The Politics Of Obamacare After King v. Burwell
In the wake of the latest Supreme Court decision, the Affordable Care Act seems to have become even more firmly established than it was before last week, and the prospect of repeal has become even less likely.
As the dust has begun to settle after the Supreme Court’s ruling in King v. Burwell, there seem to be at least some perception that Republicans on Capitol Hill and elsewhere are breathing a sigh of relief:
Even as Republicans rose in a chorus of outrage Thursday over the Supreme Court’s refusal to gut the Affordable Care Act, party leaders were privately relieved.
Republicans were spared the challenge of having to come up with a solution for the 6.4 million Americans — most of them in conservative states — who might have found their health insurance unaffordable had the court gone the other way.
And as it moves into a presidential election season, the party can continue to galvanize the conservative base by railing against both the law and the high court.
“Every GOP candidate for the Republican nomination should know that this decision makes the 2016 election a referendum on the full repeal of Obamacare,” said Sen. Ted Cruz (Tex.), one of the 13 Republicans who have declared they are running.
At the same time, the court’s second ruling in favor of the five-year-old law has increased the pressure on Republicans to tell the country how they would fix the health-care system.
A Republican nominee for president will have to have a plan to replace the law,” said former Republican National Committee chairman Ed Gillespie, who in his failed Senate campaign in Virginia last year was virtually the only nationally prominent member of his party to come up with one.
David Winston, a pollster who advises the GOP congressional leadership, said, “Ultimately, the challenge for Republicans is not just how to deal with this law, but where’s the direction? Where are the alternatives?”
Republicans do have some ideas. They support, for example, the law’s provision preventing insurance companies from denying coverage to people with preexisting conditions and requiring them to allow parents to carry their young adult offspring on their policies. Most also argue for allowing insurers to sell policies across state lines.
Winston also pointed to a bipartisan proposal, advanced by House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) and ranking committee Democrat Diana DeGette (D-Colo.), that aims to accelerate the pace of medical breakthroughs.
But none of the GOP proposals would go as far as the Affordable Care Act has in guaranteeing coverage, and many health experts say that a piecemeal approach would send health-care costs soaring.
One thing that is certain: The issue will not go away.
“ObamaCare is fundamentally broken, increasing health-care costs for millions of Americans,” House Speaker John A. Boehner (R-Ohio) said in a statement issued by his office. “Today’s ruling doesn’t change that fact.”‘
Indeed, the initial round of rhetoric after the court decision suggested that the ruling had further inflamed the right and given the growing field of Republican presidential contenders a new battle cry.
“Our Founding Fathers didn’t create a ‘do-over’ provision in our Constitution that allows unelected, Supreme Court justices the power to circumvent Congress and rewrite bad laws,” former Arkansas governor Mike Huckabee said in a statement while campaigning in southern Iowa.
“The decision turns both the rule of law and common sense on its head,” Sen. Rand Paul (R-Ky.) said in a statement. “As president, I would make it my mission to repeal it, and propose real solutions to our health care system.”‘
While the legal issues surrounding the law are, with the exception of a few minor issues, largely resolved the issue of the Affordable Care Act specifically, and how the health care and health insurance industries in this country are structured is most assuredly not going to go away any time soon. From the Democratic point of view, the fact that the PPACA even has it is structured leaves millions of people uninsured and without access to regular health care will still be an issue that candidates and activists talk about on a regular basis. To some degree, we will see that battle manifest itself over the issue of Medicaid and the largely Republican-controlled states that have declined to take part in the expansion of that program under the Affordable Care Act. Beyond that, one can already see movement on the left toward something more than the PPACA although it’s generally a topic you only hear from the likes of Vermont Senator Bernie Sanders.
On the Republican side, things are a bit more complicated. For the time being at least, it is going to be impossible for pretty much any Republican to take anything other than a “repeal” position on the Affordable Care Act for the foreseeable future, at least through the 2016 election cycle. One need only look at the example of John Kaisch, who managed to win election and re-election in the vastly important (from the perspective of Presidential politics) state of Ohio, and before that has a record on fiscal issues that made him a star on the right, but who know is largely derided on the right because he chose to support Medicaid expansion. It’s simply politically impossible for a Republican to take any position on the PPACA other than “repeal,” even though it seems exceedingly unlikely to happen. Even if a Republican wins the White House in 2016, any bill that fully repeals the Affordable Care Act will have to somehow get past the filibuster rules in the Senate. Given the state of play of Senate races in 2016, the odds of the GOP winning a filibuster proof majority are fairly low, so I wouldn’t put much hope in that possibility. There’s been some suggestion that Republicans may be willing to end the legislative filibuster altogether if the GOP wins the White House, but that seems unlikely for many reasons not the least of them being the fact that even Ted Cruz is against the idea. If Republicans don’t win the White House, then they would need to hold the House of Representatives and a win veto-proof majority in the Senate in 2016. Since that’s unlikely to happen, you can pretty much write-off complete repeal off the table. What might be more likely would be a Republican sponsored bill that reforms significant parts of the PPACA while living much of the basic structure intact, but even that will require at least winning the White House, maintaining control of the Senate and making a deal with incoming Democratic leader in the Senate Chuck Schumer that convinces him not to lead a filibuster among his fellow Democrats. The most likely outcome it seems to me, though, is that eventually Republicans will shift from the position of trying to repeal the PPACA altogether, because they won’t be able to do it, and begin talking about reform of a law that even many of its proponents will admit could use some reforming. In that regard, I suspect that we will be seeing major Republicans advocating PPACA reform by the 2020 election, if not sooner than that.
In reality, of course, the political battle over Obamacare was over when President Obama won re-election in November 2012. At that point it was clear that Republican efforts to repeal the law before it went into effect in October 2013 would not succeed, meaning that millions of people would be signed up and receiving something from the programs established under the law well before the next opportunity to nullify the law would present itself. It’s also worth noting that the business community has largely accepted the law and adjusted to it, and the insurance and health care industries are strong supporters. Given all of that, it seems unlikely that a campaign centered around the repeal of a law that will have been in full operation for three years by the time the 2016 General Election takes place is going to be much of a winning message for Republicans. Perhaps I’ll be proven wrong about that, but it’s worth noting that the gap in the polls between those who approve of the law and those who disapprove has been shrinking in recently. That’s not to say that people are pleased with the state of health care, or that there aren’t serious issues on the horizon such as rising health care costs that will become issues in future campaigns. What it does suggest, though, is that a position of complete repeal and return to the status quo in March 2010 is not a winning political message in a General Election even if it might be one that is essentially required for anyone running in a primary in the Republican Party. Eventually, something is going to have to give in the inherent contradiction between those two truths, the only question is when it will happen and how Republicans will adapt to the new reality.