Terry H. Schwadron
June 19, 2021
After the third U.S. Supreme Court decision to confirm the essential constitutionality of the substance of Obamacare, how about Republicans pledge allegiance to health care?
The Court skipped over the essential question that several Republican-majority states wanted nailed by conservative-leaning justices, with a seven-justice majority ruling that the plaintiffs had not suffered the sort of direct injury that gave them standing to sue. By bypassing a decision over whether the law could stand without a provision that initially required most Americans to obtain insurance or pay a penalty, the Affordable Care Act should now be able to survive.
With three straight Supreme Court decisions all for legality, how strong a precedent do we need for partisan attacks on health care to cease?
Republicans have launched waves of legislative and court skirmishes over the central provisions of Obamacare, never devising a better plan that wouldn’t leave millions dropped from health plans. Donald Trump’s administration went further, knocking out financial supports for key parts of the law.
In this most recent court challenge, the central issue was whether the whole law was considered invalid if a central tenet essentially nullified the law’s ability to mandate coverage. That was the position taken by a federal judge in Texas; an appeals court in New Orleans agreed that the mandate was unconstitutional but did not rule on the rest of the law.
Effect on Health Care
Of course, an opposite ruling would have knocked 21 million people from health care, according to recent estimates from the Urban Institute.
As The New York Times noted, the biggest loss of coverage would have been among low-income adults who became eligible for Medicaid under the law after most states expanded the program to include them. But more millions stood to lose private insurance, including young adults whom the law allowed to stay on their parents’ plans until they turned 26 and families whose income was modest enough to qualify for subsidies that help pay their monthly premiums.
And it would have ruined the principle of requiring insurers to cover pre-existing health problems, something that insurance companies have been doing basically because they have had to do so.
Unaddressed in all of this is the year we’ve just lived, in which pandemic shows the even more obvious need for health care coverage across the country. Those hospitals that were jammed with coronavirus patients were totally dependent on a system whose coverage was outlined by Obamacare.
As Always, Politics
But the ruling has a distinct political odor as well. It begs the question of what Republicans do now — waste more time, effort and money at pursuing a partisan campaign against federal rules for health care or actually live up to their now ballyhooed “bipartisan” responsibilities by helping to rebuild the foundational pegs for current-day Obamacare and working to improve its deficiencies.
The Biden administration is reported at work on legislation to lower the eligibility age for Medicare and the to. create a public alternative to private health plans sold through the ACA insurance marketplaces.
This would be an excellent time, for example, for the emerging Senate centrist caucus to declare that health care has been held up as legal, important, and mainstream, not some loony vision of progressives only. Those Republicans who insist lately that they are standing up for workers might take up the cause of health care in a way that shows the claim to be true and reasonable.
Instead, we hear vague notions from some GOP members of Congress who suggested that they would, instead, start plotting legislatively to trim back parts of it. Plus, as we have seen in other programs, the states, particularly those with Republican-majority legislatures, will act on their own whatever federal law holds.
At the same time, the time for a Bernie Sanders-style set of improvements is yet even more demonstrable. Declaring the principles of Obamacare beyond the reach of these partisan lawsuits from red states should finally put to rest the question of whether the federal government has a role in health care access and turn it into how to make it work the best way possible.
That would be a more useful and responsive bipartisan conversation.