Ruling allows Americans to weigh in on what happens next.
This artist rendering shows Supreme Court Justices from left, Sonia Sotomayor, Stephen Breyer, Clarence Thomas, Antonin Scalia, Chief Justice John Roberts, Anthony Kennedy, Ruth Bader Ginsburg, Samuel A. Alito, and Elena Kagan inside Supreme Court in Washington, Monday, June 25, 2012.
Thanks to the U.S. Supreme Court, the question of how Americans should provide and pay for their health care needs is back where it belongs — in the realm of politics, not constitutional law.
In its ruling Thursday upholding nearly all of the 2010 Affordable Care Act (ACA), the high court served this nation well. In an opinion that hewed narrowly to the law and eschewed partisan ideology, a 5-4 majority determined that no constitutional impediment stands in the way of the law’s requirement that all Americans purchase health insurance.
Further, it upheld the law’s extension of Medicaid to more people — though it struck down the ACA’s requirement that states must agree to and participate in that extension in order to receive any federal Medicaid funds. Minnesota has already made the extension. It was DFL Gov. Mark Dayton’s first policy act as a new governor on Jan. 5, 2011.
Minnesota’s 84,000 new Medicaid recipients are some of the millions of Americans who can rest easier in the wake of the court’s ruling. It’s also more likely that low-income Americans will receive primary health care in clinics rather than costly emergency rooms. It means that more struggling young adults can stay on their parents’ insurance plans through age 26.
It means that seniors have less reason to worry that they will again fall into a Medicare “donut hole” and be forced to pay several thousand dollars more per year for prescription drugs. It means that people with pre-existing conditions have less reason to fear that they will be denied coverage. And thousands of small businesses have already taken advantage of tax credits designed to help them provide health insurance.
Those Americans who have struggled with the country’s inadequate health insurance patchwork have much to gain from the ACA. They are the biggest beneficiaries of Thursday’s ruling.
President Obama and the Democrats, who enacted the ACA with nary a single GOP vote, have plenty to crow about as well. But they also have more work to do. Backers of the ACA have failed to adequately explain and sell their landmark law to the American people. Their reticence has allowed the law’s opponents too much opportunity to mislead the nation about its merits and its costs. As a result, despite the court’s affirmation, the ACA remains at risk.
Within moments of Thursday’s ruling, leading Republicans — including presidential candidate Mitt Romney — renewed their vow to seek the ACA’s repeal. Democratic politicians ought to take the GOP at its word — even if the Republicans soon switch their campaign narrative back to the economy, as we expect they will.
Minnesota GOP U.S. Senate candidate Kurt Bills quickly showed how the court’s majority opinion would be spun by the GOP. Because Chief Justice John Roberts argued that the individual insurance mandate can be likened to a tax, Bills said of his DFL opponent: “Amy Klobuchar voted for the largest tax increase since the imposition of the income tax.”
That bit of political offense should be answered with a robust defense: Requiring that people either buy health insurance or pay a tax penalty is a tool to get them to take personal responsibility for their health care costs. Too many of the uninsured become health care freeloaders when they are sick or injured. Minnesotans who already buy health insurance paid nearly $500 million in additional premiums last year for such freeloaders. The ACA will lift that burden.
Beginning in 2014, key provisions of the law kick in to make coverage more affordable. Americans with incomes between 100 and 400 percent of the poverty level — up to $88,000 for a family of four — will be eligible for tax credits to help buy private insurance. The protections for adults with pre-existing conditions take effect in 2014, as well as safeguards that prevent someone who’s ill or aged from paying prohibitively high premiums. State health care exchange are also scheduled to become operational in 2014, which should help control the cost of policies for people who buy on the individual market.
Americans deserve to hear that kind of explanation of the law many know as “Obamacare” — a term the president would be well advised to embrace. He should take the lead in explaining the ACA’s poorly understood subsidies to help low-income households buy insurance. He should help Americans see the ACA’s little-noticed measures aimed at controlling health care inflation — measures that are at risk if Republicans control both ends of Washington’s Pennsylvania Avenue.
The still-struggling economy is bound to be the dominant campaign theme for the next four months. That’s as it should be. But by tossing the health care issue back into the political arena, the Supreme Court has given Americans a chance to be more than passive spectators of what happens next on that front. Voters should seize that chance and bone up on the ACA reforms.
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