This graphic from the Kaiser people is self-explanatory.
?Best comment this morning comes from Naomi Freundlich.
So the question remains: What happens next? Most importantly, health reform implementation can now proceed without the specter of imminent demise. This enormous experiment whose ultimate goal is to re-design our dysfunctional health care system and offer affordable, comprehensive coverage to the majority of Americans, can begin to play out-warts and all. It's like making the decision to get married after a couple has lived together a couple of years-there's no guarantee of success but at least the threat of an uncomplicated break-up is gone.
There are huge questions about implementation, the most compelling of which involve how reform will play out in the states. Will states maintain their Medicaid programs in the run up to the ACA-mandated expansion now that the Supreme Court has ruled that they no longer have to? Or will some states opt out of the Medicaid expansion altogether; refusing an expected infusion of billions of federal dollars and leaving hundreds of thousands (if not millions) of their poorer residents without benefits? How will states that have so far refused to set up health insurance exchanges carry out their required duties?
Now that the mandate has been upheld, ironically questions arise about how well it will function to prevent healthy people from "gaming the system;" staying out of the health insurance pool and making coverage more expensive for the rest of us.
As Ezra Klein wrote in Washington Monthly at the start of the Supreme Court arguments; "Perhaps the best deal in the bill is to pay the mandate penalty [which maxes out in 2016 at $695 per adult and $2,085 or 2% of income for families] year after year and only purchase insurance once you get sick. To knowingly free ride, in other words. In that world, the mandate acts as an option to purchase insurance at a low price when you need it. For that reason, when health-policy experts worry about the mandate, they don't worry that it is too coercive. They worry it isn't coercive enough."