As it turns out, the scariest part of Thursday’s ruling on the Affordable Care Act was the issue that got the least attention. Yes, the Supreme Court upheld the individual mandate and its associated reforms of private insurance. But it also ruled that the law’s expansion of Medicaid was unconstitutional. Does that mean the Medicaid expansion might not go forward? Does it mean that a significant number of low-income Americans will remain uninsured because they can't get into the program? In the long run, probably not.
The hearings are over, finally. The afternoon argument, over the Affordable Care Act's expansion of Medicaid, was as contentious as the rest -- with the justices giving both the government and the states challenging the law extra time to make their arguments. This time, the liberals wasted no time in pressing Paul Clement, attorney for the 26 states, about his assertion that the law's expansion of Medicaid for the states was coercive.
My first impression from day two at the Supreme Court: I was more confident yesterday than I am today. With the caveat that I know health policy a lot better than I know law, I can still imagine the justices upholding the individual mandate. But, at this point, I can just as easily imagine them striking it down. Tuesday's hearing was energized and contentious, from start to finish. But while the justices hammered lawyers from both sides with difficult questions, Solicitor General Don Verrilli seemed to struggle more than Paul Clement, attorney for the states.