What Happens if the Court Overturns Health Care Reform?

Mike TuffinManaging director of APCO Worldwide’s Washington, D.C., office, Mike Tuffin previously served as executive vice president of America’s Health Insurance Plans (AHIP).

In Washington, we tend to over-analyze things. Surf through cable news channels and you will inevitably hear pundits and strategists straining to devise fashionably counter-intuitive interpretations of current events. That will surely be the case regardless of how the Supreme Court rules on the Affordable Care Act (ACA).

Still, there will be no way to spin a ruling overturning health reform as anything but an historic, defining loss for President Obama. Such a ruling would surely energize Democratic activists. And, yes, certain health policy issues that will re-emerge, such as pre-existing conditions, are favorable for the president. But the bottom line is that this ruling will mean that the president devoted more than three years to waging a bitterly divisive, partisan health care battle during a tough economy and emerged with…absolutely nothing to show for it.

Republicans will feel triumphant. Democrats will feel betrayed. Independents will be concerned about what comes next.

Democrats will be tempted to run against a so-called activist Republican Court that has taken away health care benefits that were duly enacted through the legislative process. Coming on the heels of Bush v. Gore and Citizen’s United, such a call to liberal arms will resonate deeply with core Democratic voters and boost fundraising. Yet swing-state swing voters are unlikely to be moved. Candidate Obama ran as the one who would bring people together, transcend the petty partisan squabbles in Washington and actually solve problems—not the finger pointer in chief. Blaming the ref may rile up the home crowd, but it doesn’t grow the fan base.

Suffering a loss for the history books does not mean the president cannot ultimately gain the upper hand on health care with moderates and Independents. These voters can be very forgiving if they feel a politician has listened and learned.

Resisting the temptation to placate his base will not be easy because raging against the Court will play very well with the president’s supporters. It’s easy to imagine the famously competitive sports-nut president displaying a newfound edge on the campaign trail as he takes on the unelected conservative justices. Moderates would rather see a rare dose of humility combined with pragmatic resolve to make steady, lasting progress with incremental reforms that voters in both parties support, such as re-codifying the insurance provisions that are already in place and re-closing the Medicare donut hole. Anything that sounds like it will disrupt voters’ current coverage, burden struggling small employers or divert funds from Medicare will be non-starters, as will big new federal spending schemes in the current economic and fiscal environments.

Should the Court overturn, Republicans would be very wise to heed Speaker Boehner’s admonition that they not spike the football. The forthcoming ruling is neither a judgment on the policy merits of the Democrats’ law, nor a validation of the Republicans’ policy critiques. The Supreme Court will base its decision solely on the justices’ collective interpretations of the Commerce Clause, constitutionality and severability.

Some have speculated that a ruling overturning the ACA may actually harm Republicans and the Romney campaign in the near term based on the theory that GOP voters will feel they have accomplished their mission and lose motivation for the fall. Don’t buy it. If the Court strikes down health care reform exultant GOP voters will sense an opportunity to win everything and to vanquish a president whom they sincerely believe has an irreconcilably different understanding of what America is.

The political paradox of health care reform is that it has twice in recent history delivered the Speaker’s gavel to Republicans, yet the electorate hardly trusts the GOP with the issue. Republicans are clearly effective at running against Washington overreach in health care, but are still widely seen as too ideological and too close to corporate interests on an issue that is hyper-personal to voters. Republicans’ B-school health care rhetoric about consumerism and markets turns off health-care-conscious voters, mainly women, who are intensely concerned about kitchen-table access and affordability issues.

Overturning the ACA will be a devastating setback for a president struggling to make a compelling case that he should be rehired amid painstakingly slow job growth and nightmarish fiscal conditions. But it is not a victory for Republican health policy prescriptions. It is a reset. And the debate about reforming the sector that is fast approaching a staggering one-fifth of the U.S. economy will start anew.

Posted on Wednesday, June 27th, 2012 By Mike Tuffin
Catogories  Health Policy and tagged , , , ,
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