The Future of Health Reform
On Thursday, June 28, 2012, a majority of the United States Supreme Court upheld the Affordable Care Act – one of the most important social policy breakthroughs in American history. With the constitutional quarrel settled, what are the prospects? SSN experts have a lot to say about both policy and politics.
New Political Realities
In the decision upholding Affordable Care, Chief Justice John Roberts called the “individual mandate” an exercise of the federal government’s tax power. This gives new rhetorical ammunition to the opponents of health reform, who remain committed to repealing or hobbling the law.
But the individual mandate requirement (for everyone to either have health coverage or pay a fine) will actually hit very few Americans after reform is put into effect. In a new Basic Facts brief, Theda Skocpol draws from the latest research to pin down "The Truth about the Individual Mandate in Health Reform.” And Amy Fried dispels “Mandate Myths” in her regular blog at the Bangor Daily News.
Political battles will continue through November 2012 and beyond. But Affordable Care will almost certainly not be repealed, and the momentum now lies with reform – as Theda Skocpol and Lawrence Jacobs explain in “Bending Toward Universal Health Care,” an OpEd in the New York Times.
Also in the Times, Andrea Campbell asks “Will Time Heal Health Care Wounds?” She considers what the evolution of public attitudes about a similar reform in Massachusetts might indicate about future public acceptance of Affordable Care at the national level.
Fifty States Front and Center
The Supreme Court enhanced the role of the states in implementing health reform. Not only must states set up “exchanges” to allow individuals and businesses to comparison-shop for health insurance plans, they must also decide whether to accept generous new federal subsidies to expand their Medicaid programs starting in 2014. States can refuse, the Court said, without losing prior Medicaid funding.
SSN scholar Colleen Grogan lays out the central role of Medicaid in American health care and tells us how popular this program has become with most Americans. Her brief suggests that it will not be easy for state officials to refuse federal grants to expand Medicaid. Those that demur at first may soon come under pressure from voters and health-care providers.
Lawrence Jacobs comments on the steps Minnesota is taking to implement Affordable Care. And in the Bangor Daily News, Theda Skocpol pens an OpEd on the benefits and challenges for Maine.
Affordable Care has many provisions encouraging experiments to improve the quality of medical care delivery in hospitals and clinics. SSN scholar Paul Cleary explains what patient-centered care is all about and why it is important.
As Affordable Care goes forward, Jacob Hacker’s reflections in Democracy: A Journal of Ideas remain relevant. What will reform look like in 2015 – and why might future struggles to improve American health care be even harder than the ones so far?