There are implications for the role of the State as we have understood it from the New Deal onward; what Phillip Bobbitt would call a change a Constitutional Order:
The rejection of the Commerce Clause and Nec. and Proper Clause should be understood as a major blow to Congress’s authority to pass social welfare laws.There is the new Constitutional Order:
Using the tax code — especially in the current political environment — to promote social welfare is going to be a very chancy propositionFinally, Using the tax code to optimize rental extraction— in this case, by health insurance companies — is the very essence of Cass, Sunstein et al’s. Nudge Theory
Ie, ACA is set up to assure private insurance companies, the only purpose of which is to basically embezzle health care dollars at all levels*, an assured future. And, doing this, we get further away, not closer to, an actual efficient healthcare system without embezzlement built in. See The Political Genius of John Roberts, below.
*Medicare spends 5% of each health care dollar on administrative expenses, compared with the 17% consumed by private insurers for other things like marketing, executive salaries, and profit. link.
Update: Ok, "Health Insurance" companies do do some useful things, like organize, to some extent, one's health delivery system. But Hey! - there's an app for that! At least for Drugs