Let me start by saying this is not a prediction of how the Supreme Court will rule in the days ahead on the Obamacare case before them. Nor is it a rant against the evils of Obamacare, or a proposal for how to replace it, as my able BD colleague has outlined.
No, what is most important at this point is the durability of this 2300 page law – whether or not the Supremes rule that recipients of Obamacare benefits in two thirds of the states in this country will continue to receive subsidized health insurance.
So, what is the legacy Obamacare will leave behind, whether it is effectively shot down by the court, repealed by a fully Republican congress and president in 2017, or remains in place with a favorable court ruling or Democratic control of the White House and/or at least one chamber of Congress?
The answer is that the most significant element of Obamacare will live on, even if the law goes away. It is the thing the left has placed at the center of their agenda for as long as anyone can remember. The thing that far and away trumps the Obamacare law itself or the framework within which it is implemented. The thing that will ultimately eliminate questions of access, cost controls, portability and pre-existing conditions, because those things will likely be contained in this thing that will remain no matter whether Obamacare itself survives or not.
Universal coverage.
Yes, as unpopular as Obamacare may be, and as much as it was sold on the false premises that you can keep your plan, keep your doctor and lower your premiums, Obamacare has almost certainly cemented into place the permanent expectation of universal coverage. It has become a permanent part of the political and cultural landscape. It is the new healthcare paradigm.
It is not like the country did not have the chance to (de facto) vote for the repeal of Obamacare. In fact, in some senses, they did so twice, resoundingly. In 2010, Obamacare was the single most important issue, and the Democrats were thrashed. And in 2014, when Obamacare was still a key issue, Democrats were dealt an equally overwhelming defeat.
The problem, of course, is that the voters would not close the deal in the most important election since Obamacare became law – in 2012. The reelection of Obama (and the assistance of Chief Justice John Roberts) assured the survival of the law. So by the time we get a new president, the law will have been in effect for almost seven years, effectively rendering the 2014 election moot on the matter of universal coverage. That horse is out of the barn, and the barn door is closed. Good luck trying to remove this entitlement.
Think about it. What is the GOP going to do, cut people off from their subsidies, strip the insurance companies of all the extra business they’ve generated under this law, forge a political solution that tells millions of people we’re going back to the way it used to be? Not gonna happen. The question now is how to continue universal access to healthcare in a free market framework. And you can tell how worried the Republicans are about this very reality by all the gnashing of teeth regarding what they would do if the court hands them the “gift” of effectively destroying Obamacare.
The problem is not what the left and the establishment media has said, that the GOP has no alternatives. It’s that they have too many alternatives. They have at various times proposed tax credits, making insurance plans available across state lines, assigned risk pools, expansion of health savings accounts, the permanent reassignment of the needy to the Medicare rolls, and many more possible ideas. But a dozen different ideas – no matter how viable they are – won’t work from a political standpoint. They must coalesce around a single market-based plan and strategy that will bend to the reality that universal coverage is here to stay. And it must be both prudent and bold, offering solutions plural, not singular, because if we’ve learned anything from Obamacare, it is that a massive omnibus federal solution to an equally massive issue does not work. Incremental reform is, as usual, the only approach to fixing the many systemic problems inherent in our healthcare system long before Obamacare became the law of the land.
In their heart of hearts, most Democrats favored a full government takeover – a single payer system – instead of only federal management of the healthcare system. But they were more than willing to embrace whatever path was viable to assure universal coverage. The fact that few if any actually read the ACA bill was ultimately irrelevant – details, really – Democrats only cared that it accomplished the ultimate goal of universal coverage. And that is exactly what it has done.
If the Court rules against the Obama administration, the GOP would likely kick the can down the road a piece by passing a bill to temporarily continue subsidies to the beneficiaries of ACA, but you can be sure that, no matter the judicial outcome, anything they propose in the end will have to be consistent with the new paradigm that healthcare is no longer a privilege, but a right.
