The Economist: Democracy in America. Obamacare and Medicaid

The individual mandate has been the most contentious part of Obama-care, leading to fights that will continue into the future. The House of Representatives will vote to repal the law next week, while Mitt Romney, having passed a mandate of hisown in Massachusetts, promises to end Obama-care, should he win in November. Democrats, meanwhile, are using Mr Romney's own language about punishing freeloaders and free riders to defend the mandate. But the reality of the mandate does not warrant the furor surrounding it. As Ezra Klein explained last week, the penalties for not buying insurance are small. So small that some Americans may simply ignore it. Mr Klein pointed out that those in Massachusetts complied anyway. I'd argue that voters in Wichita are different than those in Worcester. Much more important, in practical terms, is the looming fight over Medicaid. The 26 states that fought Barack Obama's health-care reform in court, challenged not just the individual mandate, but the expansion of Medicaid, the public health program for the poor. Washington pays for 50% to 83% of each state's Medicaid program. Beginning in 2014, the reform extends Medicaid to all those with incomes of up to 138% of the federal poverty level. The states charged that the expansion is so big and the terms so stark, extend Medicaid or forgo Washington's money, that they had no choice but to go along. They received little sympathy from the lower courts. So it was somewhat of a surprise when the Supreme Court agreed to hear the issue. But in its ruling last week, the justices sided in part with the states: Congress may offer states money for the Medicaid expansion. If a state refuses, the state may keep the Medicaid money it has already.