Obamacare: Not Perfect, But ‘Here to Stay’The Supreme Court’s ruling on the Affordable Care Act established it as a vital part of the nation’s social safety net and too much a part of American life to be ripped out.
Republicans have been cornered by a president they had vowed to drive from office. Obamacare, an imperfect but badly needed revolution in health care, is, as President Barack Obama said, “here to stay.” Tens of millions of Americans will keep health insurance long denied them, and millions more will obtain such policies in the future.
Republicans sound angry and confused as they try to convince these many millions that they got a bad deal. It reminds me of earlier GOP generations warning Americans that Social Security and Medicare would land us all in the poorhouse. No doubt their latest effort will backfire, too.
The Supreme Court’s 6-3 decision Thursday, assuring that Affordable Care Act subsidies will continue for low-income people throughout the country, gave Obama a huge political victory. The decision also was a great policy victory for Obama, establishing the Affordable Care Act as a vital part of the nation’s social safety net and too much a part of American life to be ripped out.
“What we’re not going to do is unravel what has been woven into the fabric of America,” Obama said. Or, as health care expert Henry Aaron of the Brookings Institution said on the Kaiser Health News website, “The ACA is already deeply entrenched and will be more so in 18 months when the opportunity for legislative action will occur. You won’t see any opportunity for legislation until 2017, and at that point more than 30 million people will be receiving coverage in one way or another under the ACA. And hospitals, drug companies, device manufacturers will all have new customers under the ACA, and it will be politically risky to roll it back to any significant degree.”
While Obama was pleased as a politician and policymaker, what may have made the president—a former law professor—happiest was the language Chief Justice John Roberts used in upholding the law.
In straightforward, dry terms Roberts skewered the contention of the conservative lawyers trying to destroy Obamacare. Their argument revolved around the online marketplaces, called exchanges, through which consumers buy insurance.
The conservatives had argued that residents of the 34 states that had not set up Affordable Care Act exchanges—but relied on the federal government exchange—were not eligible for subsidies available to those living in the states that had their own exchanges. These subsidies are in the form of tax credits, which can be subtracted from your income tax bill.
The law says subsidies are available through an exchange “established by the state.”
Through a twisting, misleading interpretation of the law, conservative lawyers tried to convince the court that these four words—“established by the state”—meant that subsidies would go only to those buying policies from state exchanges. But Roberts rejected the argument that the state and federal exchanges were different. “State exchanges and federal exchanges are equivalent—they must meet the same requirements, perform the same functions, and serve the same purposes,” he wrote. The Affordable Care Act, he said, requires individuals to be treated the same, no matter where they live.
Roberts ripped into the conservative lawyers. He dismissed their contentions as “a winding path of connect-the-dots” arguments to reach a conclusion that had not occurred to Congress. Congressional and presidential intent, he said, was to fix an ailing health care system.
Roberts said, “In a democracy, the power to make the law rests with those chosen by the people. Our role is more confined—‘to say what the law is.’ That is easier in some cases than in others. But in every case we must respect the role of the Legislature, and take care not to undo what it has done. A fair reading of legislation demands a fair understanding of the legislative plan. Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”If the court had gone the other way, the results would have been disastrous.
The website ACA Signups.net, which tracks the number of people covered by policies whose standards are regulated by the Affordable Care Act, reported that almost 40 million have signed up for policies that comply with Obamacare rules on cost, coverage and other matters. Of these, 10.1 million have purchased policies through exchanges. Another 8 million have bought Obamacare-approved policies on their own. And 13.4 million low-income people received policies through Medicaid and the federal children’s program.
It’s not a perfect law. Medicare for all would have been much better. And, as Jordan Rau pointed out on Kaiser Health News, Obamacare faces a “weighty struggle … to keep prices under control, entice more consumers and encourage quality medical care.” And public support isn’t strong. A CBS poll showed 47 percent approved of Obamacare, although a larger number favored the subsidies and protective provisions of the law, such as the one allowing young adults to remain on their parents’ policies.
But it’s now part of our lives. You don’t have to stay on at a lousy job just for the health insurance. As the conservative Commentary Magazine noted in a grudging headline, “Obamacare Likely to Live Forever Now.” By the 2016 election, it will be a powerful weapon for Democratic presidential and congressional campaigns, and the father of Obamacare will be a valuable ally for the candidates.Wait, before you go…
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