I agree with Alec MacGillis. Had ObamaCare been ruled unconstitutional by the Supreme Court it would have been hugely beneficial to Mitt Romney’s campaign. Most obviously, it would have made one of Romney’s weakest arguments against the law seem entirely justified. Mitt has said that the Massachusetts health care law was a good law but that Obama’s health care law is bad. He bases that mainly on state’s rights principles. A state may require you to purchase health insurance because it isn’t precluded from doing so by the Constitution, but it is an overreach of federal power to create an insurance mandate.

If Romney had been proven correct about this seemingly artificial distinction, he would have been off the hook for the inherent hypocrisy of arguing that what is good for Massachusetts is not good for the rest of the country. He could have gone on criticizing the health care plan while enjoying a boost in his credibility. He could have mocked the president for having wasted so much time and effort enacting a law that wasn’t even legal.

In the wake of the Court’s ruling, Republicans have vowed to fight on. Several governors have indicated that they will wait until after November’s election to begin full implementation of the law, and congressional leaders have promised to work towards repeal. But the reality is going to be somewhat different:

The exchanges do not need to be up and running until 2014, but states are required to demonstrate by Jan. 1, 2013, that their exchanges are in progress, and will be operational by the 2014 deadline. If they fall behind, the Department of Health and Human Services would then come in and set up the exchanges.

“If the state decides not to establish an exchange, then the federal government establishes the exchange for them. So it’s kind of a pick-your-poison scenario, if you will,” said Renee M. Landers, a professor of law at Suffolk University Law School in Boston. Presumably, governors who are resistant to setting up exchanges would be more resistant to the federal government establishing the exchanges for them.

If the exchanges are going to be set up in all 50 states, it doesn’t seem like Republican resistance to Medicaid expansion is going to do anything but blow up their state budgets. If you want proof of this, just look at the states the opted to do an early adoption of the Medicaid expansion. Their budgetary situation has improved dramatically and they’ve dramatically reduced their levels of uninsured people. Here’s a more realistic assessment:

Some health care experts said it was unthinkable that state leaders would really opt out, since the vast majority of the cost is covered by the federal government — taxes their citizens will pay, regardless of whether the state opts in or out. For the first two years, the federal government pays for 100 percent of the expansion. Starting in 2017, the states start chipping in, but they will never contribute more than 10 percent of the cost.

“A governor would be walking away from millions, in some cases billions of federal dollars,” Tim Jost, a consumer advocate and professor of health law at Washington and Lee University, told CBSNews.com.

Furthermore, they’d be leaving a significant portion of their citizens without health care. Florida, according to the nonpartisan Kaiser Family Foundation, has the second-highest rate of uninsured Americans at 21 percent. The expansion of Medicaid in the state would have covered 951,622 people according to Kaiser.

Jost said he’s not surprised that governors like Scott and Haley are saying they will opt out of the Medicaid expansion. However, he said, “I will be surprised if they do it.”

In the heat of the moment, many Republican governors and Republican-controlled legislatures will resist Medicaid expansion. But it won’t make sense for them to do so for long. Paying 10% of the costs of a Medicaid patient is ultimately much cheaper than having tens of thousands of uninsured people in your state. There may be a handful of states that will feel a temporary pinch at the cost of paying even 10% of the costs of new Medicaid patients, but those are the states that have been shortchanging Medicaid patients and restricting their rolls. This penny wise, pound foolish mindset will quickly be exposed as non-viable as health care providers and hospitals punish states that don’t cover their people.

No matter whether you look at it from a narrow political point of view or you look at it from a broad policy point of view, the Supreme Court ruling was good news for the people, the president, and the Democrats, and bad news for Mitt Romney and the Republicans.

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