For 20 years, I was afraid.  Afraid of get­ting sick and not hav­ing health insur­ance.  But when I got can­cer, I final­ly had a health plan that I could afford.  With­out it, I wouldn’t be here…I’ll always remem­ber how afford­able health care saved my life.  I believe every­one deserves the same chance I had.  Don’t you?  Julie, the pro­tag­o­nist of a recent ad pro­mot­ing Obamacare

The Supreme Court next month will issue a rul­ing that could result in Julie los­ing the health insur­ance cov­er­age she feels she deserves.

At issue is whether the IRS act­ed unlaw­ful­ly in extend­ing tens of bil­lions of dol­lars in sub­si­dies to an esti­mat­ed 7.5 mil­lion Amer­i­cans and in col­lect­ing bil­lions in tax penal­ties from mil­lions of unin­sured peo­ple.  The law cre­at­ing Oba­macare autho­rizes these sub­si­dies and penal­ties only in states that have estab­lished their own health insur­ance exchanges.  Julie lives in Ten­nessee, one of 34 states that have not done so.  She obtained cov­er­age through an exchange estab­lished by HHS, not by her state.

A deci­sion that strikes down sub­si­dies in those 34 states would con­front Repub­li­cans with a crit­i­cal moment.  It would, on the one hand, deal a crip­pling blow to the Admin­is­tra­tion and its star-crossed law.  On the oth­er, Repub­li­can Gov­er­nors and Mem­bers of Con­gress would face some very stark choic­es on what to do about Julie and mil­lions like her.

The Pres­i­dent will demand a do-over.  He signed a defec­tive law and has admin­is­tered it law­less­ly and with breath­tak­ing incom­pe­tence. But don’t expect an apol­o­gy.  Instead, he will rail against the Court for call­ing out his ille­gal impro­vi­sa­tions and insist that Con­gress rewrite the law to retroac­tive­ly legit­imize his ille­git­i­mate actions.

Con­gres­sion­al Repub­li­cans are not inclined to go along.  Most will like­ly favor pro­vid­ing some sort of tran­si­tion­al assis­tance to Julie, though the form this tran­si­tion takes and where the tran­si­tion should lead remains the sub­ject of ongo­ing dis­cus­sion.

Some con­ser­v­a­tives can be expect­ed to resist pro­vid­ing even tran­si­tion­al relief.  They argue that restor­ing sub­si­dies in those 34 states also would rein­state the employ­er man­date and the tax on the unin­sured, pro­vi­sions they find espe­cial­ly odi­ous.  If the Supreme Court has effec­tive­ly repealed Oba­macare in most states, why should Con­gress un-repeal it?

Julie pro­vides a poignant answer.  She did noth­ing unlaw­ful when she enrolled in sub­si­dized cov­er­age the Admin­is­tra­tion unlaw­ful­ly pro­vid­ed.  She relied in good faith on her government’s men­da­cious promis­es, promis­es the Supreme Court might force the Admin­is­tra­tion to break.  She and mil­lions like her would be vic­tims of Obamacare’s shod­dy draft­ing and ham-hand­ed imple­men­ta­tion.  Sure­ly, Con­gress should grant her relief.

And yet there is some­thing that ran­kles about Julie’s sto­ry.  It’s unclear why she chose to “be afraid” for 20 years rather than buy health insur­ance.  It may be that she and her hus­band have had an incred­i­ble run of bad luck – unable to hold steady employ­ment, per­haps, or refused cov­er­age by health insur­ers.  Still, 20 years is an awful­ly long time to go with­out health insur­ance, espe­cial­ly when var­i­ous gov­ern­ment sur­veys show that spells of unin­sur­ance typ­i­cal­ly last less than a year.

Regard­less of whether her lack of insur­ance was due to mis­for­tune, bad choic­es or a bit of both, she has health cov­er­age now.  That por­tion of her sto­ry is gen­uine­ly uplift­ing and her courage to sur­vive can­cer and share her strug­gle with the world should inspire oth­ers who are bat­tling life-threat­en­ing ill­ness­es. Insur­ance paid for her can­cer treat­ment, which evi­dent­ly put the dis­ease into remis­sion.  Oba­macare “saved her life.”

Well, sort of.  It is far more accu­rate to say that her fel­low cit­i­zens saved her life.  How­ev­er it came about, Julie is a free rid­er.  While the rest of us paid our health insur­ance pre­mi­ums whether or not we required med­ical care, Julie didn’t pay a dime for two decades.  She enrolled when she was sick and even then paid pre­mi­ums that didn’t begin to cov­er the costs of her treat­ment, costs she dumped on oth­ers.  The pre­mi­ums she pays for insur­ance in the future will not off­set the risks she impos­es, forc­ing oth­ers in her insur­ance pool to pay an unfair­ly high rate so that she can pay an unfair­ly low one.  And if she and her husband’s earn­ings qual­i­fy her for assis­tance, her fel­low Amer­i­cans will pay at least a por­tion – and per­haps the lion’s share – of her pre­mi­ums for her.

Julie may not have con­sid­ered that oth­er peo­ple are pay­ing her way.  If she did, she might feel a mix­ture of grat­i­tude and embar­rass­ment – grat­i­tude for hav­ing been giv­en life-sav­ing treat­ment worth hun­dreds of thou­sands of dol­lars at oth­er people’s expense and embar­rass­ment for hav­ing gone 20 years with­out pay­ing pre­mi­ums that would have helped finance treat­ment for others.

Per­haps she does.  The ad, how­ev­er, con­veys none of this. It might more prop­er­ly have been a mea cul­pa: “I am deeply grate­ful to you for sub­si­diz­ing my insur­ance pre­mi­ums now that I am run­ning up med­ical bills that far exceed those pre­mi­ums.  You have been very good to me, and though I’m a bit ashamed of tak­ing advan­tage of you, I will con­tin­ue to do so.  Thank you!”

But the ad sounds no note of grat­i­tude, much less shame. Julie is por­trayed as believ­ing that she “deserves” to have oth­er peo­ple pay for her treat­ment.  “Every­one” deserves that, she says. But, of course, “every­one” can’t shift their costs to some­one else. Some­one gets stuck with them.

The thought that Julie’s enti­tle­ment comes at oth­er people’s expense seems for­eign to the peo­ple who script­ed the ad.  It has become an under­ly­ing assump­tion of our pol­i­tics that peo­ple who make bad life deci­sions deserve to have oth­er peo­ple bear the cost of mit­i­gat­ing the con­se­quences of those decisions.

You can nev­er­the­less count me among those who believe the gov­ern­ment should pro­vide tran­si­tion­al assis­tance to Julie – not because she deserves it, but because she shouldn’t be penal­ized for her detri­men­tal reliance on an unre­li­able gov­ern­ment. That tran­si­tion should lead away from the ill-con­ceived and bun­gled fed­er­al reg­u­la­to­ry tan­gle known as Oba­macare and toward a sys­tem designed and run by the states.

Wash­ing­ton has made a hash of health care.  But that does­n’t mean that gov­ern­ment should aban­don the project of reform­ing our med­ical sys­tem.  Those reforms are best car­ried out by the states.  The fed­er­al gov­ern­ment should pro­vide states the resources and the oppor­tu­ni­ty to replace Oba­macare with some­thing bet­ter, some­thing that is fair both to Julie and to those who are pay­ing her med­ical bills.

We deserve that.