Ken’s comprehensive analysis of the ACA ruling provides much food for thought. For the Obama administration, they get sorely needed legitimacy for their centerpiece legislation. In politics, winning is better than losing and it allows the administration to “move on” from what has been a difficult political struggle for them. It gives Obama the ability to forward a narrative of having “solved” a major social challenge… even if there are flaws with the legislation.
Romney can run on repeal of “ACA”, but as Ted Lowi observed in The End of Liberalism, policy drives politics. For starters, the old maxim of American politics — It is harder to kill legislation than to pass it, — hold true in this instance. Once you build a constituency for a program (narrow benefits), those beneficiaries will fight tooth and nail to keep it, particularly if those constituencies have political clout. Imagine a coalition of “ordinary Americans” lobbying against changes to the law that would remove the ban on insurers dropping coverage for pre-existing conditions. That’s chum for 24 hour news networks (maybe not Fox). Those who oppose the law on philosophical grounds, one could argue, won’t have the same intensity of interest once the law begins to take effect. Opponents of the ACA can spin all they want, but this was the best, and perhaps only, chance to kill the legislation.
Whether ACA is good policy has to be considered in reference to the “politics of the possible.” This Chicago-style, horse-trading style of lawmaking is how Obama envisioned governing in those dewy-eyed days of 2008-2009. The law isn’t optimal, but the mandate brought the insurance companies to the table and in exchange real people get to avoid the calamity of getting kicked off of their plan without a pre-existing condition. For that reason alone it is more equitable than our current system. It’s messy, irrational, and clientelistic. In other words, American politics at it’s best.
For better or worse, this is what social policy looks like. Indeed, Congress might need to revisit this issue after the election. One thing the court did strike down the ACA provision that would allow the federal government to withhold Medicaid funding to states that did not extend the program to %133 of the poverty line. This could have far reaching effects on the Federal government’s ability to use “strings” to compel states to go along with its mandates. While lots of speculation suggests that states wouldn’t turn down federal money to expand coverage, that money is only temporary. As as we’ve seen in states throughout the country, services for the poor and indigent are one of the first things to get cut during hard economic times.
For the moment, it is a progressive social advance… and a progressive dying of thirst in the political dessert isnt’ well served to ask for a lemon with a gift glass of ice water!