The political world is on pins and needles, waiting for the Supreme Court to hand down its ruling on President Obama’s sweeping reform of the health-insurance system. A decision could come as early as Monday.
At the White House, on Capitol Hill, in the Romney campaign, and inside interest groups, political players are preparing contingencies for the range of possible outcomes at the high court – from full affirmation of the law, to full rejection, to something in between.
Tough questioning from some justices, especially “swing” justice Anthony Kennedy, has led some observers to believe the individual mandate to purchase insurance – or even the entire law – could be ruled unconstitutional. But no matter how the court decides, the stakes are high, as Election Day draws closer.
Publicly, Mr. Obama and his surrogates express confidence that the court will uphold the Affordable Care Act. Implementation is proceeding on schedule, they say. Still, at the White House correspondents’ dinner in April, the president joked: “In my first term, we passed health care reform. In my second term, I guess I’ll pass it again.”
Administration officials have been attending meetings with groups that support his reform, strategizing about how to respond when the court rules.
“The best way to demonstrate public outrage or public celebration about the decision is to stage an event that shows average people actually responding to the news,” said a May planning memo obtained by Bloomberg News from an official at the Herndon Alliance, a coalition that supports Obama’s reform.
At a White House forum June 11 for seniors, a top Obama aide made clear that she’s thought about the “what ifs.”
The changes already in place “are terribly important to people’s lives, now,” said Cecilia Munoz, director of the White House Domestic Policy Council. She spoke of the popular provisions that pay for the coverage gap for prescription drugs under Medicare and allow young adults up to age 26 to stay on their parents’ insurance.
Republicans and Democrats on Capitol Hill have both been gaming out scenarios. The House Republican leadership put out talking points on what to say if the Supreme Court throws out some or all of the law.
“Unless the court throws out the entire law, we need to repeal what is left of Obamacare and enact common-sense, step-by-step reforms that protect Americans’ access to the care they need, from the doctor they choose, at a lower cost,” said the memo.
The talking points also advised against repeating the Democrats’ “mistake,” and rushing to pass “a massive bill the American people don’t support.” But divisions are cropping up among House Republicans. Some, like Rep. Phil Gingrey (R) of Georgia, a physician who heads the GOP Doctors Caucus, want to ensure that people with preexisting conditions are still able to purchase insurance. Other provisions popular with the public – see young adults on parents’ insurance – get Republican backing, and could be introduced as stand-alone legislation.
But some conservatives are adamant that no aspect of Obama’s reform should survive. “I don’t want any vestige of Obamacare left in law,” Rep. Steve King (R) of Iowa said last month, according to Politico. “Not one particle of DNA.”
House Democrats, for their part, have been given statistics-filled pocket cards to carry around, The New York Times reports. Per the cards, 86 million people have received free preventive care; 105 million people no longer face a lifetime cap on benefits; and up to 17 million children cannot be denied coverage due to preexisting conditions.
If the reform is thrown out in part or in total, it will certainly be an embarrassment to Obama. But the Democrats can argue that they gave it their best shot and the Supreme Court undid their work. There are already suggestions that Democrats will claim political motivations on the part of the court’s conservative justices.
“You’ve now seen a series of what seem to be extremely partisan decisions out of the Supreme Court, from Bush v. Gore to Citizens United to taking on the Affordable Care Act months before the election,” says Neera Tanden, president of the Center for American Progress, a Democratic think tank close to the White House. Ms. Tanden was also part of Obama’s White House health-reform team.
If the court strikes down the whole law, that would be “an incredible act of judicial activism at a time where you’ve already seen the standing of the court declining,” Tanden continues. “I hope the ACA will disprove that theory, and they follow precedent.”
But as pained as the Democrats will be if Obama’s reform is tossed out, in whole or in part, it’s the Republicans who could face bigger political pressure. The ball will be in their court. Mitt Romney, the likely GOP presidential nominee, outlined a plan June 12 to make the health-insurance system more like a “consumer market,” in which competition drives down prices and boosts quality.
Mr. Romney said it was important to make sure “every American has access to good health care,” but that it was the states’ job to care for people in the way they feel is best. He also said his plan would cover people with preexisting conditions.
As governor of Massachusetts, Romney instituted a health-insurance reform with an individual mandate that served as the model for Obama’s reform. That fact proved problematic during the GOP primaries; but now that Romney has effectively won his party’s nomination, he can speak more freely.