Who knows? The adjectival clause “established by the state” in context seems perfectly clear to me: “state” means “the Federal government.” But now the Nine Wise Souls, as Charlie Pierce likes to call them, get to decide the fate of some millions of people and their tenuous grip on middle class status.

If it decides that the plaintiffs’ case is correct, the entire health care system as envisioned and currently in place folds up and dies. Some thousands of people will be unable to afford life-giving medications like transplant anti-rejection drugs, chemotherapy and radiation, and other prescriptions. They’ll die.

Millions more will be unable to afford health insurance and will be at the mercy of the health care system as it previously “worked,” meaning they’ll be one major medical emergency away from bankruptcy.

The infrastructure of the system itself has been entirely reworked to conform to the Affordable Care Act’s requirements, from hospitals to insurance companies. If the Court agrees with the plaintiffs, that’s going to be a nightmare for those institutions as well.

And we don’t really have a clue how the black-robed politicians are going to decide.