Health Reform, SCOTUS and Elections

The Supreme Court ruling on the ACA allows the implementation of the law to continue, reserving the ultimate outcome of the law for the electoral process, while also providing some landmark legal precedents. The legal case around the ACA is over for the time being, though there will certainly be skirmishes about portions of it as with all major pieces of legislation. However, the bottom line is that the law has passed constitutional muster.

Republicans have scheduled another repeal vote in the House and Gov. Romney remains adamant that he will repeal and replace it if elected (indeed, he claims he will undo it with an executive order on day 1; I have my doubts about this, but it is a testable hypothesis). The ball is now decidedly in the court of the public, with our next crack at the ACA being the upcoming election. We will elect a President, all members of the House, and around one-third of the members of the Senate. Two years after the passage of the ACA, there remains no coherent vision for replace from those committed to repeal. If the public wants to elect politicians committed to repealing the ACA while being unclear about what comes next, we can get that outcome by late January, 2013.

Other than allowing the ACA to go ahead roughly speaking as is , the opinion identifies a limit of what is allowable under the Commerce Clause of the Constitution, and in the Medicaid aspect of the ruling the court identified the penalty of losing all of your states’ Medicaid funding if you don’t undertake the prescribed Medicaid expansion, to be something that the Federal Government could not do because it would be coercive to states. While this may seem to Conservatives a bit like the question “other than that Mrs. Lincoln, how was the play?” in the long run I suspect this precedent will be important going forward in policy debates.

Leaving the Medicaid expansion in place, while allowing states to not undertake the expansion without losing all medicaid funding has set up a fascinating test of ideology v. financial self interest for Conservative states. People’s lives are at stake here and I don’t mean to minimize that, but again, elections are important and I suspect what State politicians plan to do about the Medicaid expansions will be a key question in some states this Fall.

In the long run, we need a deal on health reform, that makes the hard work of addressing coverage, cost and quality the responsibility of both parties. I think this ruling makes such a deal down the road more likely than would have overturning the law, but the next big step in the long game of health reform is the election in November. In the end, my biggest take away from this decision is that elections are important, and especially the next one.

(cross posted at freeforall)

Author: Don Taylor

Don Taylor is an Associate Professor of Public Policy at Duke University, where his teaching and research focuses on health policy, with a focus on Medicare generally, and on hospice and palliative care, specifically. He increasingly works at the intersection of health policy and the federal budget. Past research topics have included health workforce and the economics of smoking. He began blogging in June 2009 and wrote columns on health reform for the Raleigh, (N.C.) News and Observer. He blogged at The Incidental Economist from March 2011 to March 2012. He is the author of a book, Balancing the Budget is a Progressive Priority that will be published by Springer in May 2012.

7 thoughts on “Health Reform, SCOTUS and Elections”

  1. Massachusetts Mandate Mitt – all hat and no cattle. Without the hat.

    The ACA is here to stay. Too many people like too many of the provisions in the law for Mitt to even imagine touching it. Not that he’s going to be president anyway.

  2. How many white folks in Alabama would gain Medicaid coverage under an expansion? And is that a voting issue for them?

  3. If Obama is smart — and like Shimon Peres, I think he is — the rest of the campaign will be: This act ensures that you can get affordable health insurance regardless of pre-existing conditions. Yet Romney is against it. This act ensures that your kids can stay on your insurance plan until they’re 26. Yet Romney is against it. This act ensures that you — that every American — can afford health insurance. Yet Romney is against it.

    Run on that. The market dropped today because the plutocrats understand that now the status quo is on our side; and Romney will have to defend why he wants to take these things away and what he’ll do to compensate for that.

    1. Sadly, a campaign strategy that seems so obvious to you and me has, time and time again in the past thirty odd years, been too difficult for the Dems to ferret out.

  4. the court identified the penalty of losing all of your states’ Medicaid funding if you don’t undertake the prescribed Medicaid expansion, to be something that the Federal Government could not do because it would be coercive to states.

    Isn’t there a long history of the Federal Government doing exactly that with, for instance, federal highway funding?

    1. Roberts was clerk for Rehnquist when that was decided….decision said it wasn’t coercive, but that something might be. So, Roberts identified a set of facts that would be coercive and then essentially rewrote the medicaid part of the statute

  5. “If the public wants to elect politicians committed to repealing the ACA while being unclear about what comes next, we can get that outcome by late January, 2013.”

    Sadly the “public” is not a unitary being and what the minority of swing voters in the half a dozen or so crucial swing states want may not be what even a plurality of all voters want or vote for…

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