The recent Supreme Court ruling means another year of Affordable Care Act (ACA) uncertainty for health insurers, but if they take decisive action, that time could be a golden opportunity. Timely strategic investments in Managed Medicaid membership growth will ensure that health insurers avoid an expensive entrance into an oversaturated market and lock in a growing revenue stream now. Emerging technologies like analytics and virtual care will help health insurers better manage the US’s high-risk population and build stronger profit margins in the Medicaid market. There’s a favorable risk-reward profile for health insurers that double down on Managed Medicaid while the ACA awaits its fate.