Democrats celebrated the Supreme Court decision upholding President Obama’s health care law. Commentators focused on the surprising support by Chief Justice John Roberts for the individual mandate and the victory for Democrats.
But beneath the surface, the ruling is less liberal than it looks. Two provisions limit the scope of the law’s impact. First, the Medicaid ruling limits the power of the federal government to encourage states to extend medical care. This gives states the authority to resist national efforts to expand health insurance coverage for the uninsured. With the dire fiscal straits of many states, many places will be unlikely to extend coverage and the result will be fewer uninsured will receive coverage than was expected when the legislation passed.
Second, although Chief Justice Roberts supported the constitutionality of the individual mandate, his opinion limited the ability of the federal government to regulate interstate commerce through tactics other than taxes. This part of the decision will restrict the ability of future Congresses to regulate commerce.
As with many policy decisions, the ultimate assessment of the court’s decision is in the details. Liberals should applaud the overall decision, but fear how the ruling with affect health care implementation. The ultimate result of this decision will be that fewer uninsured will be covered than thought by health care reformers.