After the Supreme Court Decision: What Happened? What’s Next?

Tom MillerAmerican Enterprise Institute

July 9, 2012

The Ruling

• “It’s a big *#@?>! deal”• A strange “majority of one”• One door closes, another one opens• Tie goes to the government• Whatever doesn’t kill me makes me stronger!

Let’s cultivate our gardens, in the best of all possible worlds

The Chief’s Opinion

• Roberts: no commerce clause authority• Inactivity, can’t compel commerce• If necessary, it’s not proper• But, results-driven judgment call• There must be a tax in there, somewhere…

Tax vs. Penalty:

Decepticons

Without Limits, What Could Future Congresses Do?

Medicaid Coercion

Severability:Chainsaw, Implosion, or Weedwhacker?

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Post-Scotus Takeaway Points

• Exit fees, weak enforcement• Rewinding Medicaid?• CBO rescoring• Pressure on exchanges• Back to politics by usual channels• Overinvested in courts• Industry shrugs or smiles• Fed overreach didn’t start with mandate

Is There a Health Policy Consensuson the Right?

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