Here is today’s U.S. Supreme Court ruling upholding the constitutionality of the Patient Protection and Affordable Care Act. The Court upheld the individual mandate to buy health care insurance as a tax (it would not have upheld the individual mandate under the Commerce Clause). The Court also upheld the national expansion of Medicaid to all individuals below 133 percent of poverty but overturns the authority of the Centers for Medicare and Medicaid Services to withhold all other (current) Medicaid funding if a state declines to so expand Medicaid. It is not yet clear how a state might “opt out” of the Medicaid expansion under the ruling.