The Affordable Care Act has just turned two years old, yet tomorrow begins the Supreme Court challenge that will determine whether the ACA lives and thrives, or shrivels, or dies. For all the ways that it would secure the promise of affordable, comprehensive health care for most all Americans, it is regrettable -- indeed, almost incomprehensible -- that the ACA faces this legal battle.
As the huge stakes in this lawsuit suggest, however, the battle will be epic, a rarity for the decades. While the Supreme Court customarily allots just an hour for the cases it hears, it has set aside three days for hearings on the ACA. A big chunk of that time will be devoted to the issue of constitutionality of the ACA's mandate for all non-poor Americans to obtain insurance. Another will revolve around its severability clause, which, if upheld, would allow other parts of the law to remain in force even if the purchase mandate was found to be impermissible under federal interstate commerce precedents.
This battle was always predictable. Republicans fought tooth-and-nail to defeat the creation of the nation's two other vital leavening social benefits -- Social Security and Medicare. Their fight to keep health care under the unbridled control of the nation's most cold-blooded for-profit industries -- the rich health insurance and pharmaceutical insurance industries which fill their campaign coffers -- was to be expected.
The court has promised a ruling by the end of June, guaranteeing huge political ripples whatever the verdict.
If it goes in favor of the administration, Democrats would be able to build on the victory by implementing other major reforms and benefits that are set to take effect in 2014. Chief among these would be the establishment of regulated health insurance exchanges in every state that would allow for-profit companies to compete for customers under rules requiring comprehensive, no-exclusion plans that would limit companies over-head cost, require flat-rates for all customers, and set a floor on benefit provisions.
Any of the 56 percent of adult Americans under 65 who receive employer-sponsored insurance could simply keep the insurance they've got. The mandate wouldn't affect them. But for those without access to affordable comprehensive insurance, for the uninsured, and for those whose insurance is skeletal, inadequate and overpriced, the regulated insurance exchanges will be a godsend.
Most of the broad American middle class families and individuals who would want to consider the exchanges would also qualify for significant, income-adjusted federal subsidies to aid their purchase of one of three levels of insurance to be offered in the exchanges. The rules would require each company to state its benefits in plain language, so the plans could easily be compared.
Why any Americans would resist such an option for affordable, comprehensive insurance is a mystery. It is the closest thing to a Medicare-for-all type plan that Republicans would accept. Indeed, the exchanges, anchored by for-profit insurers under reasonable regulation, was actually proposed by Republicans.
Yet if the Supreme rules against the qualified mandate to purchase insurance, Republicans will claim a victory, even if it puts them on the hook to make good on their vague promise to "repeal and replace" the act. They have never defined the latter, except to say that they would keep in place a virtually unregulated for-profit health insurance and pharmaceutical industries.
Americans know what that out-of-control machine ultimately rendered to us: Broad exclusions for pre-existing conditions; unaffordable annual and lifetime limits on benefits; cherry-picking the healthy and leaving too many of the ill to die; denials for care and preventive check-ups; millions of uninsured young adults and children; limits on prescriptions; 50 million total uninsured; increasingly unaffordable deductibles; high co-pays and donut-hole costs for seniors' prescriptions; and a stunning rise in America's rate of medical bankruptcies.
That system also generated lavish administrative perks and multi-millionaire salaries for those who make the rules and denied care to juice their profits, prompting high double-digit annual cost increases for policies with same year-over-year benefits.
Many of these problems already have been or are being remedied by the Affordable Care Act. Yet truly affordable care for all awaits the scheduled 2014 start-up of the states' insurance exchanges. If the Supreme Court wisely rules that the insurance mandate is constitutional as a means of reasonable regulation for the interstate commercial activity of what has been a runaway national health care system, all Americans will benefit.
If partisan ideology by the court's arch-conservative majority results in overturning the ACA, the beast will return, with an unbridled vengeance, entrenching the United States of America as the only advanced industrial nation without affordable, universal care. Which brings to mind the adage: Be careful what you wish for; you may get it.