The Affordable Care Act was running well. Despite an early online snafu, the number of uninsured is dropping. Now, some say otherwise, claiming that premiums will eventually go up for all or that the large sum of poor people benefiting from this is evidence that unnecessary welfare is running wild. But consider how much milder these things are than the “death spirals” of plans malfunctioning or old people overloading the system to the point of collapse that some warned about. Whether they meant to or not, opponents of the bill have made giant concessions in their arguments with likely more to come. And in doing so, they have made a case for the ACA.
But then came a judiciary that ruled the ACA’s subsidies unconstitutional due to the way they were worded in the legislation. Within hours, another court had reversed that ruling. The question is, what now?
Obviously, there will be more rulings to come. The Supreme Court has already ruled on the constitutionality of the law, so it might not even hear this. Even if it does, it could rule in favor of the ACA again. And even if that doesn’t happen, there have been some articles out there that claim that there are some steps the Obama administration could do to get around that ruling. But I must admit that this goes beyond my understanding of policy.
But let’s say all of the ACA’s paths to preservation fail. What then?
The states that have set up their own exchanges won’t be affected in any way. While there are few at the present time, it was assumed that there was no difference between federal and state exchanges. Now there are. Which means that new exchanges will likely be built. But how many? This will probably be a blue vs red divide similar to the one surrounding the Medicaid expansion. At first not many did it. But now there is a close mix of states with and without it, depending mostly on the voting habits of the state in question, and whether the Governor is a Democrat, impure Republican (Ohio, Arizona, and New Jersey are Republican-run states with the expansion), or ultraconservative. The exchanges will likely follow a similar path.
It’s kind of like the blue vs red meme that occurred after the 2000 and 2004 elections. Hardly any 2000 states changed their winning party in 2004, people noted. This demonstrated North/South and urban/rural divisions.
So The ACA may survive on a states’ rights basis. After a century and a half of consistent disappointment, the Ron Paul state sovereignty types may have finally won one. Probably not the battle they wanted to win (they hate this kind of thing as much or more than the neoconservatives), but congrats, I guess.
Or maybe the attack on the ACA won’t get that far, making me look stupid. One can never know.