That the Affordable Care Act (aka “Obamacare”, “Baucus-care”, or “Obamneycare”) survived is indeed huge. But the discussion about the law has been extremely narrow thus far.
The mandate is often described as its “centerpiece”, which has been true politically, but only kinda-sorta in terms of policy. It’s an unlovely way to get to universality, and one that we at BMG were skeptical or contemptuous of when Governor Romney introduced it to the negotiations back in 2005. Yes, let’s remember that not only did Romney sign the law that included the mandate — it was his idea to put it in there.
And yet, the number of people it would actually affect is scant, compared to the many millions who would benefit from subsidies, exchanges, and Medicaid expansion. I’m actually much more concerned that the court’s nixing of mandatory Medicaid expansion by the courts could leave a lot of poor people uninsured and ineligible for subsidies. And some states are wingnutty enough to leave federal bucks on the table to do exactly that, if for no other reason than that Nancy Pelosi said they probably wouldn’t.
In any event, I hope the decision takes some of the emphasis off of the mandate, the most controversial and difficult part of the law. I hope it moves polls and legitimizes the law in some folks’ eyes. But most importantly, I hope it changes the discussion to the wide range of things that the law does, making health care fairer, more available, more accessible and hopefully more efficient as well.
Keep this litany by the bedside:
And here are the President’s very apt remarks: