Before the Supreme Court arguments began I was pretty confident they would rule as follows: The Anti-Injunction Act wouldn’t apply (they would move forward on the other items), they would narrowly determine the individual mandate to be Constitutional (requiring everyone to have some type of protection for health care costs), the Severability provisions wouldn’t apply (since the individual mandate would remain in place), and the expansion of Medicaid would move forward (since states aren’t necessarily “forced” to participate in Medicaid in the first place). After this week, I could be wrong on three out of four.
While oral arguments are seldom indicative of what the final results will be in a Supreme Court
decision, the picture that emerged last week was less than optimistic for the Affordable Care Act. All Justices seemed to indicate the Anti-Injunction Act does not apply so there was little disagreement between the sides. However, the government simply could not defend its position for requiring the purchase of health insurance for everyone, why the rest of the law should remain in-force even if the mandate was repealed, and why the Medicaid expansion is not a “coercion of federal power.” At times, listening to the government blurt its incoherent responses to questions was painful. If the Affordable Care Act is thrown out in its entirety, we will once again be starting over with health care and it’s not going to be any easier the next time around.
Republicans will continue to push to rely on the free-market which simply will not work in health care today. Democrats will move to a single-payer argument which will not be accepted by most of the population. We will once again be at a stalemate. In the meantime, individuals and families will continue to struggle with the system we have patched together and be destroyed by its rules and its costs. We have lost precious time and millions of dollars fighting this fight.
Hopefully, the Supreme Court will come to a legal and yet rational decision. If the individual mandate is ruled unconstitutional, let’s hope they keep some of the provisions in the Affordable Care Act that make sense and let Congress piece together a plan that can work- by fixing the delivery of health care first- and then worry about getting everyone in the game.
It’s what they should have done from the beginning.
