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Whose healthcare idea was it?

Whose healthcare idea was it?

Posted: Monday, December 27, 2010 8:01 pm
By: Douglas Cohn and Eleanor Clift

WASHINGTON — A federal judge’s ruling in Virginia that the individual mandate to purchase health insurance is unconstitutional energizes the political effort to roll back the health care reform law. Two other federal judges earlier ruled the law constitutional, but the Virginia decision gets all the attention because it assures the law will head to the U.S. Supreme Court for what could be a legal showdown between left and right in assessing the law’s constitutionality.
The good news for advocates of health care reform is that Virginia Judge Henry Hudson didn’t throw out the entire law, limiting his ruling to the constitutionality of the mandate, which he considers an overreach of federal power.
The fate of the mandate will eventually fall to Justice Anthony Kennedy, the one justice on the divided Supreme Court whose views are not wholly predictable along party lines, and whose vote is likely to be decisive whichever side he takes.
If the Supreme Court tosses out the mandate, that does not mean the end of President Obama’s signature accomplishment. During the campaign, Obama did not support a mandate to require people to buy health insurance; that was Hillary Clinton’s idea. Obama opposed Clinton on that, arguing that if premiums were affordable, the overwhelming majority of people would voluntarily purchase coverage.
Obama’s premise may be tested. Without the mandate, healthier people, and young people, will be tempted to forego health insurance until they need it, and that undermines the concept of affordable coverage, which is spreading the risk. The health exchanges that will be in place by 2014 are the core of the bill. A variety of plans and competitive pricing should broaden the pool to the point where insurance companies can offer quality coverage at reasonable prices — or at least that’s the theory.
Opponents of what they call Obamacare are cheering the Virginia ruling that strikes down the individual mandate, but Republicans didn’t always feel that way about a mandate. The idea originated with Republicans, not Democrats. It was the chief weapon in the GOP arsenal to oppose the health care plan that Hillary Clinton proposed when her husband was in the White House, and had the backing of Senate Majority leader Bob Dole and other venerable Republicans, including Utah’s Orrin Hatch and Iowa’s Charles Grassley.
The health care reform that Obama signed into law early this year is modeled after the Massachusetts plan that then Governor Mitt Romney (R) signed into law in 2006 with bipartisan support, and with Senator Ted Kennedy (D) at his side smiling broadly. The Massachusetts law has boosted coverage in the state to near universal, with over 98 percent of residents covered with the help of subsidies where needed. The consensus is that the plan has been a success, but there are worries going forward about holding down costs, as there are with the plan passed by Congress.
As the states take steps to implement the new health care law, there is significant leeway as to how they set up their exchanges.
Some of it is substantive in how a state with a big urban population operates versus a less densely populated state which has different needs. It’s also political. Fourteen states are suing the federal government in an effort to stop what their attorney generals are calling a costly and ineffective takeover of the health care system. Virginia Attorney General Ken Cuccinelli has been the most aggressive and media savvy in taking his case to the courts and the general public, and the fact that his lawsuit succeeded has made him the leader of the opposition, and a hero to Republicans who campaigned on repealing the health care law. President Obama thought the fight was over when he signed the health care bill into law, but it’s just beginning.

Published in The Messenger 12.27.10

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