From Health Reform To a Medicaid Expansion

Here’s my brief nutshell analysis of what’s on tap at the Supreme Court today:

Pretty much everyone understands that yesterday’s oral arguments represented the Big Enchilada, and we’ll all just have to get used to the fact that nobody–and that includes fearful progressives and gloating conservatives–actually knows what is going to happen to the individual mandate.

Today’s issues–severability and the ACA’s Medicaid expansion–mainly matter if the individual mandate does indeed fall. On the former issue, neither the administration nor ObamaCare opponents really want the “guaranteed issue” and community rating provisions of the law–basically the provisions that protect folks too sick to get private health insurance at affordable rates right now–to survive without a mandate; such an outcome would send premiums through the roof. But the administration would like the provisions that help poorer Americans–notably the Medicaid expansion–to survive in any event, along with reforms aimed at curbing health care spending, especially in Medicare. So that’s the position federal attorneys will take.

The constitutional challenge to the Medicaid expansion is not taken that seriously by anyone other than genuine judicial radicals who seek a ruling that would not only stop the ACA’s major expansion of Medicaid elibility, but call into question the whole system of federal-state relations on which big portions of the New Deal and Great Society rely. If the Justices start looking amenable to this challenge, then some of yesterday’s progressive panic is fully justified.

If you want a fuller preview, check out Wonkbook’s analysis.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.