While the Supreme Court upheld the Affordable Care Act's individual mandate, the justices altered its biggest component. The most important yet under-reported aspect of the ruling deals with Medicaid. Most people who will get health care coverage under the law will get it from an expansion of the program. But, the Supreme Court switched the expansion of Medicaid from being mandatory in all states to being optional in all states. As msnbc’s Lawrence O’Donnell explained on Monday’s show, it may turn out that more people will lose coverage because of the Medicaid rewrite than would have lost coverage if the individual mandate had been thrown out.