JAMA Forum: After Supreme Court Ruling on the Health Care Law,
Focus Turns to the States … and November  Larry Levitt, MPP
Larry Levitt, MPP  In an effort undoubtedly designed to confound
all prognosticators, the Supreme Court today issued a surprising
decision on the Affordable Care Act (ACA).  A majority of the
justices ruled that the ACA can go forward, including the
controversial mandate that most people obtain insurance or pay a
penalty starting in 2014. This involved some complicated legal
reasoning around whether the mandate was being imposed under the
federal government’s power to regulate interstate commerce or
its power to tax, but the practical effect remains the same.
The justices also upheld the ACA’s expansion of Medicaid, a key
component of the law that is expected to insure up to 17 million
low-income Americans who are now uninsured. But in their most
surprising move, the justices ruled that the federal government
cannot withhold all Medicaid funds to states that refuse to
implement the expa