Maximum Governmental Uncertainty!
Affordable Care Act Medicaid Expansion Has Been Turned into a State's Option Expansion

Oyez! Oyez! Oyez!: Next Steps for Health Care Reform Implementation

In the wake of the surprising Supreme Court decision Thursday morning on the constitutionality of the Affordable Care Act, the natural question is: what next for health-care reform?

One piece of background is all-important.

ObamaCare is RomneyCare.

The health-care reform plan that Mitt Romney proposed when he was Governor of Massachusetts and shepherded through the Massachusetts legislature with, as he used to boast, only two dissenting votes is the health-care reform plan that Barack Obama proposed in the first year that he was President of the United States and shepherded through the U.S. Congress with not a single Republican vote in favor. No Republican made audible complaint that RomneyCare was bad policy, or would destroy the economy, or whatnot--as long as it was the signature policy initiative of a Republican governor. When the same policy became the signature policy initiative of a Democratic president, however, every single Republican in office changed their minds.

For the most part, they claimed that they had not changed their minds. They said that when a state government required that people who are likely to wind up in the hospital at some point in their lives by insurance so that the cost of treating them would not fall on other patients or taxpayers, that was Good Small Government, an assertion of the Conservative Principle of personal responsibility people needed to accept responsibility for the consequences of their actions. but, they said, when a federal government requires that people who are likely to wind up in the hospital at some point in their lives by insurance so that the cost of treating them would not fall on other patients or taxpayers, that is Bad Big Government, an assertion of the liberal Nanny State principle that people needed for the government to boss them around, and unconstitutional.

Go figure.

Well, now the Supreme Court has settled the "unconstitutional" part.

Now it is time for all Republican officeholders to say that although the Supreme Court is not infallible, it is final, and that they will turn all their energies to making the implementation of what was President Romney's signature initiative when he proposed and implemented it as Governor of Massachusetts and will be President Romney's signature initiative when he implements it as President of the United States into a smashing and total success.


We will soon see if God Himself can save this not-very-honorable court...

Apparently yes: the individual mandate is a tax, and so survives...

Tom: The bottom line: the entire ACA is upheld, with the exception that the federal government's power to terminate states' Medicaid funds is narrowly read.

What does "narrowly read" mean in this context?

Lyle: The key comment on salvaging the Medicaid expansion is this (from Roberts):

Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding. (p. 55)

Indeed:

Lyle: To readers of the Roberts opinion, a caution: It is the opinion of the Court through the top of p. 44; the balance is labeled as, and is, Roberts speaking for himself.


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