Health Care Wars

Patricio Navia

Buenos Aires Herald, April 3, 2012


The Supreme Court decision on the constitutionality of the Affordable Health Care Act expected in late May will have enormous consequences on the upcoming presidential election. If, as expected, the Supreme Court overturns key provisions of the reform, it will be a giant defeat for the White House.  Republicans will feel emboldened, but Democrats will have a good reason to rally around President Obama.  Though Obama would certainly prefer to have his health care reform ruled constitutional, his re-elections changes might even be strengthened if the conservative majority in the Supreme Court strikes down the controversial provision that will make mandatory for Americans to buy health insurance.


The Affordable Health Care Act, known by its critics as ObamaCare, was voted on along party lines in 2009. As a way to address the skyrocketing costs of health care and the growing number of Americans without health insurance (more than 50 million), President Obama championed a health care reform soon after he took office in 2009. The complex arguments surrounding health care include the high costs of insurance for people with pre-existing conditions, the fact that most Americans have their health insurance linked to their jobs, the insufficient access to preventive care for the uninsured and the huge costs for local governments that provide expensive emergency care to the uninsured. The plan passed by Congress in 2009 introduced an individual mandate to take effect in 2014.  All legal residents will be required to have health insurance.  Non-compliers would be subject to a fine.  Conservative groups and several state governments have challenged the constitutionality of the health reform on grounds that the government cannot compel individuals to acquire health insurance by penalizing inaction.


Advocates of the reform argue that the reform was designed using the existing health insurance mandate in Massachusetts, implemented when likely Republican presidential candidate Mitt Romney was governor.  Moreover, some even argue that the initiative championed by President George W. Bush to privatize social security would have required individuals to contract a private pension fund to administer their mandatory pension contributions.  Republicans argue that the Federal government would be overstepping its authority. Romney himself argues that states have the power to enact individual mandates, but not the federal government. 


However, the arguments are more political than legal.  In fact, the Supreme Court itself is expected to align along party lines, with the 5 justices appointed by Republican presidents voting the reform unconstitutional and the four justices appointed by Democratic presidents rendering it constitutional. Such an ideologically-aligned decision will further polarize the political arena along party lines, deepening an already extreme divide between Republicans and Democrats.  Since the mid-1990s, there has been a decline of a tradition of bipartisanship that brought Republican and Democratic moderates to broker agreements in Washington.  As politicians from both parties have taken more radicalized positions, room for bipartisanship has been greatly reduced.  The Supreme Court already voted along ideological lines in the highly controversial decision in 2000 that gave the presidency to George W. Bush after the controversial vote counting process in Florida. A new controversial decision by the Supreme Court will have far more repercussion in an already polarized political climate in the U.S.


Republican and Democratic hardliners already feel very strong about the health care reform and most other issues. Presidential candidates will feel pressure to adopt the more radical positions held by the ideological extremists of their respective parties.  The Supreme Court decision will be a catalyst for ideologues in both parties to convert the 2012 election into the mother of all ideological battles.


Fortunately, American voters have more moderate views. While most Americans favor reforms that will bring down costs and expand coverage, many are worried about the negative externalities of an individual mandate.  If they unabashedly assume the positions favored by the ideologue extremists in their parties, presidential candidates will alienate moderate voters. If instead, they adopt moderate positions, promising to find ways to move forward by creating consensus, their message will resonate with moderates. 


Recent experience has shown that promises of bipartisanship work well in campaigns but do not necessarily materialize when actual bargaining over legislation occurs. Yet, because the Supreme Court decision on Obamacare will have immediate repercussions on the campaign, presidential candidates should resist the temptation of joining their rank-and-file ideological purists in a call for a mother-of-all-battles election in November.  They should remember that American voters are moderate and, precisely when the political climate becomes polarized, they will look for a moderate candidate to support in the next election.


Because Republican hopefuls are still campaigning to win the nomination, they are more likely to adopt radical positions championed by the party activists. President Obama knows that Supreme Court decision will polarize his party base, but he knows that the election will still be won among moderates.  If the Supreme Court votes against Obamacare, Obama will have a fired up party base. If he is able to stick to moderate positions, a reversal in late May will might end up helping his re-election chances in November.