An overturn of the ACA, no matter how eloquently or concisely the decision is articulated, will never be interpreted as being anything other than an unabashedly biased political maneuver. The SCOTUS justices, in spite of all of their faults, have to be aware of that perception, and so their impending decision (IMO) will have to take that fact into consideration. Now, I’m not a legal scholar, but seriously, you can’t just disregard decades of precedent and months of conventional wisdom (that the law is constitutional), not to mention a majority of prior rulings (some delivered by a number of reputable conservative judges) in favor of the ACA’s constitutionality simply because the oral arguments were rough on the government’s position. FWIW, here’s my prediction:
I predict that the SCOTUS will rule 6-3 in favor of the ACA’s constitutionality, but their verdict will be worded along the lines of “yes, this law is constitutional, but no precedents can be derived from this decision.” Basically, they’ll pull together a ruling a la the outcome of Bush v. Gore, issuing their verdict in such a way so as to stop future politicians and lawyers from reading too much into the decision. Now, I could be wrong, but I just don’t think that Chief Justice John Roberts wants to go down as the guy who presided over the death of the long-sought-after US universal health care bill for purely political reasons.
That’s what I’m anticipating. Now for the negative, horror-story-worthy possibility:
I think that, even more than a complete overturn of the ACA, the absolute worst outcome would be for the justices to rule that both (a) the IM is unconstitutional and so the guaranteed issue and community rating provisions are severed, and (b) that the Medicaid expansion is unconstitutional as well. In that event, what we’ll essentially be left with is a worthless phantom law that’ll mandate the states to establish insurance exchanges and…that’s it. Now, maybe the government subsidies to buy insurance would help a little bit, but in that scenario virtually every issue that the ACA was designed to address will have been eliminated. The GOP will have a heyday championing the law as having been DOA, and it’ll be another twenty years before HC reform is tried again.
I’ve said it IRL, but seriously, I think that the only way to get a federal single-payer solution would have to be under the leadership of today’s 20-somethings. Basically, we just need to wait until this country is run by people who were born after the fucking Cold War and who consequently don’t have an irrational fear of socialism. The problem with that idea, though, is that we’re 30-40 years away from that happening, and a lot of people would suffer needlessly in the meantime.