A Healthy Judgment

Given that the United States Supreme Court upheld Obamacare, can we expect the Republicans to let go? This is certainly Barack Obama’s victory politically, but socially it is mainly [the victory] of close to 7 million Americans whose health care coverage was threatened.

Americans, in their view of the government’s role, are not like the Quebecois, which is a bit surprising given our geographical vicinity. Or maybe, underneath it all, they are more like us than their noisy, ultraconservative minority would have us think.

No matter what, in the U.S. context the health care system reform that President Obama succeeded in implementing in 2010 is something of a revolutionary act. It opened the door to universal coverage and put the brakes on insurance companies’ greed. About 50 million citizens —15 percent of the population — were uninsured five years ago; today, there are 16 million fewer. The law created the obligation of taking out an insurance policy and prohibited insurers from denying coverage to clients based on pre-existing health conditions. It ensured that the rate at which health service costs increases was reduced significantly. The result of this reform, which only displeases conservatives who oppose it tooth and nail for conspicuously partisan and ideological reasons, is now largely accepted within American society.

In front of the Supreme Court, the challenge was great but the case was pointed. Leaning on an ambiguity in the law’s text, the plaintiffs were contesting the legality of part of the federal tax credit program — $272 per month on average — set in motion by Washington across the entire country to help Americans who are less well-off provide themselves with health insurance. Had the Supreme Court ruled in favor of the four plaintiffs, militant conservatives from Virginia, the whole reform system would have crumbled, given that 85 percent of Americans who have now taken advantage of Obamacare are eligible for these tax credits.

It therefore would have been tragic for the Supreme Court to repudiate this part of the law. Many, including Mr. Obama, wondered why in fact the court had even decided to hear this case, because they considered it to have such bad intentions, and especially because the Supreme Court had already confirmed that the health care reform was constitutional in a first decision in 2012.

In the end, the law was upheld with more clarity — by vote: six judges against three — than some were expecting, which is telling: Chief Justice John Roberts and Judge Anthony Kennedy, who are considered conservatives, have joined forces with two colleagues who are more progressive. “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” wrote Justice Roberts in his legal opinions. In this decision is an additional sign that the White House has finally succeeded in forging consensus around this reform.

How will Republicans react? We cannot underestimate their capacity to do harm. As of right now however, experts said right after the fact that it does seem that by approving the role the federal government has taken in implementing the law, the verdict guarantees the integrity of a reform that, though not a cure-all, represents obvious social progress.

For Mr. Obama, the verdict ensures the continuity of his presidency’s domestic policy masterpiece, a continuity that Hillary Clinton can also claim. She attempted, let’s not forget, a health care reform during her husband Bill’s first term. She will surely want to use that in her new life as candidate in the 2016 election.