If the entire Affordable Care Act gets struck down tomorrow, that would trigger a fair bit of chaos, with lawsuits and scrambling for reauthorization of programs like the Indian Health Service expected. But if the Supreme Court just throws out the individual mandate – and even if they toss insurance regulations like guaranteed issue (the bar on denying coverage due to a pre-existing condition) – the nation’s biggest state is prepared to move forward with the law, and even prosper, according to a leading health advocate.

I don’t think you needed to be Nostradamus to figure this out. Insurance regulations are the soft spot where industry lobbyists know how to navigate much better than anyone looking out for consumers, and insurers are launching their attack on reform in this area. Basing the entire reform on a regulatory regime inevitably exposed it to this kind of danger.

Guaranteed issue doesn’t mean a whole lot on its own without accompaniment with some form of community rating. Otherwise, the insurer can increase premiums to such a degree for the particular family that they wouldn’t be able to afford insurance without keeping the child off the policy.

Louise Slaughter (D-NY), a co-chair of the Pro-Choice Caucus and the Chair of the House Rules Committee, has laid down a powerful marker, signaling that the Senate’s bill should be defeated, and suggesting that the Congress start over from scratch.