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Ultimately, the court is heading to a doctrine of 'separation of campaign and state.' This doctrine, like separation of church and state or separation of military and civilian authority, is not explicit in the Constitution but flows naturally from its structure and commitment to freedom and democracy.

Ultimately, the decision to expand Medicaid is one of common sense and necessity; the facts make it clear that it is good for state economies, good for hospitals, and good for the people who need healthcare coverage.