Health coverage shouldn’t hinge on court ruling

Opponents and supporters of the Affordable Care Act take very different stands on the issue, but most agree that the 2010 health care law should not simply be repealed.

U.S. Sen. Bob Casey Jr., a supporter of the law, acknowledges that there are some problems with the law. He recently told the Reading Eagle editorial board that more needs to be done to make health insurance affordable enough to get everyone covered.

But the senator expressed great worry about what would be lost if the law were to simply disappear — guaranteed coverage of preexisting conditions, the Medicaid and exchange-secured coverage of nearly 20 million Americans (an estimate shared by the RAND Corp. and the Center on Budget and Policy Priorities) and parents’ ability to keep adult children on their health plans up to age 26.

That’s why he’s worried by a lawsuit supported by 18 Republican governors. The legal efforts aims to overturn President Barack Obama’s signature law on constitutional grounds.

The lawsuit says that when Congress repealed a tax penalty meant to enforce the law’s mandate that individuals obtain health coverage, it removed a provision the U.S. Supreme Court cited as a key to its constitutionality.

Casey’s voice rose as he condemned the lawsuit.

“It’s a bad, bad result for America if this succeeds,” he said of the lawsuit now before the Fifth Circuit Court of Appeals and possibly headed to the U.S. Supreme Court.

Opponents of the law would say Casey is overstating the law’s benefits and failing to note its deficiencies. Many conservatives argue that pushing people into Medicaid coverage is not much of a benefit because the program offers a narrow field of doctors from which to choose. And they say the law’s expansion of Medicaid and its means-tested subsidies both leave people open to gaps in coverage should their incomes rise.

But even such critics want what Casey noted has not been offered: an alternative.

And the Pennsylvania Democrat is right to challenge his Republican colleagues to come up with a replacement for the Affordable Care Act.

While some say the law was itself a disruption of health insurance markets, papered over with government subsidies to individuals and insurers, it’s hard to deny that the law’s sudden repeal in court would destabilize the health insurance market.

A December commentary for the conservative Heritage Foundation made the case for replacement over simple repeal via the courts:

“As the case continues to wind its way through the legal system, it is imperative that policymakers pursue real health care reform. … Politicians have long promised to replace Obamacare with solutions that help everyone. It’s time to deliver — no matter which way the courts go.”

The Affordable Care Act has been described as an unpopular law with very popular provisions. Republicans’ inability to repeal it while they had a congressional majority during President Donald Trump’s first two years in office supports this view. And that failure was largely a result of Republican senators’ inability to come up with a replacement.

At this point, with Trump’s administration backing the law’s repeal by refusing to defend it in court, his party should consider itself duty-bound to at least offer a health care reform plan that will protect those with coverage under the Affordable Care Act.

If it’s better and more affordable coverage — results conservatives insist a market-based approach would deliver — that would be ideal.

Meanwhile, if Republicans are unable to pass such an Obamacare replacement bill, they should support legislation that would keep the Affordable Care Act in place in the event it’s overturned by the courts, and take their reform plan to the voters in November 2020, with control of the White House and the House and Senate on the line.