

Neither benefit is in place yet, as the bulk of the Affordable Care Act does not take effect until 2014. No one would lose coverage they already have ' rather, some would not gain coverage they were set to receive.

This, of course, depends on how much and what parts of the law are struck down (if any, but it's a pretty damned safe bet that the mandate goes). If the Court goes so far as to agree with the 26 states who have argued that even an expansion of Medicaid is unconstitutional coercion, then it's possible that current Medicaid rolls could be cut. The ACA prevents states from cutting eligibility until the reforms kick in in 2014, and those protections might not be in place after Thursday's ruling.

That's a contingency Republicans have been planning for for a couple of years now, because they want to make it worse. Rep. Paul Ryan's budget, adopted for two years running by the Republican House, and glowingly endorsed by Mitt Romney, would eviscerate Medicaid.

More uninsured people is a feature, not a bug, of the Republican plan, the plan that the Supreme Court's five conservatives seem to have adopted, too.