I am not an attorney, and I don’t even play one on TV, so I do not want to venture onto the likely outcome of the Supreme Court challenge against the Patient Protection and Affordable Care Act (aka PPACA, or ACA, or Obamacare). If pressed, I would note that those who argue that the Court has for many decades not been kind to legal challenges based on the commerce clause of the Constitution seem persuasive. But that may be yet another rule that always is true, until it is not.
However, also on the table is the legislative repeal of the ACA – either in whole (“repeal and replace”) or in part (as in House Budget Committee Chairman Paul Ryan’s recently proposed budget resolution for fiscal year 2013). Neither of these approaches is going anywhere in 2012, with the Senate and the White House controlled by Democrats. However, both options could be live next year, depending on the outcome of the November elections.
CED recommended a “no” vote on the ACA when it came to the end of the process, because we believed that it did too little to contain health costs. However, it is worth noting briefly that the partial repeal of the ACA in the House budget resolution (it apparently would eliminate all of the provisions that spend money, but retain all of the law’s budgetary offsets) would scrap the law’s saving grace, which we highlighted throughout.
The ACA would create health-insurance “exchanges” to provide information and access to those who are not covered by employer plans. The exchanges also would deliver premium subsidies to families with modest incomes, which is why the House budget resolution would repeal them.
CED believes strongly in insurance exchanges to force private plans to compete for household customers, door-by-door, on the basis of quality and price. The exchange system was the heart of our own 2007 recommendation for reform. We believed that informed and cost-responsible consumer choice would force health plans to seek efficiencies while at the same time providing the highest quality of care. Competition works in every segment of the U.S. economy, from automobiles to computers to haircuts to restaurants. Businesses that fail to satisfy customers on the basis of quality and price must make way for those that do. Health care – which now is not subject to such competition – could, too.
As noted earlier, in a complex calculation of advantages and disadvantages, CED did not favor the ACA. However, it would be unfortunate if a selective repeal would terminate the most promising part of the new law, while retaining much of the rest. After 2009 and 2010, our legislators and our fellow citizens alike clearly suffer from “healthcare fatigue.” However, we just as clearly need another, better-informed, national conversation on healthcare reform.