The Supreme Court’s 6-3 decision in King v. Burwell ensures that tax credits will remain available to income-qualified purchasers of private insurance in all states and was a total victory for the Obama administration. As a supporter of the law, my victory lap is short because I live in a state, North Carolina, that has 500,000 persons signed up for private coverage via healthcare.gov, but even more who remain uncovered and in the so-called coverage gap between 0 and 100 percent of poverty because we have not expanded Medicaid. The Affordable Care Act (ACA) was and is a good step, but any health policy person knows it was never intended to be the last one.
The biggest meta health policy question facing our country now is:
- Is there a version of health reform that the South will embrace?
The biggest policy question that looms unanswered as we approach the third ACA open enrollment is:
- What is an appropriate deductible/out-of-pocket cost exposure for a person with insurance?
What the country (including liberals) most needs to address are these and myriad other health policy questions and for elected Republicans to start being very clear about what set of policies they favor. This will require a big change for them. Since approximately 12:15 p.m. on Jan. 20, 2009, Republicans have been against ObamaCare. On that score, they have lost, because regardless of what the healthcare system looks like in 20 years, the first step to that system will always be the Affordable Care Act that broke the logjam of the unsustainable status quo. But again, the victory lap is short because there is much to do.
{mosads}In spite of recent slowdowns in health inflation, our out-year health spending due to the baby boomers being in Medicare and Medicaid is still unsustainable, if less so than a few years back. A truce of sorts on health reform is needed to ever get to the hardest health policy steps of making our system sustainable, and it will take both sides to do the hardest things. The only way to get such a truce is for Republicans to shift gears and begin identifying things they don’t like about the ACA (or Medicare and Medicaid) and propose problem-solving solutions. They control the machinery of the House and Senate. Write bills, have markups, get Congressional Budget Office scores and make the case. If the focus is on the policy, deals will emerge.
As a supporter of the ACA, I was shocked at how plainly the King v. Burwell decision was written. I am no lawyer, but it read exactly as I understood the issues, and its logic was pretty good at Health Insurance 101. What I most want to see now are similarly clear proposals and a sustained Republican effort to make the case first to themselves, and then to the rest of us, regarding what they are for in health policy. I am certainly ready to join anyone who is ready for the next step.
Taylor is associate professor of public policy at Duke University. He blogs at www.donaldhtaylorjr.com.