As Judgment Day for the Affordable Care Act draws closer – a ruling by the U.S. Supreme Court is expected in the next couple of weeks – legal observers, health experts and pundits are trying to predict what the fallout could be if the law is eviscerated or overturned. Undoing the ACA may not be that simple. Would the horrible consequences of suddenly snatching health care away from millions of Americans be enough to force Congress to open up Medicare to people under 65? Economist and former Clinton labor secretary Robert Reich thinks so.
Reich believes that if the individual mandate is struck down, health insurance companies, arguing that they’ll go bankrupt if they are forced to continue covering people with preexisting conditions, will clamor to get the requirement dropped. The problem for the insurance companies is that the preexisting condition requirement is one of the most popular parts of the ACA and Congress may be hesitant to get rid of it.
This opens the way to a political bargain. Insurers might be let off the hook, for example, only if they support allowing every American, including those with pre-existing conditions, to choose Medicare, or something very much like Medicare. In effect, what was known during the debate over the bill as the “public option.”
I hope Reich is correct, but it may be wishful thinking on his part. Right now, President Obama and the Democrats are still pinning their hopes on a positive ruling from SCOTUS and they don’t seem to be looking at a Plan B – at least, not publicly. And the Republicans seem content to do little or nothing. Some health insurers are even saying that they will voluntarily uphold some of the more popular provisions of the ACA (I don’t believe that for a second). The “sickcare” industry would rather maintain the status quo – and their ill-gotten profits – as long as possible than to see lawmakers open up Medicare. The insurers know that once Medicare is available to more people, the program will be in even more demand, hastening the health insurance industry’s demise. In the meantime, what will the reaction be from the public? Resignation and despair? Or will the sudden disappearance of what little healthcare safety net the ACA provides galvanize the public into demanding Medicare for all? I want to see the latter happen.
Some believe that if SCOTUS deals a death blow to the ACA, that that will spell the end of health reform. This is nonsense. Ignoring the healthcare crisis in this country won’t make it go away. It will get progressively worse. More American workers will see their health coverage dropped. Fewer employers will offer health coverage. Millions more Americans will go bankrupt. Even with the ACA in place, out-of-pocket medical costs continue to explode. Lawmakers can keep their heads in the sand for only so long. As the ranks of the uninsured and bankrupt expand to an ever larger proportion of the population, public outrage will grow. At that point, the din will be impossible to ignore.