Imara Jones at Colorlines raises the issue of a negative impact of this week’s Supreme Court’s degree on the health and the health insurance options for people of color. As a result of this week’s Supreme Court narrow 5-4 decision:

the Patient Protection and Affordable Care Act’s longterm effectiveness is in doubt, and the racial and economic inequalities at the very heart of the health care system stand to be reinforced. Medicaid—funded jointly by the federal government and the states—is the nation’s health care plan for the working poor . .. . Enlargement of Medicaid is the single most important provision of the Affordable Care Act for people of color. It’s the way that almost all non-whites covered by the law would receive insurance. If implemented as written, the law expected to cover 32 million Americans, accounting for 80 percent of those currently uninsured.

The law as written would force states to expand their Medicaid programs, to include the working poor, or else loose federal funds for all Medicaid. However the Supreme Court knocked down that provision. Some states will likely still seek these funds, but other states, especially with lots of working poor of color, likely will not:

And that’s a problem, particularly in the Southern, GOP-led states where huge numbers of working poor blacks and Latinos live. The majority of states, due to the recession, want to cover less not more people. . . . As former Republican governor, now Senator Lamar Alexander told The New York Times, “If I were governor of Tennessee, I would not expand Medicaid.” Republican Gov. Bobby Jindal of Louisiana echoed the point.

Saving the mandate got much of the media coverage, as many will be helped by what was saved, but

for millions more, the Supreme Court’s ruling will only exacerbate inequities at the core of our national health care crisis, and force the battle over the law back to the states. . . . Medicaid remains a bitterly fought over program today. The ruling yesterday will make it more so.

And the costs are of course very high in human terms, and in dollars as well:

The Center for American Progress estimates that this racial gap in health care coverage costs the country $415 billion a year in lost productivity.

And then there is the underlying question of why “we the people” allow such an undemocratic institution as our Supreme Court to even have this power over our health and health care? This decision by a few unelected folks over US health care is yet more evidence that we are not a democracy, but indeed a kind of plutocracy– that is, a pseudo-democracy that is actually ruled by an elite of the well-off and powerful, an elite that is also still mostly white and very disproportionately white male.