All the health policy wonks are talking about the news of a federal judge ruling that the Affordable Care Act’s insurance mandate is unconstitutional. For those keeping score, two federal judges (appointed by Democrats) have ruled in favor of the mandate’s constitutionality while one judge (appointed by a Republican) has ruled against it. The latest ruling isn’t a surprise and the issue will ultimately be decided by Justice Kennedy (the other Supreme Court justices will simply cancel out each other’s votes). What is interesting about the judge’s decision is that he refused to strike down the entire law or stop its implementation.
This will create an interesting set of circumstance for the Court. States and insurers will continue to prepare for a post-2013 world of insurance exchanges and Medicaid expansions. If this ruling stands, those things wouldn’t go away, but it could create a lot of confusion and uncertainty for policymakers. Without a mandate, insurers will scream bloody murder about having to make insurance available to anyone who wants it. State exchanges might be made irrelevant after millions of dollars are spent on their planning and creation. How the Court does or doesn’t respond to these facts on the ground will give us wonks plenty to speculate about over the next couple years.
