Think the Supreme Court is where the future of President Barack Obama?s health care law will be settled? Think again.
The real verdict on the future of Obama?s signature achievement will come in November ? and the law?s supporters say a Republican sweep could pose a bigger threat to the law than the nine justices ever could.
Continue ReadingThe court is expected to hand down its decision at the end of its term in June. But most legal observers doubt that it will strike down the?whole of the?Affordable Care Act, even if it finds the mandate unconstitutional.
In contrast, the Republican candidates are all on record as promising to scrap the whole thing.
While a Republican president wouldn?t be able to hand out waivers for states to get out of all of the health law?s requirements, as some of the presidential contenders suggest, he?d be able to direct the new?Health and Human Services secretary to slow-walk pivotal programs, dramatically relax the regulations and possibly defund the law.
Front-runner Mitt Romney has pledged to repeal the law, and his policy aides are figuring out just how much dismantling could be done through the White House and HHS, without congressional action.
?I do think the law itself is in jeopardy? if a Republican wins the White House, said Neera Tanden, who served as a senior adviser for health reform at HHS during the legislative debate and is now president of the Center for American Progress.
A new president and HHS secretary would have a lot of power during their first year in office. That?s when HHS will have to finalize all the regulatory details for the state or federal health insurance exchanges where many consumers will buy coverage after 2014.
The concern of the law?s backers is based in part on the unknown: It?s unclear exactly how far a Republican administration would go to slow down the law, especially if there is backlash over getting rid of its popular pieces.
And it?s unknown whether the Senate or House will be controlled by Democrats, who could stop legislative efforts to repeal or defund the law. Even if they lose control of the Senate, Democrats may still have enough votes to be able to slow down or block efforts to repeal the law signed by Obama nearly two years ago.
Ron Pollack, executive director of Families USA and a strong supporter of the law, said the election is the ?most important development for the future of health care that could take place this year.?
Pollack said he?d be even more concerned about a Republican winning the White House if the Senate and House are controlled by Republicans, too, allowing them to run the table on repealing the health law.
Joseph Antos, a health policy expert at the American Enterprise Institute who opposes the law, agreed that the election matters more than the Supreme Court ? but he also said Republicans may have to compromise on repealing the whole law if they get public backlash over repealing its most popular provisions.
?I can?t see a Republican getting rid of guaranteed issue,? Antos said, referring to the provision that requires insurance companies to accept all applicants regardless of their medical history. ?Certainly no Republican is going to change the provision that says children under 26 can sign on to their parents? plans.?
John McDonough, who helped draft the health law as a senior adviser in the Senate and is now a professor at the Harvard University School of Public Health, sees the most extreme outcomes of Election Day like this: Republicans take the White House, and both chambers of Congress, allowing them to repeal significant pieces of the law through reconciliation. (That?s assuming there is little chance Republicans get a filibuster-proof majority ? though if they did, they could repeal the law immediately.)
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