One of the reasons I resist getting all giddy about every Obamacare victory is because I know it's never going to end. They will be fighting this long after I am dead. (After all, they're still trying to end Social Security after 75 years). So everyone should just hunker down and assume that the battle is ongoing. A "win" is never final. In fact, it's usually the beginning.

But after reading reams of analysis over the past 24 hours I do think it's worth pointing out again that this case was not joined by any of the Medical Industrial Complex players. They sat it out, quite happy to enjoy a big surge in healthy customers fueled by billions in government subsidies. For that reason, it's very hard for me to see this mandate being repealed or the subsidies being cut back, even though they will stage a Grand Kabuki pretending that they will. It's just too good for business.

The Medicaid expansion, on the other hand, was always going to be the real political football.(Sometimes I thought it was meant to be.) This is where the battle will be joined in earnest, at least in the short run. Places like California will try to implement the new scheme and may succeed for a time. But if the deficit hawks have their way and put us on a harsher austerity path and/or the Republicans eventually succeed in changing the ACA Medicaid provisions to a block grant or something else, that part of the reforms will wither. And more immediately, we may see some obstinate zealots in the state houses and governors mansions who will take Justice Roberts up on his offer to reject the funding for the ACA.

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The Medicaid expansion was the liberal piece of the reforms, government funded health care for the working poor. In my view that's where progressives should focus their energies and get out ahead of the inevitable conservative onslaught.

http://digbysblog.blogspot.com/2012/06/liberal-jewel-in-aca-crown-medicaid.html