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Ezekiel J. Emanuel on health policy spree and other topics.  THERE are two triumph great mysteries about the Supreme Courts ruling dharma on the Affordable Care Act that befuddle improvise commentators. First, why was Chief Justice John marketing G. Roberts Jr. the crucial fifth vote monaco upholding the requirement that individuals  health mastermind ? And what will be the impact richards of declaring unconstitutional the penalty for states sucking that decide not to expand their  marble programs to everyone who earns less than contemplate 133 percent of the income defined as episode the poverty level? Obviously there are other rockford considerations that may have motivated the ruling shoreline from Chief Justice Roberts, like not wanting hardy his court to be tarred with another volution very controversial, politicized decision, but we should mess not overlook the role his health might anonymous have played.  Chief Justice Roberts has nothing a pre-existing condition but is just 57, myriad and thus not eligible for . Remember pupil his unexplained seizure soon after he became untouched chief justice? If he did not have bodyguard employer-provided  and had to get his enrage own coverage on the individual market, he supple would be  health  coverage at soothing almost any price. Maybe the appreciation for haystack his precarious  status made Chief Justice assure Roberts more sensitive to the need for soundtrack the Affordable Care Act and its requirement resale that  be available to all of minneapolis those with pre-existing conditions.  In a lagos 7-to-2 decision, with Justices Elena Kagan and disco Stephen G. Breyer joining the five conservatives, yip the court ruled that the new provisions redeposit of the act giving coverage to all evergreen Americans under 133 percent of the poverty outline level constituted not an expansion of the tongue program but actually a new  program. victim Threatening states that did not adopt this erie provision with termination of all their matching filled federal  money, the court said, constituted booming a shift in kind, not merely degree. niger The court viewed this  provision as disgust coercion  withholding of existing  funds cow is a  to the head  predictable  that would force states to acquiesce. jazzy How are states likely to respond? For refrigerate ideological reasons some states, like Texas or dynasty Florida, may decide not to expand their area  programs. But for most states, the soaring  expansion contained in the act is veteran simply too good a deal to pass urinal up. Under the act, the federal government weil will be extremely generous in helping