Though opponents of President Obama’s healthcare law were once again let down by the Supreme Court on Thursday, the legal challenge to the law’s federal exchange subsidies still had at least one positive consequence — it got Republicans talking about healthcare alternatives.
In the lead-up to the decision, there was a flood of different ideas from Republicans on healthcare policy. Some on the Left dismissed this flurry of activity as a cynical attempt to convince the justices that Congress would avert chaos if they struck down the subsidies, and in the coming months, Republicans will show whether the cynics were right.
Had the justices declared the subsidies illegal, it would have given Republicans a head start in dismantling the program, and transitioning to a market-based system. Now, they have a lot more work to do.
This fall and in the fall of 2016, millions more will enroll in health insurance through Obamacare, creating facts on the ground that will mean any Republican alternative would displace more people. Industry, too, will have had several more years to adjust their business models around Obamacare as the status quo.
That said, severe problems with the law remain. Premiums are high and access is narrow in many health plans offered on the exchanges. Insurers report that those who have signed up for insurance so far are older and sicker than expected — the flip side is that fewer younger and healthier people are signing up. Several of the temporary measures meant to stabilize the market in the first years of Obamacare will expire after 2016, and it isn’t clear how well the program will do without the training wheels. Next year, the number of enrollees on the exchanges is supposed to roughly double to 20 million — but that may be out of reach.
With these problems with Obamacare festering, the combined expense of Medicare and Medicaid taking up a growing share of the federal budget, it’s inevitable that at some point, there will be another major effort to overhaul the healthcare system.
If Republicans go back to hibernation mode on healthcare after this decision, it will guarantee that the next round of reform will once again wait until Democrats can reclaim power. No matter how much Republicans blame Obamacare for the nation’s healthcare problems, Democrats will argue that the problem was that Obamacare didn’t go far enough — that it allowed private insurers, drug companies, and medical providers to retain too much power — making further government intervention necessary.
The only way for Republicans to avert this outcome — and to make sure that the next round of healthcare reform is fought on their terms — is to lay out a detailed vision for market-based system, and to spend the next election doggedly making their case.
