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Saturday, December 10, 2016

Once I imagined the Affordable Care Act would generate a mighty political force of Obamacare voters, but that time was long ago. Now I doubt there will ever be a groundswell of grassroots support for this besieged law. Tens of millions of people are benefiting from it, but too many don’t make the connection. Too many who do recognize how it’s helped them would never consider voting for a Democrat. And since virtually no Republicans support the act, well, you see the problem.

There’s only one scenario that might conceivably produce a “keep your hands off my Obamacare” army. That is if the Supreme Court guts the law, the Republican Congress declines to fix it, the whole thing falls apart, and a Republican president — elected at least partly by attacking it — signs an official repeal. The first casualties would be the several million lower-income people losing subsidies and dropping their coverage, especially the healthy ones who keep premium costs down for everyone. Then would come seniors confronting the sudden reappearance of the “donut hole” in their prescription plans; people with pre-existing medical conditions once again unable to get insurance, and other people knocking up once again against annual and lifetime insurance limits.

They’d all be upset. But how much do you want to bet that many of them wouldn’t connect the loss of these benefits and protections to the killing of Obamacare?

To compare the adventures of the ACA to The Perils of Pauline is not a stretch. “She fought pirates, Indians, gypsies, rats, sharks, rolling boulders, and her dastardly guardian,” Filmsite.com says of the 1914 serial. Like Pauline, the ACA has survived its share of existential threats.

Next week the Supreme Court will hear a case claiming that lower-income insurance customers in some three dozen states are not entitled to federal subsidies to help them pay for their premiums. The law requires most people to buy insurance, and offers online comparison shopping for those who don’t get insurance through work. Relatively few states set up their own sites, so the rest are served by a federal marketplace. The lawsuit is based on the notion that Congress didn’t mean for the federal website to offer subsidies. Which is ridiculous. And yet here we are, with arguments scheduled March 4.

The challenge rests on a phrase in the complex law about subsidies being available on exchanges “established by the State.” The plaintiffs’ interpretation hangs on those four words, with no consideration of the rest of the text, the law’s intent or its legislative history. Congress could fix the problem in a half-page bill by simply adding “or the federal government.” From a legacy standpoint, that might turn out to be what President Obama needs most in his last two years, as I write in my contribution to a new book, The Surge: 2014’s Big GOP Win and What it Means for the Next Presidential Election. But virtually every Republican in Congress ran on a pledge to repeal the ACA — so what are his odds?

There is always the chance the Supreme Court will follow its own precedents on considering context in interpreting a law. The justices could also decide that the plaintiffs in this case don’t have standing to bring it. Or, they could decide they must strike down the subsidies and warn lawmakers they need to be more precise.

Nearly two-thirds of America would want Congress to just fix the darn phrase, according to a new Kaiser Family Foundation poll. But polls haven’t moved conservatives on much of anything involving the ACA. Years of legal and political attacks on the law have been a boon to the Republican Party in the voting booth. That’s even though individual elements of the law are popular and it has already proved to be effective and sorely needed.

The uninsured rate dropped from 17.3 percent nationally in 2013 to 13.8 percent in 2014, according to Gallup — the lowest in the seven years the organization has measured it. Arkansas plunged from 22.5 percent uninsured in 2013 to 11.4 percent last year, Kentucky from 20.4 percent to 9.8 percent. Adoption of a voluntary Medicaid expansion, financed by the federal government, was key to the double-digit drops in those two states.

More than 20 states have not expanded Medicaid, creating needless financial and medical hardship for millions while crimping their own productivity and growth. Anti-Obamacare diehards on Capitol Hill, meanwhile, those unworried by an avalanche of chaotic medical and economic consequences, would cheer a Supreme Court ruling that starts the law on the road to ruin. So far, the brief life of the ACA is proof that what doesn’t kill you makes you stronger. But that only lasts until someone delivers the deathblow.

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.

Photo: Matt H. Wade via Wikimedia Commons