- The U.S. Supreme Court has ruled largely in support of President Barack Obama’s health care reform law. Watch for continuing coverage and analysis from Maclean’s Luiza Ch. Savage.
- There was much confusion during the initial reporting of the ruling, as Jaime Weinman explains. Follow his coverage here.
- In the following story from current edition, Maclean’s considered the swirl around the decision:
It’s a potential bombshell looming over the American presidential election.
Sometime later this month, the U.S. Supreme Court will rule on the fate of the signature domestic policy accomplishment of President Barack Obama’s administration: his health care reform law, which delivered the long-held Democratic dream of universal health insurance.
But the massive legislation, the Patient Protection and Affordable Care Act, came at a price. It swallowed so much political energy and sparked so much opposition that other Democratic ambitions—climate change legislation and immigration reform chief among them—were left to wither. And the Tea Party backlash it helped fuel cost the Democrats control of Congress in the 2010 midterm elections.
If the justices strike down the law, it would be a blow to the President’s image just as he fights for re-election—a vindication for the Republican coalition and a frustrating defeat for the Democrats who invested so much in the law. “If they strike it all down, it’s a huge victory for the Tea Party grassroots—we’ll do a victory dance on Pennsylvania Avenue,” said Dean Clancy, vice-president of health care policy for Freedom Works, a Tea Party-aligned advocacy group. But a defeat at the hands of the Supreme Court could also create a new rallying cry for liberals. Both sides anxiously await the decision.
The U.S. top court has been asked to decide whether the federal government has the constitutional authority to require all Americans to obtain health insurance, including, for those who do not get it as an employer benefit, purchasing it on the private market or facing a fine (subsidies would be offered to those who qualify). The U.S. Constitution gives Washington the power to “regulate commerce” between the states. Few doubt that health care counts as commerce between states, but the 26 states that brought the suit say that this does not include the power to force individuals to enter into commercial agreements they don’t want in the first place. It appeared from the questions they asked in the oral arguments last March that several of the justices share this skepticism.
It is ironic that the fate of Obama’s legacy may rest with this provision, known as the “individual mandate.” After all, when Obama ran against Hillary Clinton for the 2008 Democratic presidential nomination, he, too, opposed the individual mandate, calling it unnecessary. It was only after taking office that he became persuaded that the other features of his reform—requirements that insurance companies cover people with pre-existing medical conditions, for example—would not be feasible unless young and healthy people were required to buy insurance to help subsidize the costlier patients.
The second irony is that the individual mandate was initially proposed by a conservative think-tank to solve the problem of the tens of millions of people who lack health insurance. This way, the system doesn’t rely on a government program; rather, Americans buy insurance on the private market.
Obama disappointed many liberals by taking the so-called “public option” off the table, but the market-based approach was more palatable to conservatives and insurance companies who feared it would eventually swallow the market and lead to a single-payer system like Canada’s. This was in fact a key feature of the health care system presumptive Republican nominee Mitt Romney brought in as governor of Massachusetts. (The U.S. Constitution does not limit state government powers in the same way as federal ones.)
All this could change with the court decision. If the justices strike down the mandate it would “deflate the Democrats somewhat—unless there is a real bold move by the President,” says John Hlinko, a Democratic strategist and founder of Left Action, a large network of progressive grassroots activists. “He could say, ‘They struck down the mandate? Okay, then it’s time to have Medicare for all.’ ” Hlinko hopes the President will seize the issue of Canadian-style health care and motivate the Democratic base. “I would say, ‘We tried to compromise. We tried the individual mandate. And now it’s time for what we know to be the best system, which is single-payer. And I would push that even if there is no hope of getting it passed.’ ”
Whatever happens, both sides say they’ll turn any defeat at the courthouse into a political cause. “If they uphold all of it, it’s a huge energizer for us to work to elect politicians who will repeal it,” said Clancy, the conservative. “And if they strike down the individual mandate and leave the rest of the law—then it’s a huge victory and an energizer to complete the job of full repeal.”