In 2012, the Supreme Court's decision in the NFIB v. Sebelius case sent shockwaves through the health-policy community, with Chief Justice John Roberts's majority opinion causing much teeth-gnashing all around. Among many conservatives, the preservation of the Affordable Care Act's individual mandate constituted “one of the worst Supreme Court decisions in American history.” For supporters of the law, the decision to turn the ACA's expansion of Medicaid into a state-optional program threatened to destabilize the entire project of expanding coverage to the poorest Americans. For them, Roberts's decision was, to borrow a phrase from The Atlantic's first editor James Russell Lowell, “a good umbrella but a poor roof.”
In the five years since that decision, the worst predictions have yet to come true. Before its repeal last year, the individual mandate hadn't become a springboard for more tax-enforced big-government reforms. And Obamacare hasn't been undone by the optional Medicaid expansion.
