The Supreme Court ruled last month to uphold the bulk of Pres­i­dent Obama’s con­tro­ver­sial Afford­able Care Act, but the jus­tices’ split deci­sion raises new ques­tions that could rede­fine the fed­eral government’s rela­tion­ship with the states.

North­eastern Uni­ver­sity pro­fes­sors debated the issue on Wednesday after­noon in a panel dis­cus­sion spon­sored by the School of Law Health Law Society.

Fac­ulty mem­bers dis­cussed the court’s deci­sion to strike down an expan­sion of the Med­icaid pro­gram, which is admin­is­tered by the states and par­tially funded with fed­eral money.

I think it’s a stealth claim because, like the bombers, it went under the radar,” said Wendy Parmet, the asso­ciate dean for aca­d­emic affairs and George J. and Kath­leen Waters Matthews Dis­tin­guished Uni­ver­sity Pro­fessor of Law. She authored an amicus brief cited in the court’s ruling.

The expan­sion would have deliv­ered health cov­erage to Amer­i­cans whose income was 33 per­cent above the poverty line, with 90 per­cent of the funding coming from the fed­eral gov­ern­ment. The court ruled that por­tion of the law was uncon­sti­tu­tional because states risked losing all their Med­icaid funding if they did not comply.

What’s inter­esting is that this expan­sion … will be rejected by the states with the highest levels of the unin­sured and the weakest Med­icaid pro­grams,” Parmet said. “That means a lot of people the Afford­able Care Act was going to cover will not get insurance.”

The court’s ruling to dis­allow the fed­eral gov­ern­ment to place strong con­di­tions on the funding it pro­vides to states is a game-​​changer, pan­elists said, altering policy going back as far as the New Deal of the 1930s.

It’s really star­tling,” said Michael Dukakis, former Mass­a­chu­setts gov­ernor and cur­rent Dis­tin­guished Pro­fessor of Polit­ical Sci­ence at North­eastern. “This has always been a factor in federal-​​state grant programs.”

He added, “As someone who has been involved in this area for a long time, I can say this: This is truly weird.”

Even the court’s ruling to uphold the indi­vidual man­date caught many off guard. Pan­elists noted that the deci­sion raises new ques­tions because of the court’s deci­sion to rule on the grounds of the fed­eral government’s ability to levy taxes, not through its powers to reg­u­late commerce.

[Chief Jus­tice John Roberts] did some­thing that sur­prised a lot of people by saying it was a valid exer­cise of the gov­ern­ment under the Taxing Clause,” said Kristin Madison, a pro­fessor of law with a joint appoint­ment in the Bouvé Col­lege of Health Sci­ences.

Many have sus­pected that the case’s majority ruling, authored by Chief Roberts, was an attempt to keep the Supreme Court above the par­tisan fray, espe­cially in an elec­tion year. That may not have worked, though, con­sid­ering that the Court’s pop­u­larity is nearing record lows.

I might have expected the oppo­site,” said Martha Davis, a pro­fessor of law who also authored an amicus brief sub­mitted to the Court. “Chief Jus­tice Roberts’ ruling seemed to try to give some­thing to everyone. It’s a problem when the most respected branch of gov­ern­ment has an approval rating under 50 per­cent and no clear plan of how to turn that around.”