While the White House will put on a brave face regardless of the decision, an
adverse ruling will be a major political blow and would confirm Republican
accusations that “Obamacare” represents an unprecedented, and
illegal, power grab by the federal government.
“If Obamacare is not deemed constitutional, then the first three and a
half years of this president’s term will have been wasted on something that
has not helped the American people,” Mitt
Romney, the Republican presidential candidate, said yesterday.
At the heart of the decision is the legality of the “individual mandate”,
the clause in Mr Obama’s law that forces all Americans who can afford it to
purchase health insurance.
By compelling young and healthy people into the insurance market, the White
House believes it will be able to push down the cost of insurance premiums
for all.
The mandate is being contested by 28 Republican states, who sued the Obama
administration claiming that it had no right to force people into insurance
programmes.
“It is the constitutional issue of our time,” Greg Abbott, the
Attorney General of Texas, told the Daily Telegraph. “It will define
the future arc of the United States Constitution and at the same time it is
a decision of immeasurable economic impact for workers, employers and the
economy.”
The court has a number of options before it. Justices could either strike down
or uphold the law in its entirety, or reach a partial verdict that would
strike down the mandate, but leave the remainder of the law in place.
If the mandate were struck down the remaining provisions of the law – reforms
of insurance laws and subsidies for the poorest – would return to Congress,
where politicians would decide whether it was possible to still implement
them.
The court could also decide to delay a decision until 2014, when the mandate
comes into force.
Not since the Supreme Court effectively handed George W Bush the presidency
after the disputed 2000 election have Americans paid so much attention to
the cloistered workings of their high court.
“Everyone in the United States is going to be watching this closely,” said
Monica Haymond, a 23-year-old whose Vietnam veteran father, Chuck, was
unable to get health insurance after returning from the war after being
exposed to Agent Orange.
Her two unemployed sisters are among the 32 million Americans without health
insurance. Today, they are on a path towards coverage but face an uncertain
future should the law be overturned.
“This is personal for everyone, because everyone will know someone
without care or be directly impacted themselves,” Ms Haymond said.
The healthcare reforms – known formally as the Patient Protection and
Affordable Care Act – were the result of a long and difficult political
struggle that dominated much of Mr Obama’s first year in the White House.
Having pledged as a candidate to make “healthcare affordable to every
single American”, Mr Obama reached the Oval Office in 2009 with no
detailed plan of how to solve a policy question that has vexed presidents as
far back as Harry Truman.
To the frustration of his liberal allies, Mr Obama essentially left the
intricacies of the policy to Congress. In a bid to secure some Republican
backing, Democrats moved ever further from an NHS-style service and
eventually settled on the idea of the individual mandate, a proposal first
made by a conservative group in the 1990s.
Republicans fought the law at every stage accusing the White House of
orchestrating a “takeover” of healthcare by federal bureaucrats.
Sensing Mr Obama’s political weakness on the increasingly chaotic reforms,
one Republican senator warned that the bogged-down policy would be the
President’s “Waterloo”.
Many of the President’s senior aides believed he squandered time and political
capital when he should have focused on employment and the economy.
The law’s eventual passage in March 2010 played a major role in the spawning
of the Tea Party, the conservative anti-government movement, and today
remains deeply divisive.
A recent Rasmussen poll found that 54 per cent of voters favoured its repeal
compared to 39 per cent who wanted it to stay in place.
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