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My Little Golden Book of the ACA Supreme Court Decision

The Affordable Care Act--ObamaCare--deals with the fact that America's seniors are relatively happy with their health care insurance, Medicare, by leaving it and them alone.

It deals with the fact that a great many of America's poor have no health insurance, and so get only half of standard medical care, by requiring that states expand the Medicaid program--with the federal government paying for the expansion--if they want to receive any federal Medicaid funding at all.

It deals with the fact that health insurance is broken for middle-class Americans who do not work for large bureaucracies--and thus they cannot obtain fairly-priced health insurance, and so also get only half of standard medical care--in three steps:

  1. Creating, in each state, a "health exchange", a benefits department for those who do not already have a large bureaucracy's benefits department to negotiate for them.

  2. Requiring that health insurers charge each member of a health exchange the same price for a policy

  3. Mandating that every individual buy health insurance, so the health exchanges do not get gained by those who say that I will save money now and only buy insurance when I get sick.

Last Thursday the Supreme Court considered and decided two questions about the Affordable Care Act:

  1. Is the mandate that individuals buy health insurance a command that Congress can issue under its general power to regulate interstate commerce, or is it an illegitimate grab by Congress for power that it does not have?

  2. Is the federal requirement that states expand Medicaid if they want to get any federal Medicaid dollars at all a legitimate use of the federal government spending, or is it an unallowable coercivity infringement on state sovereignty?

Four Democratic justices answered (i) that the individual mandate is a legitimate use of commerce clause power, and (ii) that the requirement to expand Medicaid is not unduly coercive.

Four Republican justices answered (i) that the individual mandate is not a legitimate use of commerce-clause power, and *(ii) that the requirement to expand Medicaid is unduly coercive.

This left the decision up to Republican-appointed Chief Justice John Roberts.

And this is where things get very tricky very quickly:

Chief Justice Roberts agreed with the Republicans that the individual mandate is not legitimate under the commerce clause. But he then pulled a fast one, and said that the individual mandate is legitimate use of the federal government's power to tax.

Chief Justice Roberts agreed with the Republicans that the requirement that states expand Medicaid if they want any federal government Medicaid funding at all was unduly coercive. But he then pulled another fast one, and said that the cure was not to declare the entire Medicaid expansion part of the Affordable Care Act unconstitutional, but rather for the Supreme Court to rewrite the Medicaid expansion to say that a state that does not expand Medicaid loses not all of its federal Medicaid funding but just the extra funding to pay for the expansion.

Republicans are livid. Some are calling Chief Justice Roberts "Dishonest John". Republicans are especially exercised because he added his two additional wrinkles, allowability under the taxing power and rewriting the Medicaid title, at the last minute--after two months during which our Four Republican Horsemen thought that Roberts was firmly on their side.

Democrats are praising Roberts as a judicial statesman, and a fine Chief Justice.

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