The U.S. Supreme Court will rule on the constitutionality of the Affordable Care Act this week, maybe as soon as Monday, and there have been reams written about what the ruling might be, and what it will mean.

Here are some quick thoughts - from someone who covered the court for five terms, from 2003 to 2007, and who now edits the Free Press' editorial page - about what we're likely to get.
The ruling itself

Most have identified Justice Anthony Kennedy as the pivot point on this ruling, as he typically is in closely drawn cases.

But from the beginning, I've believed Justice Antonin Scalia -- a more consistent court conservative -- will play just as important a role, and is at least as likely to mark the cleave between those on the court who believe the ACA's insurance mandate is constitutional, and those who don't.

That's because Scalia has, in a relatively recent case involving the scope of "commerce" regulable by Congress, expressed a particularly broad view -- broader, in fact, than the court itself had embraced before.

In Gonzales v. Raich, a case about whether Congress could use the Controlled Substances Act to regulate locally grown, medicinal marijuana, Scalia wrote that it could.

His reasoning was that medical pot, while not explicitly part of any interstate commerce, substantially affected interstate commerce. And so in seeking to regulate the commercial marijuana market (by trying to eliminate it) Congress had the power to do anything "necessary and proper" to pursue that end.

Scalia would limit Congress' "necessary and proper" clause powers only to the extent that they are related to actions that can be "reasonably adapted" to legitimate commerce clause powers.

In other words, Congress can do just about anything to fulfill its commerce clause authority.

Reaching beyond interstate commerce to regulate home-grown, never-sold pot is not fundamentally different from compelling patients (and let's face it, everyone becomes a patient at some point) to carry health insurance.

In order to strike down the insurance mandate, Scalia will have to depart from his opinion in Raich -- either by drawing some distinction between that case and the health care reform, or by (very unlikely) declaring himself wrong in Raich.

Whether and how he does that will be important -- not just for him, but I think for the court as a whole. How good is his argument? And will it convince other justices, like Kennedy, who may be part of the swing on this case?
• Editorial: Uninsured millions depend on the court's support
• Q & A: Supreme Court ruling on health care act unlikely to be final word.
• Related: For people with pre-existing illnesses, Supreme Court ruling on health care act is personal
It's only a win if it's big

If the justices strike the insurance mandate, but leave the rest of health reform intact, this case will provide little relief to opponents of the Affordable Care Act.

That's because the insurance mandate was mainly intended as a way to contain costs.

Without it, but with the other reforms charging forward, the pressure will be back on Republicans in Congress to work with President Obama to come up with an alternative form of cost savings.

The most obvious would be to embrace the idea of a tax to replace the mandate -- something no one will want to discuss in an election year.

My hope would be that striking the mandate might also inspire a more robust discussion of other cost-saving measures, and maybe an explication of what's really driving costs, which is the fee-for-service model that we have in this country.

But either way, it's to much of a win for critics of the law itself. It would go forward, with new urgency to find ways to prevent health care from gobbling even more of our economy.
The real losers will be the people

If the justices strike the entire law, it will be proclaimed a political victory for Obama's critics.

And in some respects, it will be.

But it will also be a huge loss for millions of families that have already begun to realize some of the benefits of health care reform. Families who had previously been denied health insurance because of pre-existing conditions. Families whose young adult children couldn't be on their parents' policies before the reforms.

The one abiding rule of government is that you can't easily take something from someone once you've given it to them. Think about social security and medicare -- programs that were assailed when they were proposed, but could not be deconstructed (and can't even be rationally debated in some circles) without political bloodshed.

Health reform is already on its way to that kind of status.

And that's bad news for GOP critics of the Affordable Care Act -- who'll need to explain why it's better to return so many people to the rolls of the uninsured.