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Critical Condition

NRO’s health-care blog.

The Battle Isn’t Over



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The U.S. Supreme Court’s 5–4 decision with Chief Justice John Roberts siding with the liberal wing of the court upholds the individual mandate as a tax — not under the Commerce Clause which grants Congress the power to regulate commerce. As of this morning, the Patient Protection and Affordable Care Act is now upheld as constitutional. 

However, there was one small victory in that the Court at least ruled that by restricting the limits of the Commerce Clause, the federal government does not have the authority to create activity for the purpose of regulating it. The good news is the government will not be able to force me to eat broccoli or purchase a Prius against my will. But by maintaining the mandate as a tax, it means that this regressive tax will have the most impact on the middle class. This is something that the president wanted to avoid as he had promised the American people there would be no tax increases on the middle class.

The high court may have deemed Obamacare constitutional, but politicians in both parties realize that this ruling won’t bring about affordable, accessible, quality care for all Americans. Health-care spending already accounts for 17.9 percent of GDP or one-sixth of our economy. According to a study published in Health Affairs, it will reach 20 percent of GDP by 2020 unless changes are made. And for many people, coverage will remain unaffordable.

The president had two main goals for the law: universal coverage and bending the cost curve down. Under Obamacare neither will be accomplished. There will still be 23 million Americans uninsured in 2019 and the cost will be about $2.7 trillion over the decade 2014 to 2024. Already costs are out of control. The Congressional Budget Office projected that between 2010 and 2020, the law would cost $940 billion. However, the cost from this year till 2022 has now been revised to $1.76 trillion. While the Court ruled the law constitutional, it doesn’t mean it is good policy.  

The polls have consistently shown that the American people do not support the law. Prior to the decision today, 54 percent of Americans wanted the law repealed. That number held steady following the ruling. And, according to a new Reuters poll, 61 percent of voters want the individual mandate repealed. 

While the decision may be a short-term victory for the president, fortunately, Americans have the chance this fall to put in place a Congress and a president who will dismantle this law as it was created — through the legislative process — and replace it with reforms that actually lower health-care costs and improve the quality of Americans’ care. Chief among these ideas are allowing a health insurance market to develop with high-deductible plans coupled with Health Savings Accounts; allowing consumers to purchase insurance across state lines; changing the federal tax code; state-based medical malpractice reform; Medicare reform that focuses on vouchers/premium support, means-testing, raising the eligibility age; block grants to the states for Medicaid, and focusing on innovation in the medical-device and drug industries so that we all have access to the latest treatments and procedures.

The battle over health-care reform will continue well into the future. Our main goal is to achieve affordable, accessible, quality care for all by empowering doctors and patients, not the federal government.

 Sally C. Pipes is President, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute. Her latest book is The Pipes Plan: The Top Ten Ways to Dismantle and Replace Obamacare (Regnery 2012).



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