Based on quickly looking at the main opinion and dissenting opinion summaries by Chief Justice Roberts and (I think) Justice Kennedy, the Supreme Court's strategy is brilliant... in terms of seemingly keeping SCOTUS out of politics, in terms of upholding states rights, and in terms of gutting PPACA without appearing to (which is my guess, before I read it, why Justice Ginsberg concurred with a dissenting opinion).
First, Congress CAN order people to buy broccoli as long as it taxes them when they don't.
And as long as there is no onerous enforcement of the tax.
- Now lawyers can debate that idea forever and SCOTUS can quietly start to pull in Commerce Clause expansion.
- Politically the Democrats will have to defend this “you can tax not buying things” finding ad nauseum in upcoming elections, being asked time and time again... what will you lefties tax me for next for not doing?
- As that finding applies to PPACA (as opposed to broccoli), Roberts probably looked at Massachusetts' RomneyCare results and realized the individual mandate was much ado about nothing.
- About half of one percent of the population in Massachusetts pays the Massachusetts tax penalty.
- About the same amount (40,000 people plus or minus) buys health insurance that they otherwise wouldn't have bought because they are mandated to (that's a SWAG).
- Neither activity affects the Massachusetts health care insurance market to any great degree (to Romney’s chagrin, it turned out there were basically no free loaders).
- On the other hand about 20% of Massachusetts' population gets free insurance or highly subsidized insurance through Medicaid, about 20% are on Medicare, and the other about 55%-59% get insurance from an employer.
Why go to the mat over 1% of the population? Especially when you can use the opinion to finally fix the expanding Commerce Clause problem.
But, second, while the individual mandate was always much ado about nothing, the Court’s 6/28 Medicaid ruling in favor of the states (which I think roughly translates to "you can't force states that don't want to to expand their Medicaid rolls") totally guts PPACA.
- In Massachusetts under RomneyCare, all the newly enrolled 400,000 residents are getting Medicaid (or expanded Medicaid under three different waivers).
- States that don't want to accept -- and match -- new funding to expand their Medicaid rolls the way Massachusetts did can basically kiss off PPACA.
- Those states that go the other way will increasingly go bankrupt (or as in the case of Massachusetts, which has a forced balanced budget, will spend all its money on healthcare, screwing cops, courts and kids even more).
- In the states that increase their Medicaid rolls, more and more doctors will stop accepting Medicaid and the newly insured will be worse off than before PPACA. The already insured will see premiums skyrocket and onerous conditions added the same way as happened in Massachusetts while hospital and doctor prices rise out of sight.
- In a few years PPACA will go the way of DukakaCare without a Roberts' fingerprint anywhere on the carcass.
As for us Medicare recipients, nothing new. We were going to get higher Medicare Part C premiums whether PPACA was upheld or shot down. And the availability of hospital beds and other Part-A-related services were going to be underfunded and evenually rationed either way as well.
-- Dennis Byron