Healthcare and the Supreme Court

Today the United States Supreme Court will hear arguments for and against the so-called “individual mandate” required under the Patient Protection and Affordable Care Act, the healthcare system reform law signed by U.S. President Barack Obama in March 2010. This is a fundamental tenet of the legislation, but also its challenge: to set a standard that requires all citizens to be covered by health insurance.

About 85 percent of the U.S. population has access to medical care through employer-sponsored insurance, but more than 35 million people (and an estimated 11 million illegal immigrants) live outside of the system, without recourse to non-emergency healthcare. This is one of the reasons behind the high cost of medicine in the United States: Millions of people are treated only when they have serious conditions that require prolonged or costly treatment, and because they are not covered by a policy, the burden of payment is placed upon taxpayers. Another reason has to do with the essentially private nature of the system, where prices are regulated by the health care industry itself.

The law states that once insurance coverage becomes obligatory in 2014, all those who are unable to bear the costs of their policy will be entitled to subsidies, and those who still prefer to stay outside the system will be subject to a fine. The law does not change anything for people who are covered by Medicare and Medicaid or for those who already have employer-sponsored healthcare insurance.

At issue in today’s hearing is a simple question: Can the federal government force someone to purchase a good or a service? There is a complex legal argument involving the law regulating interstate commerce, and the decision of the court may decisively alter the division of power and the relationship between federal and state governments.

It will also inevitably have political repercussions.

Healthcare reform, a laborious process that exposed the weaknesses of bargaining behind closed doors in Washington, was one of President Barack Obama’s great successes, although it cost him almost all the political capital gained in the 2008 elections. The reform, which was established by Congress under the supervision of the White House, is not fully advocated by the president. As a presidential candidate, Obama did not support the option of an “individual mandate.” Despite the controversy, the Affordable Care Act (referred to by critics as “Obamacare”) is a historic statute, comparable to the legislation that created Social Security and, when put into action, will lead to a profound change in how American society functions.

Obama’s success has been accorded another dimension by the decades of failure during which a succession of presidents – Democrat and Republican alike – promised and failed to “fix” an admittedly broken system.

The law, however, is also deeply unpopular and not only because of the opposition bloc of the Republican Party. For conservatives, the issue is one of ideology and principle rather than one of human rights or the economy (the health sector represents one sixth of the U.S. economy). It was the fierce opposition to Obamacare that catapulted the tea party to national attention and allowed Republicans to gain a House majority in 2010.

The Supreme Court’s final decision is scheduled for late June. Ideological meaning aside, it will no doubt have a significant effect on both parties’ campaign for the White House.

For now, the candidate who has ridden the wave of opposition best has been former Pennsylvania Sen. Rick Santorum, who has made his opposition to Obamacare – and its precursor, Romneycare (the law for universal access to medical care signed by Mitt Romney in Massachusetts) – one of the centerpieces of his campaign. This is, perhaps, the difference between him and his rival that is most easily understood by the conservative electorate: In his rallies, Santorum never fails to state that, running against the president, he would offer a clear contrast to him, unlike Romney.