Rumour has it that the US Supreme Court will hand down its decision on Obamacare this month, with potentially far-reaching consequences for the health care system in the USA. Various supporters of Obamacare are either optimistic about the damage a decision to gut Obamacare will cause the Republicans, or pessimistic depending on how cynical they are about Republican motives. My personal opinion of Obamacare is that it is a vast improvement on the status quo, it is working to achieve its stated goals, and though it could be a lot better it is obviously an important reform to the health policy landscape in the USA that needs to be retained, so a decision to gut it by the Supreme Court would be a disaster for America. I also get the impression that a decision to gut Obamacare would have long-term negative consequences for the general political environment in the USA, since it sets a precedent in which a minor technical vagueness in a statute can be used to undo the statute even when everyone involved in framing, writing, debating, opposing and passing the statute was clearly aware of the plain meaning that the erroneous text supposedly makes unclear. This basically will lead to a long-term shift away from open political debate over policy to a process of Supreme Court gotchas, in which the opposition party finds some tiny detail in very large statutes that appears to be wrong, and uses the Supreme Court to smash them, and that doesn’t seem like a good governance outcome.
My guess [I won’t honour it with the word “prediction”] is that the Supreme Court will reject the plaintiffs’ case and keep Obamacare un-gutted, which leads to some interesting questions about the political situation as the presidential election nears:
- Will Republican states start to break with the national leadership and the tea party, and start setting up exchanges and taking the Medicaid expansions? What implications will this have for national Republican policy?
- Will the Republicans finally give up their opposition to this bill, accept that Obamacare is the law of the land, and start thinking about ways to contribute positively to health care policy?
- If they don’t, will the Republicans continue to find sneaky administrative and states’ rights workarounds, or will they try to fight openly on the politics?
- If they choose to fight openly on the politics, will they actually go to the 2016 presidential election on an explicit platform of repealing the law and taking away 6 million people’s insurance?
- How will that work out for them?
My guess is that a failure to convince the Supreme Court that a single misplaced pronoun on page 666 is the devil in the detail will leave the Republicans politically stuffed. They have made their opposition to Obamacare very clear but they don’t have the spine to make an explicit declaration of intention to repeal, and they don’t have the policy knowhow to craft an alternative. If they did, they would be running that and getting lots of help from their right-wing media friends, rather than pulling shameless stunts in the Supreme Court.
But will a Supreme Court decision in favour of the plaintiffs, which basically destroys Obamacare, be a political disaster for them? There are many questions to ask about the fallout for the Republicans in that case:
- Will the media spend months talking about the Republicans took away 6 million insurance policies? There was wall-to-wall coverage for months of Obama’s failed promise that noone would lose their plan – will we get the same coverage for the Republicans if they achieve exactly that outcome through a deliberate challenge?
- Will the media blame the Supreme Court, the people who launched the case, the people who funded it, the Republicans who supported it, the people who drafted and passed the law, or Obama?
- Will the Republicans bother to propose any solutions to the problems this decision would create, or will they literally just shrug and say it’s not their problem, as some expect them to?
- Will the Republicans then bother to go to the election with any alternative healthcare plan? They clearly don’t have one and haven’t been putting any effort into trying to prepare one, so it seems unlikely.
- Is there anything Obama can do in the current situation to fix the problem, even temporarily, through administrative means or will he have to go back to congress with a new bill?
- Is there any way that the Republicans can support any attempt to fix the problem, or are they actually seriously planning to remove 6 million people’s health insurance and then just stand back and do a golf clap?
My guess for answers to these questions is in order no, Obama, no, no, no and no. The Republicans actually believe that the situation before Obamacare was a better policy outcome, and they want to go back to that. Even if they thought otherwise, they don’t have the ability to develop nuanced policy on anything as boring and non-warlike as healthcare, so they can’t provide any alternatives anyway. Legislatively they are a joke, at which nobody is laughing.
My guess is that the next election is going to be a showdown between Jeb Bush and Hilary Clinton, which is itself such a deep and shocking indictment of American “democracy” that it’s hard not to laugh. The Republicans are going to go that election forced to make some really outrageous statements about their health policy plans, already dragging the deadweight of their “latino problem,” and after a long and bruising primary campaign in which they embarrass themselves repeatedly. Hilary Clinton is very popular and will remain popular, and it’s going to be really really hard for the Republicans to beat her. If they lose the Supreme Court case, they’re going to be fighting against her against a backdrop of this threat to remove health insurance from 6 million people. Do they have any chance of winning in 2016 if Obamacare is still in place? And how much damage can they do to the country if they do win?
These are hard times to be poor in America …