Friday, December 26, 2014

A Christmas and New Year’s Message about Obamacare’s Future

Now the question is, once again, whether ObamaCare will emerge intact from the Supreme Court. If the Court dramatically narrows the ACA’s scope, the political calculus will change substantially in 2015 and beyond, The law’s recent momentum will be reversed, the fight over ObamaCare will intensify, and the future of health reform will be highly uncertain.

Jonathon Oberlander, Ph.D, University of North Carolina, “Unraveling Obamacare – Can Congress and the Supreme Court Undo Health Care Reform?” New England Journal of Medicine, December 25, 2014

Occasionally a clear-eyed, crisp, and beautifully written summary of ObamaCare’s benefits and ills crops up. Such is the case with Jonathon Oberlander’s critique of ObamaCare in this week’s New England Journal of Medicine.

Oberlander says ACA’s fate rests with the Supreme Court, who will hear the case of the constitutionality of subsidies on April 4 and issue its decision in June.

But he says much more, namely.

• The GOP cannot repeal ObamaCare with Obama, with his veto power, as president.

• The GOP will likely focus on changing the individual mandate, the employer mandate, the tax on medical devices, and perhaps the Independent Payment Advisory Board.

• The Republican strategy will be to force Democrats to vote on bipartisan issues with a chance to pass, even if Obama vetoes them, thereby labeling the president as leader of the party of “No.”

• The GOP’s problem may not be it cannot repeal Obamacare while Obama is president but after his presidency ends “With each passing year, the ACA’s reach growls larger and iots roots become deeper- more Americans gain coverage, the health insurance marketplaces and Medicaid expansions become further entrenched, and medical providers become more dependent on ACA business."

• “The calendar, Oberlander concludes, cannot be turned back to 2009. The ACA has made some irreversible change in U.S. health care.”

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