The Supreme Court’s legalization of same-sex marriage Friday largely overshadowed its ruling the day before that upheld a key part of the Affordable Care Act. In the long run, though, that should be the more important. Obamacare is the law of the land, and undoing it has become close to impossible.
That same-sex marriage would get more attention is only natural. It is a hot-button issue for both supporters and their foes. And the word sex, in any context, gets noticed. But the critics’ fulminations notwithstanding, the fact is that in allowing same-sex marriage nationwide, the court directly touched the lives of few people.
Health care, however, touches everyone – through doctors, insurance, taxes and the overall economy. And with Thursday’s ruling, “health care” in this country means the reforms and systems derided as Obamacare.
The case decided last week turned on one phrase and whether the government could extend subsidies to people buying insurance through the federal-insurance exchange in states that refused to set up state-run exchanges. At issue was a 2012 rule issued by the Internal Revenue System that provided for those subsidies. (Colorado has a state exchange and thus would not have been directly affected had the ruling gone the other way.)
Nationwide, however, more than 8 million people could have lost their health insurance. The national market for health insurance would also have been thrown into disarray. That would have adversely affected all of us.
The court chose not to go there, however, by a 6-3 vote. It decided reading the whole law made clear that the intent of Congress in passing the ACA was, in Chief Justice John Roberts’ words, “to improve health insurance markets, not to destroy them.”
And with that, the court took an active role in ensuring the survival of Obamacare. It could have said only that the administration’s reading of the law was its call and let things stand.
That would have allowed a future president who opposed the act to end the subsidies with the stroke of a pen. But the court said the interpretation that allows for the subsidies was correct as a matter of law. That means undoing it requires changing the law. In other words, if they want to end Obamacare, Republicans will need control of the House of Representatives, a filibuster-proof 60-vote majority in the Senate and a cooperative president.
That is a tall order, one that is not mathematically possible until after next year’s election. Meanwhile, the number of Americans insured via the ACA continues to grow. There was already speculation that congressional Republicans stood to lose politically had the court ruled against Obamacare. How much stronger might that fear be in more than a year?
Last week’s ruling marked the third time Obamacare has been before the Supreme Court. And that comes on top of dozens of votes in the House to repeal it. It is past time for the president’s critics to recognize that the Affordable Care Act is not going anywhere anytime soon. Then, perhaps, they can work with him actually to improve how it works.