No matter what the U.S. Supreme Court decides on Thursday, when it's due to deliver its long-awaited ruling on the fate of the Affordable Care Act, one thing is clear: many Americans are going to be very upset.

The survival or loss (or mutilation) of the ACA could have a big impact on families and businesses, especially in our little corner of the health care universe: the medical device industry. For instance, if not just the individual mandate or Medicaid expansion, but the whole ACA is axed, it means a widely loathed excise tax on medical devices goes to its grave.

But what I've been thinking about is the impact the ruling will have, not just on health care, but on how we view the court itself. To many people this will be a repeat of Bush vs. Gore, if the case is decided along clear ideological lines, as was the ruling Monday that prohibited mandatory life sentences without parole for juvenile killers.

Part of what got me thinking about this was a new report released Wednesday by the American Enterprise Institute, a conservative think tank.

In the (obviously well-timed) analysis, the group examined decades of polls on what the American people think about their highest court. And though there's a lot of variation over the years, the trend, according to the AEI, is one of a loss of confidence.

In a poll taken in the 1940s, for instance, only 43 percent of Americans said the court reached decisions based on politics instead of relying on cold legal analysis. But a poll conducted earlier this month found 76 percent of Americans thought that justices decided cases based on their personal views.

Approval ratings are also down. A survey 12 years ago found 62 percent of Americans approved of the way the court handled things. This month, a poll found only 44 percent did.

I expect after Thursday, that number can only go lower.


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