On top of these concerns, this week a new one was added. Patients who can only afford the lofty Obamacare premiums through help with a federal subsidy (according to Health and Human Services, nearly 90% of people who signed up this year qualified for a subsidy, which on average pays three quarters of their premiums) may now be in big trouble. In 36 states where the insurance exchanges are run by the federal government, it would appear that subsidies would not be allowed by the law which authorizes them only in "an Exchange established by the State."