Health Care Politics By Jere Nash

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Posted January 23, 2013

Some weeks after we’ve all had a chance to reflect on the U.S. Supreme Court’s decision to uphold President Obama’s healthcare reform, the Affordable Care Act (“ACA”), I’ve concluded that our side is barely hanging on. From a public policy perspective, the Supreme Court reaffirmed the authority of Congress, albeit tenuous, to tackle complex problems of a national scope. While that’s a good thing for 21st century America, having to depend on John Roberts for the fifth vote doesn’t exactly leave me feeling sanguine about our future.

From a political perspective, the Supreme Court kicked the ball back to the politicians, creating opportunities and pitfalls for Barack Obama and Mitt Romney as well as most of the down ballot incumbents and challengers this election cycle. And that doesn’t give me warm and fuzzy feelings either, seeing how Democrats have failed miserably at defending the ACA and promoting the good that the legislation will engender. They’ve ceded the issue to the Republicans for far too long, so perhaps John Roberts has, inadvertently, given them a reason to take the offensive.

For Mississippians, the decision of the Supreme Court means we will continue benefiting from the general provisions of the health care reform legislation – allowing young adults to remain on their parents’ health care plans, prohibiting denial of coverage for pre-existing conditions, removing lifetime limits from insurance plans, stopping insurance companies from rescinding coverage, and many others.

That being said, and leaving aside a discussion of whether the Obama or Romney campaigns will effectively respond to the political implications of the decision, the big news in our state is the Supreme Court has effectively drawn one of those proverbial lines-in-the-sand of Mississippi politics, akin to the vote in 1982 on education reform or in 1987 on the four-lane highway program or in 1997 on the Adequate Education Program. The issue: whether to dramatically expand Mississippi’s Medicaid insurance program, as authorized by the new law. By barring the federal government from withholding all of a state’s Medicaid funding if that state opts not to participate fully in the Medicaid expansion requirements, the Court left intact the carrot of full funding for the first few years of the law’s implementation, but removed the stick should a state rebel. For the hundreds of thousands of Mississippians who are now without health insurance, but who would be covered by full implementation of the ACA, the decision on their futures now rests with the Mississippi Legislature when it convenes in January. It is a vote that will have repercussions for many, many years to come.

The irony? Virtually all of the public officials who will be choosing which side of the line-in-the-sand to cast their vote enjoy comprehensive health insurance courtesy of the taxpayers of Mississippi.