The case was filed against the federal government by Republican governors and attorneys general who claim that the ACA, aka Obamacare, is unconstitutional, a position also endorsed by US President Donald Trump’s administration. The recent hearing comes after lower court US District Judge Reed O’Connor dismissed Obama’s 2012 health care initiative as unconstitutional last year. O’Connor’s decision came after Trump signed a law in 2017 that eliminated a tax penalty under the ACA that requires all Americans to purchase health insurance or be penalized when filing taxes. O’Connor ruled that the removal of the tax rendered the whole of the ACA unconstitutional, but the ACA’s supporters disagree.
“So the politics of this whole health care issue with the ACA … is very interesting,” Luqman said. “Let’s say the Republicans prevail and get the court in New Orleans to uphold the unconstitutionality of the ACA, and presumably the headlines will read ‘The ACA is unconstitutional.’ Even though the ACA will not be immediately dismantled, because what will happen, in that event, [is that] the Democrats will immediately appeal the New Orleans court decision, and it goes to the Supreme Court.”
“So, nothing really happens with the law if the Republicans prevail in upholding the unconstitutionality of the ACA,” Luqman explained. “But politically, it would be a major win for the Republicans in 2020, giving them the talking point that they came one step closer on delivering on their promise to appeal [against] Obamacare, even though millions of their own constituents rely on the ACA, especially for covering preexisting conditions.”
“If the Republicans prevail, they’ve got a great talking point. But at the same time, if the court in New Orleans sides with the Democrats and does not hold the ACA to be unconstitutional, the Republicans can still say, ‘See, we are trying to deliver on this promise to appeal the ACA, and the Democratic courts won’t let us do it,’” Luqman added.
A 2012 Supreme Court ruling upheld the ACA but gave states the option to not participate in the law’s Medicaid expansion, allowing governors and state legislatures to make those decisions. Trump has pledged to repeal and replace Obamacare since the early days of his administration.
“It’s a double-edged sword. It delivers them this talking point they’ve been harping on for the past 10 years of repeal and replace Obamacare. But at the same time, the Democrats have been able to make inroads into this Republican base on the basis of the need for health care; Medicare-for-all is actually very popular among Republican voters. So, if the Democrats play this right … on Medicare-for-all, they can turn this talking [point] in their favor,” Luqman explained.
“The thing is, I am not confident that the Democrats are going to be that smart. I hope they will. I think [Vermont US Senator and 2020 Democratic presidential candidate] Bernie Sanders will be. But the Democratic Party, I’m not so sure.”
So, what exactly does Medicare-for-all entail?
The system would be a “single-payer” plan, which means that the US government would pay for any health expenses, eliminating all the other payers in the current US health care system, from insurance companies to state governments. In the US, Medicare and the Veterans Health Administration are examples of single-payer systems.
By contrast, people who are covered under employer-sponsored health plans or individual market health plans in the US are not participating in a single-payer system because thousands of different private insurance companies are paying their health claims.
“The answer to all of this, that eliminates all of the ambiguity and constitutional arguments, honestly is Medicare-for-all. Truthfully, it’s universal health care, but let’s just stick with the policy platforms that the Democratic candidates have now, and that’s Medicare-for-all. And honestly, the only candidates that are really advocating Medicare-for-all are Bernie Sanders and [Massachusetts Senator and 2020 Democratic presidential candidate] Elizabeth Warren, unequivocally. And I think even Warren walked back some of her support on it, but this is where Sanders is very clear, and the Democratic Party is very reticent. Because if you have a Medicare-for-all system, in which no one gets fined if they don’t have it because everyone is covered, then all of these arguments go away. But this is not something the Democratic Party wants to commit to, because they are still beholden to health insurance [companies],” Luqman explained.