In what can only be described as a shocking turn of events, Chief Justice John Roberts, a Bush appointee to the U.S. Supreme Court wrote the majority opinion for the court upholding the Constitutionality of President Barack Obama’s health care law known legislatively as the Patient Protection and Affordable Care Act and better known among political junkies as “Obamacare.” The ruling was 5-4 in favor of the law.
This decision was a huge boost to the Obama re-election campaign and both sides know this. Mitt Romney, in what was a beautifully crafted view of the U.S. Capital building, continued to promise to “repeal and replace” Obamacare on his first day in office. The key question has always been for Mr. Romney: how? And with what will you replace it with? Specifically, what parts of the law don’t you like? I think that the position of Republicans is pretty accurately depicted in this cartoon:
Thanks to the Supreme Court, the ACA and the future of health care reform are back where they belong–in the hands, not of the court, but of the people. Why should anyone be displeased with that outcome? It’s up to us, and this sharpens the choice in the coming election. Do we want a society where millions of people are uninsured and millions more under-insured? Where the rising cost of health care continues to swell the ranks of both, and millions more are a layoff away from joining them? Surely no one would really choose any of that, if there’s a choice to be had. So will we commit ourselves to making good-faith efforts to improve the health care system for as many as is humanly possible? Or will we calculate that the status quo serves our own interests better (and to hell with everyone else, if need be)?
The mandate is pretty unpopular among independents, but it will be interesting to see if the SCOTUS ruling affects that. It’s easy for conservatives to argue the liberal justices are all in the tank for overarching government blah blah, but for Roberts to write the ruling, even relatively low information voters might see that as legitimizing. Also some figured that overturning the law would be the best political outcome for Obama, because then he could run against the status quo of tens of millions of uninsured and people getting denied for pre-existing conditions, while Romney would have to defend that somehow with his non-existent repeal-and-replace plan.
The headline on the widely read SCOTUSBlog was: “the entire ACA is upheld.” That is one way of looking at this, but it’s not entirely accurate. Many political observers and policy analysts have been turning their attention to the courts ruling on the expansion of Medicaid coverage noting that the Supreme Court held that states can opt out of the plans Medicaid expansion plans without losing federal funding. When you look at some of the CBO numbers with regards to the Affordable Care Act, some of the most promising came from the Medicaid expansion. If you read the CBO report which is tough to do unless you’ve worked on Capital Hill, you’ll notice that many of the key savings that were expected to offset many of the initial costs came from an expansion in Medicaid that would bring 17 million people into the program by 2019. With that part of the law now up in the air, it is difficult to say if states will indeed opt-out entirely of the Medicaid matching program or whether they will still take part in the program despite the absence of a significant threat from the federal government.
Now, approximately 45% of the cost of Obamacare is in the Expanded Medicaid portion of Obamacare. This morning the Supreme Court prohibited the Federal Government from withdrawing regular Medicaid Funds from a state that refuses to be a part of the Expanded Medicaid Program. In Texas, the projected increase in new enrollment on Medicaid due to Obamacare is 2,416,752 additional people. This is a 56.7 percent increase over our current enrollment. A lot of teachers and government workers have been laid off as a result of belt tightening. In two years we will be faced with the choice of significantly reducing the number of teachers and government workers again, reducing services or significantly increasing our Medicaid expenditures. Many believe that states like Texas will simply not fund Expanded Medicaid in Obamacare. This poses a serious threat/problem for the long term success of the Affordable Care Act. The provision providing for the expansion of Medicaid must be addressed at some point in the future and it is this provision that will be the biggest indicator of the future success of universal health care in the United States.
Ultimately, what we must understand is that having a healthier population and spreading the costs across the entire population makes good financial sense for both the average American family and big business. It makes both more productive and competitive in a world where all other democracies have had it for decades. That we don’t have access to a single-payer medicare for all type option is troubling. Many have never been a fan of having insurance profits and their bureaucrats coming between them and their doctor, but understand that between Republicans and Blue-Dog Dems it wasn’t possible, but still disappointing.
What I find most astonishing however is that Republicans still can’t quite figure out that they’re already paying for other people’s health care today, just at the highest cost: emergency care when it’s too late. I guess it’s because it’s too conceptual, it’s buried in their tax bill, the cost of their insurance and their hospital bills, it’s not handed to them as a bill each month labeled “Coverage for people you don’t like”. I know math is hard but the fact remains: Covering everyone is cheaper overall than not. It benefits us all in the long run. They seem to forget that health care costs have been skyrocketing for decades and pretend that somehow ACA is at fault, believing that the current system we have is fine. It’s not.
