The effect of the Supreme Court ruling was to point out to many people that Medicaid (the program established to provide some payment for care for poor people  as a part of the Great Society Movement in the 1960s) never achieved greatness. This was in part because unlike Medicare (the program established to provide care for ALL people over 65 at the same time), the states were required to provide some matching funding, and some states are more interested in helping their poor than others. The states were given a Chinese menu style option to choose from and Alabama (like the other former confederate states) choose the diet vegetable option at every turn. The Affordable Care Act now ALLOWS (as opposed to requires, thank you Justice Roberts) states to select the prix fixe option and cover ALL people who make 133% of poverty (under $15,000) and below and are ineligible for insurance through their place of employment, with the federal government picking up most of the bill. From my personal experience, as well as the literature that reports on the behaviors of poor, sick people, these folks are unable to afford insurance and yet get sick anyway. Someone (the city, county, well-meaning rich people) is paying the bill anyway.

So, Alabama, Kaiser Family Foundation reports if you elect the pay-one-price option from the menu you (the state) can cover an additional 351 THOUSAND of your citizens, two-thirds of whom previously had no access to organized health care, and your increased cost will be an additional 3.6%. Perhaps you can just tip less.