On June 28, supporters of the Affordable Care Act rightly celebrated its affirmation by the U.S. Supreme Court. By the slimmest of margins, the high court upheld the individual mandate as a valid exercise of Congress’ constitutional taxing authority, permitting health reform to go forward. For millions of Americans, the importance of that decision cannot be overstated.
Still, after the celebration ceases, the act’s supporters may discover that both the Affordable Care Act and the federal government are now far weaker than they once were. While most of the attention has been on the individual mandate, the more surprising part of the Court’s decision was its ruling about Medicaid. Under the ACA, states were required in 2014 to expand their Medicaid programs to include all citizens with incomes under 133 percent of the federal poverty level. This expansion was estimated to cover approximately 16 million Americans, or about half of those who would have become insured under the ACA.
