New York is probably less affected than most states by today’s U.S. Supreme Court decision. The court effectively has said that almost all of Affordable Care Act (ACA) passes constitutional muster. This means the entire country can now experience the effects of the sort of regulatory policies (such as guaranteed issue, community rating and mandated coverages) that have done much to make health insurance so costly here, with the added element of a government-administered “exchange” from which people lacking health insurance will be required to buy it (or pay a penalty, effectively redefined by the court as a tax).

In upholding the individual mandate provision, the U.S. Supreme Court also ruled that states can’t be threatened with the loss of all their federal Medicaid funding if they choose not to expand their Medicaid programs along the lines authorized under the Affordable Care Act. But New York already has a more expansive Medicaid program than most — and as a practical matter, given our politics, to the extent the feds are willing to underwrite a further expansion of New York’s program (assuming the ACA survives in the next Congress), we will no doubt happily opt into it.