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The Affordable Care Act (ACA) is either the most significant accomplishment or the most disastrous mistake in U.S. domestic policy over the past four years. President Barack Obama has embraced the (originally derisive) nickname "Obamacare" to describe the law, saying he now "kind of likes it." Gov. Mitt Romney has promised to "repeal and replace" the law on his first day in office.
Michael Dukakis and Wendy Parmet offer their thoughts on how the next president — and Congress, and the Supreme Court — should deal with Obamacare, and how those decisions could affect the way "We the People" understand our relationship with the federal government.
The United States is the only industrialized nation that doesn't guarantee access to health care for all its citizens. And 90 percent of those without access to decent, affordable health care are working Americans and their families. We cover the elderly through Medicare and the poor through Medicaid, but we still have 50 million fellow citizens without health insurance. That's what Obamacare is designed to fix. The law also seeks to rein in runaway costs and the evidence is beginning to reveal that it is working.
It expands our liberty and improves the quality of life for all our citizens.
That's why the next president – whether it is Barack Obama or Mitt Romney — should defend Obamacare and make sure it's fully implemented. Despite what he's said on the campaign trail, Gov. Romney knows this is the responsible thing to do because of what has happened in Massachusetts since the passage of “Romneycare.” Because of the 2006 law Governor Romney signed, virtually every citizen in the Commonwealth has access to affordable health care. Not only is Romneycare good policy; it's good politics. It remains the most popular achievement of Romney's tenure as governor of Massachusetts.
Access to affordable health insurance for working Americans and their families is the biggest part of Obamacare, but it's not the only part. The ACA also provides for doubling the number of community health centers. The next Congress should fully fund that effort (community health centers have traditionally enjoyed bipartisan support for their low-cost, high-quality, community-based approach to health care), and the next president should make sure it happens.
The ACA is full of great solutions — many pioneered here in Massachusetts — to America's health care problems. Once it's fully implemented the rest of America will know what we in Massachusetts already know from our experience with Romneycare over the past six years. It doesn't threaten our liberty; it expands our liberty and improves the quality of life for all our citizens.
What power does the federal government have to take actions to improve the health of its citizens?
That is the big question thrown open by the Supreme Court in its closely divided and confusing NFIB v. Sebelius decision upholding the constitutionality of the individual mandate portion of the Affordable Care Act. While upholding the mandate as a constitutionally-appropriate tax, the Court, for the first time ever, found that Congress had unconstitutionally coerced the states by placing a condition (expanding Medicaid) on states’ receipt of federal funds (for the entire Medicaid program).The Court's conservative justices also appear to read the Commerce Clause — which gives Congress the power to regulate interstate commerce — as a limit on federal power, not a grant of federal power as the founders clearly intended.
What's at stake is not only the future of the Affordable Care Act, but the extent to which the federal government has power to regulate.
Given the degree of constitutional uncertainty created by the decision, the Supreme Court is likely to decide several additional important cases regarding the federal government’s role in health protection in the next few years. What’s more — we also can expect that the next president will likely have the opportunity to appoint one or two new justices to the Court.
This means the future of Obamacare and more broadly the future of our health care system rests, to a large extent, on the Supreme Court and the nominations the next president makes to fill the expected vacancies on the Court. What's at stake is not only the future of the Affordable Care Act, but the extent to which the federal government has power to regulate tobacco, set workplace safety standards, undertake public health campaigns (like vaccinations) or initiate any of a thousand other actions to promote the and protect the health of its citizens.
- WATCH video of these lectures — plus a Q & A with Michael Dukakis and Wendy Parmet — here.
This program aired on October 31, 2012. The audio for this program is not available.
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