LITTLE ROCK — The Supreme Court’s decision Thursday to let the core elements of the Patient Protection and Affordable Care Act stand kicks the fate of the Barack Obama administration’s signature initiative where it properly belongs-into the domain of politics-where a Mitt Romney administration would still have ample opportunity to dismantle the main elements of the law.
One thing President Romney probably couldn’t do, however, would be the politically expedient step of simply repealing the legally controversial and politically unpopular fine levied on people who decline to purchase health insurance. Both Romney (who embraced a mandate as governor of Massachusetts) and Obama (who opportunistically opposed a mandate when running against Hillary Clinton) understand the basic issue here. Requiring insurance companies to accept all customers and charge the same price regardless of their state of health (“guaranteed issue” and “community rating” in wonk-speak) are popular but unworkable ideas. If people can buy insurance after they get sick, then there isn’t enough money coming into the system to cover the bills of the people who are sick.
The Democrats may come to rue the day that they decided to delay implementation of the main parts of their signature initiative all the way until 2014. The upside of delaying implementation was that it superficially made the cost of the bill inside the 10-year scoring window used by the Congressional Budget Office look smaller than it otherwise would. The downside is that they made it much simpler for Republicans to take some unpopular actions in 2013 than might have been the case. Once the insurance exchanges created by the law are in place, repealing the guaranteed-issue and community-rating provisions would mean throwing millions of sick people off their insurance plans. That would create a large and concentrated constituency of people who’d be informed by their doctors and their insurers about possible legislative changes.
And it turns out that the provisions a Romney administration would need to repeal to gut the law are wildly popular. According to a Reuters poll earlier this week, 78 percent of self-identified Republicans favor “banning insurance companies from denying coverage for pre-existing conditions” and 86 percent of them support “banning insurance companies from canceling policies because a person becomes ill.”
In other words, once the basic framework of the law is in place, it’ll be all but impossible to kill.
The problem for Democrats is that if Romney takes office in 2013, none of this stuff will have actually happened yet. Repealing the law in its abstract form is a bit politically risky for Republicans but not nearly as risky as it will become in the future.
Scrapping the law, in other words, should be a pretty easy lift for Republicans-if they win the election. But if they lose, as provisions of the law roll out during Obama’s second term, they’re likely to find that it’s very difficult to take popular benefits away from people who already have them. By declining to do Republican politicians’ work for them, in other words, John Roberts just made 2012 a very consequential election.
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Matthew Yglesias is Slate magazine’s business and economics correspondent.
Editorial, Pages 19 on 06/30/2012