Obamacare Is Constitutional -- Now the Fight Begins

As I wrote Wednesday, I hoped Obamacare would be sustained by the Court, and it has been. Thank goodness. To strike it down would have ripped apart the fabric of our society. Are we all in this together? Or is each individual American on his or her own? What kind of country will we be if we cannot provide basic health care to our citizens? That's now a question for the November election, not a question for nine unelected judges.

Here is the decision.  It's not all rosy.

Justice Roberts joined with justices Ginsburg, Breyer, Sotomayor, and Kagan to uphold the individual mandate under Congress's taxing power, not the Commerce Clause. So there is a new limiting principle under the Commerce Clause. Tom Goldstein at Scotusblog points to this line as the "money quote" for that limiting principle: "The power to regulate commerce presupposes the existence of commercial activity to be regulated." He adds that "[t]hat will not affect a lot of statutes going forward." We shall see.

The Court also limited Obamacare's expansion of Medicaid. The federal government wanted to cover lots more people through Medicaid, because it is a more cost-effective way to provide coverage. So they offer states a huge incentive to expand their Medicaid rolls by paying up to 90 percent of the costs. But the law also provided a stick that said, if you refuse the expansion, we will take away current Medicaid dollars. That part went too far for the conservatives. There are posts here, and here, with more explanation.

But on balance, this is a MASSIVE win for President Obama and the American people. The question is: will the voters come to see the vitality of a broad national approach to health care that attempts to expand coverage, lower costs, promote equality, and prevent people's lives from being destroyed by ill-health?

All of us who support these principles have a second chance to sell this to the American people, but it's not a very big window of time in which to do so. There are 130 days until the election. And there's a clear choice. President Obama will support and work to strengthen Obamacare. Mitt Romney has vowed to destroy it.

Let the fight begin.