Defining “Massive” Supreme Court Damage

“We believe we hold the right position. If that’s what the courts decide ( a negative ruling on federal health exchange subsidies), we can’t undo the damage.”

Health and Human Services Secretary Sylvia Mathews Burwell, June 5, 2015

Obama administrations officials are making last minute statements to indicate a Supreme Court decision would cause widespread disruption of the health system, stripping low income people of subsidies, causing fewer of the young and healthy to sign on to the exchanges, boosting premiums and costs for the unsubsidized middle class, and precipitating a “death spiral” of the health insurance industry . To keep ObamaCare going as a viable enterprise, 34 states would have to create their own exchanges or strike a deal with federal authorities to help them build these exchanges.

Whatever happens, Secretary Burwell is optimistic Medicaid would continue to expand and insurers would have to continue to sell coverage for those with pre-existing conditions and young people under 26 on their parents’ plans.

Ms. Burwell is undoubtedly right when she says the Court’s decision would have a “massive “ effect on ObamaCare. It would be massive political defeat for the health law and President Obama’s legacy. It might also be a massive burden for Democrats in the upcoming 2016 elections, for Democrats “own” ObamaCare. It is their’s alone to perpetuate.

Its negative effects - rising premiums, often in the double digits; unaffordable deductibles; and declining access to doctors - are evident. On the other hand, the health law has reduced the number of uninsured roughly 20 million, if one counts the number signing up for health exchanges and those joining Medicaid. Some 25 million to 30 million remain uninsured.

If federal subsidies go down , Republicans face their own massive problems - how to explain a potential jump in the uninsured, how to avoid an insurance market “death spiral,” how to protect the newly “unsubsidized” until their program takes effect, how to scale back premiums and deductibles, how to present a comprehensive affordable ObamaCare alternative covering enough people to make it acceptable to the majority of Americans.

What may be going on here, according to a new book, A War for the Soul of America, is a cultural contest between “Normative America” - which prizes hard work, personal responsibility, individual merit, rewarding success, delayed gratification, sexual discretion, faith in God, American exceptionalism, equal opportunity but not equal outcomes, and upper mobility of the middle class - and “Sectarian America” – which favors bigger government, higher taxes backed by tighter regulations, universal health care, social justice and social equity, raising the lower classes and minorities and making them more dependent on government, protecting them from business exploitation, more sexual freedoms, less emphasis on religion, and America as just another player on the world stage, not as a world leader or policeman.