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Health Care / HEALTH CARE

Imagining a World Without ‘Obamacare’

Romney would be the best Republican for managing the aftermath of a Supreme Court rejection.

Holding a sign saying "We Love ObamaCare" supporters of health care reform rally in front of the Supreme Court in Washington, Tuesday, March 27, 2012, as the court continued hearing arguments on the health care law signed by President Barack Obama. Go ahead, call it Obamacare. Obama’s re-election campaign has lifted an unofficial ban on using the opposition’s derisive term for his health care law. Democratic activists have been chanting, "We love Obamacare," in front of the Supreme Court. And the campaign is selling T-shirts and bumper stickers that proclaim: "I like Obamacare." (AP Photo/Charles Dharapak)(AP Photo/Charles Dharapak)

photo of Jill Lawrence
March 29, 2012

Congress finally transcends dysfunction to address a serious problem that has vexed America for decades, and for its toil and trouble, its weekends and nights and vacations jammed with work, it is rewarded with--a harsh rebuke by the Supreme Court?

 

That would be epic, but everything about this saga has been epic.

 

 

The process that led to passage of the Affordable Care Act was long, sloppy, exasperating, littered with obstacles, and a turnoff for many citizens. It provided endless fodder for the hand-wringing school of reporting and commentary, a genre characterized by laments that Congress is paralyzed, broken, and partisan beyond reason.

 

Yet it also produced a landmark law that attempts to cover tens of millions of uninsured people, discourage medical freeloaders, improve care, and lower costs. If the high court strikes it down, in whole or in part, will members of Congress ever summon the resolve to tackle this problem again? And if they do, will they be able to find remedies that are constitutional?

 

It’s too soon to write the requiem for “Obamacare,” but it certainly seems as if several justices are ready to yank it from the ground by its roots. That would produce a lot of losers, starting with President Obama and the insurance companies that wanted all those new customers. Republicans and conservatives would feel like winners for a while, but theirs would be an ideological victory accompanied by a passel of practical problems.

 

First, there would be the scramble to put the toothpaste back in the tube. Would insurance companies terminate newly required coverage for children with preexisting conditions and young adults still on their parents’ policies? Would seniors start paying more for prescriptions and preventive care?

 

Then there are the prospective provisions. If you take away the act’s carrots and sticks, will hospitals stop trying to reduce infection and readmission rates? Will Medicare growth soar unchecked? Will states abandon their planning for insurance exchanges--the online, Expedia-type marketplaces that aim to foster competition and clarity for consumers trying to choose a policy?

 

Who would be happy about any of that? Who would get blamed? And, of course, what happens to the 50 million uninsured, many of whom would have received premium subsidies or Medicaid? It would be a fine mess and one that the real Congress, as opposed to the hypothetical Congress, would be unlikely to resolve with alacrity, if ever.

 

If the worst were to befall Obama, it’s hard to know if he would cut his losses in a second term or try to revive big chunks of the law. A lot would depend on the outcome of congressional elections. If Republicans do reasonably well, Obama probably could not count on much more cooperation than he has had in the past--that is, zero. If there’s a backlash against the GOP, Obama may find more willing partners.

 

Hard as it may be for Republicans to stomach, Mitt Romney--father of "Romneycare," godfather of "Obamacare"--is particularly well suited to manage the chaos that would ensue if the Affordable Care Act is struck down a few months before the presidential election.

 

Romney clearly sees health insurance for most or all as an important goal, or at least he did at one time, and he has hands-on experience in making it happen. He knows the value of state-fashioned exchanges and incentives, even mandates, to get people into the insurance market. He would bring to the table what was missing in the just-say-no fever of 2010--a constructive conservative perspective on the huge problems of rising costs and tens of millions of uninsured.

 

You won’t hear Republicans or Romney talking about any of that on the campaign trail. But if conservatives get what they want from the Supreme Court, the likely nominee many of them view as damaged goods over health care could well be the best man for the job.

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