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.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

3 Responses to Health Reform, SCOTUS and Elections

  1. Pingback: Impact of Medicaid on jobs « freeforall

  2. Pingback: North Carolina Republican’s Intro bill to block Medicaid expansion and exchange « freeforall

  3. Pingback: ACA redistribution via Medicaid: what it means for future reform | freeforall

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