The Supreme Court’s decision on health care upholds state and federal powers on health care.
Now, by upholding the individual mandate as part of the power to tax, which is in Article I, Section 8 of the Constitution, the Court has spoken on behalf of this very basic federal power.
While most arguments revolved around the Commerce Clause, some had suggested the decision could go this route and that Roberts would be in the majority. But I don’t believe I saw anyone predict a 5-4 ruling on this basis with Chief Justice Roberts in the majority and Kennedy in the minority.
The decision also has a place where states rule
The Court ruled that the Medicaid expansion is constitutional, but if states decide not to expand Medicaid, they won’t lose all their Medicaid funding.
For governors like Maine’s Paul LePage who don’t want to expand Medicaid, this gives him greater ability to limit Medicaid eligibility.
However, from what I’ve read so far (and this could be wrong), states do have to set up insurance exchanges, which some states (including Maine) had resisted.
A political/political process note: While Republicans will likely campaign and raise money with the promise to repeal the ACA, they won’t be able to do it unless they have a filibuster-proof Senate — which they won’t. The penalty enforcing the mandate could be overturned through reconciliation, thus requiring only a majority of the Senate. But that is a very, very small part of the law — and those parts would require a filibuster.