The Supreme Court will hear oral arguments about President Obama’s health care law next month, as the widely anticipated debate on the constitutionality of the law will finally come to a head. These arguments have been awaited since September, when the Obama administration asked the Court to uphold the individual mandate, the bill’s centerpiece provision, while 26 states asked for the entire law to be struck down.
The Court has agreed to hear challenges to the Patient Protection and Affordable Care Act, brought mostly by Republican governors from the 26 states. The challenges focus primarily on determining if Congress can dictate if people need to buy insurance, and the extent to which the federal government can regulate the insurance industry, which has typically been regulated by individual states.
The states claim the individual mandate exceeds its constitutional powers, and that the entire law must be stricken if the court strikes down the mandate. The Obama administration argues that the mandate is a valid exercise under Congress’s powers to regulate interstate commerce and collect taxes.
Further, the administration says that even if the Court invalidates the mandate, only two provisions, not the entire law, would have to fall – ones that prohibit insurers from refusing to cover a person with a pre-existing medical condition and from charging higher premiums based on a person’s medical history.
While the stakes for the Court’s ruling are as high as ever, the American electorate is decidedly uncertain on the ruling they desire, as recent polling shows voters have mixed opinions on the health care law.
An examination of poll data shows that depending on how the question is asked, the American people vacillate between support for and opposition to the health care law. But what is certain is that they have a number of core principles about health care that are deeply important to them, such as keeping children insured, keeping the prescription drug mandate in Medicare Part D, ensuring the portability of insurance, and covering preexisting conditions.
An examination of the various potential outcomes of the Supreme Court’s ruling indicate that the future state of our health care system could be just as muddled as voters’ opinions about the law.
If the Court upholds the law, it will be seen not only as an assertion of the bill’s constitutionality or as good public policy, but it will also vindicate Obama’s approach to governing and his judgment.
On the other hand, the Supreme Court could strike down the entire law, validating Republicans who from the start called claimed the bill was an overreach of government. However, no appeals court has gone that far.
If the Court strikes down the individual mandate while leaving the law’s other provisions intact, it would likely create chaos in the health insurance marketplace and make it almost impossible to keep the other popular but expensive insurance reforms. For instance, if the law still requires insurance companies to guarantee individuals insurance, the lack of a mandate would enable people to wait until they become sick or injured to buy health insurance, which would result in skyrocketing health care costs and make the system unsustainable.
Finally, the Court could rule that it is premature to decide the case until 2015, when individuals would owe the first penalty for not purchasing health insurance. This ruling would be based on a federal law that prohibits suits “for the purpose of restraining the assessment or collection of any tax,” with the term “tax” being broadly used.
Meanwhile, Republicans in Congress are developing plans to respond to the numerous ways the Court could rule —keeping the entire law in place, striking it all, getting rid of just the mandate, or getting rid of the mandate and other large pieces of the law.
The Republican plans are largely centered on traditional Republican health policy ideas, such as giving the tax break for health insurance to the employee instead of the employer, reforming medical liability rules, creating high-risk medical “pools” and allowing insurers to sell their products across state lines.
Regardless of the Supreme Court ruling, the decision will not be likely to end the debate on health care, as Congress will continue to dispute the role that government should play in this matter. House Speaker John Boehner has repeated his commitment to repealing the health care law and replacing it with a Republican plan regardless of the Court’s ruling.
Yet despite relatively widespread opposition to at least some aspects of the law, a repeal of the entire law by Congress is unlikely. Lawmakers may find it unacceptable to abandon the entire effort, given the fact that no one has agreed on any single comprehensive plan to cover anywhere close to the 50 million Americans who are still without coverage. Even with the law in effect, about 20 million will still be without insurance. Put simply, it will be difficult to reverse course completely.
Ultimately, regardless of what the Supreme Court decides about the constitutionality of the law, health care in America has changed in ways that are unlikely to be undone. There are popular provisions that are already firmly put in place as I indicated above – like stronger oversight of health insurers, the expansion of coverage to one million young adults, protection of the prescription drug benefit program in Medicare Part D, and coverage for those with pre-existing conditions. Whatever decision the Supreme Court makes, Congress will have to protect these key programs and initiatives in whatever health care policy emerges.