The Battle Over Health Care Will Continue

Eric Patashnik sends the following:

The Supreme Court’s decision that the individual mandate is Constitutional under the federal government’s taxing power is a huge legal and political victory for the Obama Administration.  Chief Justice Roberts found a middle path, granting the main conservative argument against the law (the federal government’s regulatory powers are not unlimited) but also allowing implementation of the law to go forward.  As I wrote with my colleague Jeffery Jenkins, this does not mean that the battle over health reform is over. The partisan and ideological struggle over Social Security continued even after the Court upheld its constitutionality in Helvering v. Davis in 1937.  Social Security’s political support was not consolidated until the 1950s.

Now the debate over Obamacare shifts to the presidential campaign trail—and back to Congress.  Look for GOP efforts to defund the law’s new benefits and bureaucracies through the filibuster-proof budget reconciliation process, especially if Romney defeats Obama and the Republicans hold the Congress.

So:  a major victory today—but the battle over health reform will continue.

Patashnik is the author of Reforms at Risk: What Happens After Major Policy Changes Are Enactedwhich is a useful book to be reading about now.

9 Responses to The Battle Over Health Care Will Continue

  1. Dan Hopkins June 28, 2012 at 11:41 am #

    In the same vein, is anyone tracking Senators’ and Senate candidates’ positions on the ACA? Have potentially pivotal Senators in the next Congress–folks like Tommy Thompson, Joe Manchin, Scott Brown, Linda Lingle, Susan Collins, Angus King, Claire McCaskill, Lisa Murkowski, etc.–committed to specific positions?

    • Matt Jarvis June 28, 2012 at 5:04 pm #

      Jon Bernstein has been tracking potential Senators’ positions on a number of things as expressed through their websites, and he’s posted more than a few summaries either on his page ( or in posts on WaPo, where he’s a blogger as well. I know he checks MonkeyCage, so maybe he’ll chime in.

  2. Elizabeth Rigby June 28, 2012 at 12:04 pm #

    In addition to “the presidential campaign trail and back to Congress,” the politics now really shift to the states — who hold even more power to shape implementation than the substantial power they were granted in the initial law (due to the Medicaid portion of today’s decision and the earlier HHS choice to let states define the “essential benefits” that plans must cover). This will be fascinating from a federalism perspective!

  3. Brian Brox June 28, 2012 at 12:04 pm #

    I would also be interested in hearing opinions (Prof. Binder?) on the likelihood that a President Romney and a less-than-60 vote Republican Senate could undo the ACA. Could it be done through reconciliation?

  4. Jim Garand June 28, 2012 at 12:11 pm #

    This is a good post. I agree that the battle over health care will move primarily from the courts to the political arena. Everyone has been waiting for the court to decide, but now that the court has weighed in the electoral stakes have increased and we should see this as a much more visible issue in the election.

    I do wonder about a couple of “hidden” issues in the decision. For one thing, the majority ruled that the federal government cannot penalize states for not participating in the expanded Medicaid program. This has gotten a lot less attention than the decision relating to the individual mandate. But does this have any implications for other cases in which the federal government has threatened states with a loss of funds if they do not comply with policies that are normally within the states’ purview (e.g., prohibition on 18-20 year olds drinking, the 55 mph speed limit, etc.)?

  5. Elizabeth Rigby June 28, 2012 at 12:30 pm #

    @Jim: I agree with you that the Medicaid part of the ruling has potential impact for lots and lots of federal-state programs. Today’s decision states that their concern stems from the very large penalty states would experience (about 10% of budget); and if I am remembering correctly, I believe the relatively small size of the highway/drinking age penalty to states was what allowed it to be constitutional in an earlier case. But, this does seem to open up a door for lots of legal challenges and complications in the many federal-state programs.

  6. Jim Garand June 28, 2012 at 1:46 pm #

    @Elizabeth–My (probably incorrect!) recollection is that the penalty was in the 10% range on highway funds for the under-21 drinking and 55mph speed limit cases. It was large enough that states felt that they were compelled to follow it, insofar as they stated that they could not afford the loss of funds of the magnitude found in those laws. Incidentally, Louisiana was one of the last holdovers on the under-21 drinking provisions (go figure!), and in the end the legislature concluded that they had no choice.

  7. Itsthespending June 29, 2012 at 1:47 pm #

    @brian. From what I have gathered, the tax ruling essentially makes repeal only need a simple majority. Not 100% sure, but that is what I read.

  8. Elizabeth Rigby July 2, 2012 at 10:08 am #

    @Jim: I agree that 10% of the funding is still pretty coercive (hence the 21 drinking age in NOLA!). But, the Medicaid penalty (which no administration would have ever administered, I feel quite sure) would be 10-20% of the entire state budget.