Pebble Beach, CA Affordable Care Act Ruling By Supreme Court Leaves More Questions Than Answers

The U. S. Supreme Court has stricken a portion of President Barack Obama's health care reform legislation (the Affordable Care Act) which requires states to adopt an expansion of the Medi-Cal program (called Medicaid in other states) which would give 17 million of the poorest American's insurance.  Despite the fact that the Federal government would pay for the full cost of this between 2014 and 2016, many states are against it.  The funding from the government would gradually decline to 90% by 2020, and cash-strapped states say they can't absorb the other 10%.  This calls into question the whole issue of health care reform, which was supposed to require most American's without insurance to buy it, with those who couldn't afford it being added to Medi-Cal and Medicaid.  But what happens when you can't afford the premiums?  This question has yet to be answered, and is likely to be in the news in the months leading up to the November elections.  Although the Governor of California, Jerry Brown, has yet to announce a position on the issue, there has not been one Democrat to come out against it so the odds are in favor of California accepting the Federal aid.  About a half a dozen Republican-led states have already said they will reject the Federal aid or had serious doubts about accepting it, but this position will be interesting to watch as we get closer to the elections.  The legislation was written assuming that wealthier Americans would get a tax credit to subsidize buying private insurance and the poorer ones would go into the Medi-Cal/Medicaid programs.  In the states which reject the Federal aid, the poorest Americans would qualify neither for the tax credit nor Medi-Cal/Medicaid.  Some Republicans are running with the idea that they will be able to repeal the legislation in total if they take control of the Senate, but it's likely to be a close race and this is anything but a sure bet.  In the meantime, Republicans are likely to treat the issue as another unfair tax imposed by President Obama.  "As I have said repeatedly, if this unfunded Medicaid expansion is implemented, state aid to education and funding for the University of Nebraska will be cut or taxes will be increased," Governor Dave Heinman (Republican, Nebraska) told the New York Times.  Despite the definitive ruling by the Supreme Court, the issue of how health care reform will be enacted remains in limbo.