I think this decision is a good compromise:
– It upheld the basic law. Given the divisions in Congress and the stupid expansion of the filibuster, it would have been impossible to make any health care laws if this one was struck down
– It didn’t use the commerce clause to uphold the law. Doing so would have noticeably widened a part of of the constitution that’s already being grossly abused to reduce states’ rights
– If red states don’t want to accept government money to pay for the health of poor people, that’s unfortunate, but they’re basically just letting Washington keep money that would otherwise go to their state economy. I suspect in the long run, most states will either take the money or suffer.