Having upheld the constitutionality of the Affordable Care Act under the Congressional taxation power, by a 5-4 majority, the Supreme Court has also delivered a personal vindication to Barack Obama — and given the lie to Mitt Romney’s accusations about the president’s lack of “leadership.” The irony of the court’s majority decision, written by Chief Justice John Roberts, is its exposure of Romney’s own leadership deficit.
For the Republican candidate, the Supreme Court decision does more than merely shut down the Tea Party arguments he has echoed over the past several months. Regardless of the details — not all of which are salutary, especially concerning Medicaid — the conclusion of this episode in law and politics is a grave wound to Romney’s image and, if he still possesses any, his self-respect. Here is a man who imposed a mandate on his own state’s citizens, in order to achieve universal coverage, and then ran away from his own actions for pure political expediency.
Now the Obama administration must do what it should have done over the past three years: Persuade the American people that the act’s survival is a victory for them. Had the Supreme Court’s right-wing majority vacated all or part of the Affordable Care Act as unconstitutional, said Mitt Romney, then the president would have “wasted” his term in the White House. “If… Obamacare is not deemed constitutional, then the first three and a half years of this president’s term will have been wasted on something that has not helped the American people,” the Republican candidate told supporters at a rally in Virginia on Wednesday. “If it is deemed to stand, then I’ll tell you one thing. Then we’ll have to have a president, and I’m that one, that’s gonna get rid of Obamacare,” he vowed.
Well, whatever Romney means by “Obamacare,” he no doubt assumes that to most Americans it represents ill-advised and even oppressive legislation – and never mind its well-documented paternity in his own Massachusetts health care plan. Having once embraced the objective of universal coverage and the mandate as its means, he evidently believes that he can abandon principle without consequence. Yet he and his fellow Republicans, who have vowed to uproot health care reform, will surely discover, along with the American people, that its benefits are indeed popular – and that its would-be killers may pay a heavy political price.
The long-term predictive value of polls showing that most voters revile “Obamacare” is questionable, if only because surveys have demonstrated how little most voters still know about the actual content of the Affordable Care Act. When people are asked about the bill’s specific aspects, they approve nearly all of the important provisions by overwhelming margins. And however ignorant they may be now, their knowledge is likely to improve when they learn what is being taken from them.
Consider the recent Reuters/Ipsos poll, which found substantial majorities of Republicans and independents — and voters overall, by a margin of 56-44 percent — reaffirming that they oppose the law. But delve below surface impressions and it becomes clear that what the law does, except for the individual mandate, is popular not only among Democrats and independents but, as both Ezra Klein and Greg Sargent have noted in the Washington Post, among Republicans as well.
The Reuters poll synopsis explains that aside from the individual mandate, its major reforms are highly popular:
Support for the provisions of the healthcare law is strong, with a full 82 percent of survey respondents, for example, favoring banning insurance companies from denying coverage to people with pre-existing conditions.
Sixty-one percent are in favor of allowing children to stay on their parents’ insurance until age 26 and 72 percent back requiring companies with more than 50 employees to provide insurance for their employees.
The poll’s crosstabs reveal that 80 percent of Republicans agree with the president’s plan to create “an insurance pool” that brings the benefits of large group pricing to small businesses and uninsured families and individuals — which is also supported by 75 percent of independents. Big majorities of Republicans and independents also support subsidies for those who cannot afford insurance, requiring firms with more than 50 employees to provide insurance, permitting children to use their parents’ insurance until age 26, and banning the denial of coverage to those with pre-existing conditions and policy cancellation because someone becomes ill.
Of course, those are all vital benefits of the Affordable Care Act that Romney, Speaker John Boehner, Rep. Paul Ryan and the entire Republican leadership have vowed to repeal – without explaining what, if anything, will replace them. Moreover, as Romney knows very well, few of those provisions can stand in a system of private insurance without the individual mandate, which ensures adequate funding for universal coverage and prevents companies from gaming risk by picking off healthy clients. There are other ways to address those problems – including the single-payer or public option, or the German model, where a a government-run central fund controls risk for the entire system.
The struggle for decent universal health care is a moral imperative and anything but a waste of effort, regardless of Romney’s pandering to the Tea Party crackpots (who cherish their “socialist” Medicare, according to other polling data). Ultimately the painful process of reform and reaction should educate Americans about the real choices before us. When that happens, the Republicans Capitol Hill may still seek to strike down “Obamacare” in their hatred, only to see it become a more powerful force they can possibly imagine.
Updated at 10:48 a.m. on Thursday, June 28.