Regardless of the ultimate legal ruling on the constitutionality of the ACA, the district judge’s decision throws a light on the opportunity and the need for policymakers to craft a system of health care policy that would improves health care for everyone. If the appeals court, and (probably) ultimately the Supreme Court, upholds the judge’s ruling, policymakers and the people will have to debate and decide on what replaces Obamacare. If the courts overturn the Texas judge’s ruling, then policymakers and the public will have to debate and decide how to fix the ACA’s flaws (in a divided Congress, no less) and use its mechanisms to improve the affordability and accessibility of health care.
Whatever the legal outcome, the ruling of PPACA’s unconstitutionality means we need to begin thinking about the future of health care and how to improve its affordability and accessibility for everyone, rather than re-living and relitigating debates and politics underlying the push for Obamacare.
What does this mean for state policymakers? It means they should begin planning and discussing how to re-envision an improved system of health care laws and policies that better serve the public good and re-establish states as primary decision-makers in health care policy. For example, it means taking the Trump administration at its word when it recently announced that it wants to give states greater flexibility and freedom from the restrictions of Obamacare by using State Relief and Empowerment Waivers. It also means using waivers and plan amendments to state Medicaid programs to transform that program into something that aids and encourages people in moving out of poverty, rather than handcuffing them to a life of poverty with the knowledge that moving up the economic ladder would mean losing health care coverage for them or their children.
What does this mean for federal policymakers? It means engaging in serious debate and negotiation over how to improve or replace various problematic components of the ACA, rather than simply waiting until after the next election to try to push something, only to produce nothing. A good place to start is the Health Care Choices Proposal, which is estimated to reduce individual market insurance premiums by up to 32 percent in just a few years, improve medical productivity by 12 percent in a decade, and reduce the federal deficit by $22 billion between 2020 and 2028.
The temptation among policymakers regarding the ruling, of course, will be to do nothing and wait for the court rulings to play out. In some cases this would be the reasonable response, because who wants to invest time, energy and political capital in something that the courts may soon rule out of bounds?
But this is different.
Whatever the courts decide, there is widespread recognition that further reform of health care policy is needed. Both sides want reform, so waiting to do anything until after the court process is complete accomplishes little more than kicking the can down the road. It would be one thing if such a delay promised to deliver an insurmountable partisan majority to one side or the other – for example, a filibuster-proof majority in the U.S. Senate. But no credible political or election analyst believes that is going to happen in 2020, so using that as an excuse for inaction amounts to shrugging our shoulders at the health care problems faced by millions of hard-working Americans simply because we don’t want to deal with the politics.
Instead of dismissing the plight of our neighbors, we must recognize the opportunity we have to make health care better for every citizen in America. Whether that happens because the courts force policymakers to act by striking down Obamacare, or because a bipartisan consensus over reforming the ACA is reached after long hours of debating and negotiating a solution, the time to start taking action is now.
Derek Monson is vice president of policy at Sutherland Institute.