OBAMACARE LARGELY UPHELD

The Supreme Court largely upheld the Affordable Care Act, the most important legislation since the Civil Rights Act of 1964. The individual mandate is now ruled to be a tax and is constitutional.

Frankly, I would have preferred a single payer provision over the individual mandate, but compromises had to be made to pass the legislation.

It was a surprise to me that Chief Justice John Roberts cast the deciding vote for Obamacare rather than Associate Justice Anthony Kennedy; however, some pundits before the decision had suggested that Roberts might vote for the Act. I'm rather surprised that Kennedy didn't go along.

The part of Obamacare ruled unconstitutional by a 7 to 2 vote was a provision on the expansion of Medicaid where, if state voted to not participate in the expansion, they would lose all or part of the regular Federal contribution to Medicaid which was judged to be coercive. In the first few years, the Federal government will cover all the cost of the Medicaid expansion, but the Federal governments contribution will eventually drop to 90% leaving states to pick up the remaining 10%. This could cost a state like Texas to pick up $500 million/year by 2019. http://www.guardian.co.uk/world/2012/jun/29/supreme-court-medicaid-expansion-states?newsfeed=true. If states opt out of the expanded Medicaid, this will add thousands to millions of poor people to the uninsured role and make them use the emergency room for their primary care, as is the situation now, adding costs to the insurance bills of those who have health insurance thus defeating an important part of Obamacare.

Roberts' ruling makes up a bit, perhaps, for the worst ruling the Supreme Court has ever made that corporations are people, the Citizens United decision, which they not only ruled constitutionally initially but reaffirmed recently. Maintaining this ruling perhaps led Roberts to his vote on Obamacare to preserve the reputation of the Court.