NOTE: This post is on both the TSAP blog and the Twenty-One Debunked blog
The recent Supreme Court ruling on the Affordable Care Act ("Obamacare") was a mixed bag overall. The individual mandate (which the TSAP does not support) was upheld, but as part of the government's taxing power rather than under the Commerce Clause. While it is clearly a stretch to say it is constitutional because it is a tax (just think of poll taxes), and thus unfortunately provides a roadmap on how to make an end-run around some parts of the Constitution in the future, at least the Court recognized that the Feds do not have unlimited power under the Commerce Clause. Thus, the ruling took some of the wind out of the sails of the dangerous Gonzalez v. Raich precedent in 2005.
One thing the Court did strike down was the primary mechanism for ensuring state compliance with the Medicaid expansion, namely the withholding of existing federal Medicaid funds as a penalty for noncompliance. This was basically the same form of coercion used by the feds to force states to raise the drinking age to 21 in the 1980s, which was upheld by South Dakota v. Dole in 1987. Since then, this power has been used to coerce the states to follow other mandates as well, and not just ones related to highways. Thus if there is any silver lining to the Obamacare ruling, it is the fact that it may make it easier for states to lower the drinking age (and possibly even legalize cannabis) without federal interference.
As we have noted before, the TSAP supports a single-payer healthcare system similar to what Canada currently has, which is also what President Obama originally wanted as recently as 2008. Anything less would be uncivilized.