Many call the Affordable Care Act (ACA), often referred to as Obamacare, the most important achievement of Barack Obama’s presidency. However, since it was enacted in 2010, several legal cases have been filed against the law, and it has now been brought to the Supreme Court of the United States. In late June, in the midst of the presidential race, the court will issue a final ruling on the constitutional legality of Obamacare.
The United States’ health care system is dominated by private insurers. While some Americans are covered through public insurance programs, most who are insured receive health insurance through their employer. However, many Americans are not even part of the system. In 2010, the number of people uninsured was roughly 50 million—16 % of the population.
The Affordable Care Act would provide major changes to the health care system. Supporters of the act claim it is an effective reform that reduces costs and improves access to affordable health care for families and small businesses. It would end coverage cancellations, pre-existing condition discrimination and in many ways strengthen national insurance programs such as Medicaid and Medicare. According to current estimates, over 20 million people would receive coverage through the ACA, from 2016 and on. What is being reviewed in the Supreme Court case is the part of the ACA that requires Americans to buy insurance before 2014 or else incur a tax penalty. The main issue before the court is whether or not this demand for “minimum coverage” exceeds Congress’ mandate under the American Constitution.
Opponents of the ACA argue that the “minimum coverage” policy is distinctively different from anything the government has done before, saying the act is imposing an affirmative duty on people. It is one thing for a government to prohibit a certain activity (which is what governments do all the time), but quite another to force people to do business with private companies. Some critics also assert the slippery slope argument: if Congress can force everyone to buy health insurance, then why not food or cars? What speak against this argument is that health care is a unique product; everyone—the sick and the healthy—must take part for the system to work. Allowing people to opt out would leave the country with a dysfunctional insurance system.
Considering these arguments and many more, it is now up to the Supreme Court of the United States to decide on the matter. The court is divided not only along ideological but also partisan lines; Republican presidents have appointed the five more conservative judges, whereas Democrats have appointed the four more liberal ones. Assuming the judges will vote along those lines, the liberal camp will need to win one of the conservatives over to their side in order for the law to pass. In March, the court heard arguments in the case and will now negotiate until it issues a ruling, possibly sometime at the end of its term in June.
Obama seems confident the Supreme Court will uphold his health care law. On the White House web page, the argument that the Affordable Care Act is unconstitutional is called a myth, with supporting reference from legal experts and federal judges appointed by Republicans and Democrats. Obama has spent a huge amount of political capital to get the law through Congress; a defeat would be a major setback as well as an important victory for Republicans. If the law is overturned and Republicans manage to present an innovative free-market solution to the problem, they could come out looking like keen problem solvers.
Further, should the decision go against Obama, his administration will have to rethink the issue during the presidential campaign. He could still score political points talking about the broken health care system. In fact, if only parts of the law are overturned, Obama could still advocate the use of other methods to have more people covered by insurance. However, if the law is overturned in its entirety, it is unlikely that Obama will take any other legislative measures considering there is only six months left until the election and the difficulties he faced in pushing the ACA through Congress. If Obamacare doesn’t pass the Supreme Court this time, it seems as though the United States will once again be a long way from a meaningful health care reform.