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Thursday, December 8, 2016

When the Supreme Court rules on the latest challenge to the Affordable Care Act, I’m hoping the justices will say the intent of the law is crystal clear, uphold the subsidies that help people pay for health insurance, and spend at least a few pages reaming out Congress for not doing its job. Twice.

Democrats’ harried search for a way to pass the ACA, after slow-walking through 2009 and losing their filibuster-proof majority in early 2010, will not soon be forgotten by anyone who followed the rock-strewn path to enactment. Still, that’s no excuse for “established by the State” — the phrase that has thrown into question whether residents of states with federal rather than state insurance marketplaces are eligible for the subsidies that make coverage affordable. Think of all the time and energy that lawyers, politicians, judges, lobbyists, and health policy analysts could have devoted to more productive pursuits had just one Democrat on Capitol Hill noticed that sentence and tacked on “or the federal government.”

Even worse, think of how easy it would have been for Congress to fix the problem once it became known. Congressional Republicans despise the law so deeply, or at least profess to, that nearly every single one of them ran on vows to repeal it. But they are having tremendous difficulty coming up with an alternative to Obamacare. They can’t even agree on whether or how to simply preserve subsidies for a while should the Supreme Court strike them down in King v. Burwell, a decision expected within the next couple of weeks.

The case has put some 6.4 million people at risk of losing their subsidies and coverage, a possibility that has begun to worry some Republicans. They could have saved themselves and everyone else a lot of trouble by passing a temporary fix with an expiration date. That would have been smart politically, too, since most of those relying on subsidies live in presidential and Senate battleground states.

For as long as the ACA has been under discussion — six years now — Republicans have let ideology override practicality and even principle. That’s been evident in their refusal to make technical fixes (usually routine after a major new law takes effect) or even changes that move the ACA in a more conservative or business-friendly direction. It’s also been evident in the refusal of most Republican governors to set up their own insurance marketplaces and to rely instead on the federal exchange — a triumph of hostility toward President Obama and Obamacare over devotion to state control and autonomy.

Underpinning the relentless resistance is the hope and faith that the law will disappear. But that’s not going to happen. The need for it, or something like it, is simply too profound.

The most obvious proof is in the numbers. The ACA has led to a net increase of more than 14 million people with coverage, according to Charles Gaba at ACASignups.net, and Gallup pegs the rate of uninsured at 11.9 percent this year — down from 18 percent at one point in 2013. There’s far more to the law than that, however. It has helped people in largely unheralded ways that fall mostly under the often forgotten first phrase of its official name, the Patient Protection and Affordable Care Act.

I was reminded of that protection twice this month. Once was when Extra correspondent Jerry Penacoli said in a Rose Garden interview with Obama that the ACA helped him survive melanoma and thyroid cancer. The law bans lifetime coverage limits, enabling him to receive the treatment he needed. “You pretty much saved my finances and my life,” Penacoli told the president.

The other reminder came when I opened a file folder and discovered a long-ago letter to my son. It was dated a month before he turned 19. “Recently, we were notified of your loss of dependent eligibility status on October 31, 2004,” the letter said. “As a result, your current coverage ends.”

I remember the shock of learning he had been kicked off the family policy and the scramble to figure out how to get him covered. Now, under the ACA, insurance companies must give parents the option of keeping kids on the family plan until they turn 26. So that is a shock and a problem no one will ever have again. The same is true for running up against annual or lifetime limits on benefits, and for getting rejected by an insurance company for having a medical condition, even a minor one.

For millions of others, the law and its subsidies have also ended the problem of being priced out of health insurance. But it will be back if conservative justices on the Supreme Court grab the opening handed to them by a sloppy Democratic Congress and an intractable Republican one.

Follow Jill Lawrence on Twitter @JillDLawrence. To find out more about Jill Lawrence and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com. 

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