News on Top Obamacare supporters in front of the supreme court today.

The new law expands Medicaid to a national floor of 133% of poverty ($14,404 for an individual or about $29,326 for a family of four in 2009) to help reduce state-by-state variation in eligibility for Medicaid and also include non-Medicare eligible adults under age 65 without dependent children who are currently not eligible for the program. Children currently covered by CHIP between 100% and 133% of poverty would be transitioned to Medicaid coverage.
These changes help to provide the base of seamless and affordable coverage nationwide through Medicaid for those with incomes up to 133% of poverty and then subsidies for coverage for individuals with incomes between 133% and 400% of poverty through state-based Health Benefit Exchanges. Individuals eligible for Medicaid would not be
eligible for subsidies in the state exchange. For most Medicaid enrollees, income would be based on modified adjusted gross income without an assets test or resource test.

Under the supreme court decision, it appears, individual states can refuse to accept the Medicaid expansion.

10.33am: The court's ruling on the Medicaid expansion makes today's decision somewhat reminiscent of the Arizona immigration ruling – the court has left a depth charge inside its decision.

The Medicaid expansion would have offered health insurance coverage to 16 million people. Now states apparently can make up their own minds whether or not to accept the expansion – and that means if Florida, Texas and other big states knock it back, then there will be millions of Americans who will miss out on the benefits of the healthcare reforms.

10.29am: On the Medicaid expansion: the court has ruled that the government can only offer a carrot in terms of higher funding, but not the stick of taking away all of a state's Medicaid funding.

States have complained that the expansion costs them money, despite the extra funding they'll receive. Now they can turn down the expansion, which offers the expansion of coverage to mainly low income people without health insurance.
We'll need to see some analysis of the consequences of this decision, and which states may decide to snub their noses at the Medicaid expansion.

10.28am: The history of the supreme court is that presidents make appointments and are often disappointed by their subsequent career. Has John Roberts joined the likes of Warren Burger and David Souter?

10.23am: There's a big silver lining here for Obamacare opponents. Here's the majority opinion on the Medicaid expansion, as written by Roberts:

Nothing in our opinion precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.

That means that states that refuse to accept the federal government's expansion of Medicaid can't be penalised by the government – the status quo remains.
That's actually a tricky decision, and it can be read as a defeat for the Obama administration. It puts the ball back in the court of the states that – for whatever reason – want to reject the Medicaid expansion, which is a key part of the reform's attempt to expand healthcare coverage.
This blows a hole inside the Affordable Care Act. Hold off popping those champagne corks.

10.21am: In the detail: the supreme court appears to have also redefined the commerce clause and tightened its use. The clause's power has been trimmed by the court in recent decision, but this is another attempt to box it in further.