By: Bob Lucore
The Supreme Court upheld the Affordable Care Act (ACA). Pundits have offered numerous predictions about what the ruling means. Here are some thoughts about what progressive activists, liberals, and others on the democratic left should do in the aftermath of the ruling.
While ADA and similar organizations would certainly have preferred more comprehensive reforms (such as Medicare for all), it is important to recognize that if the ruling had gone the other way it would be much harder to move healthcare—or any other progressive policy—forward. Some argue that the ACA without a mandate would have opened the door to a single payer system. That hardly seems likely in any foreseeable alignment of political forces.
We should cheer the fact that the President’s signature achievement, while far from perfect, has survived. We should work to defend it against legislative repeal, to strengthen it and to build upon it. Vermont shows one way to do this, by working to create a single-payer system on the state level with the confines of the ACA. We should work to expand the number of states attempting such improvements. We should also oppose those state officials that seek avoid full participation in the new system as they attempt to take advantage of the Court’s ruling on the expansion of Medicaid.
As implementation of the ACA is underway, Medicare is under constant attack from those who seek to undermine the nation’s limited system of social entitlements. We should continue to defend against these attacks. But we should also get out of the defensive posture and argue that Medicare is a remarkably successful system that could be expanded rather than limited. For example, while we may not be able to immediately achieve Medicare for all, how about working to incrementally expand eligibility for Medicare, so that it covers more people? At the same time we could work to strengthen its financing. Within the confines of the ACA, we could see Medicare for more, even if not yet Medicare for all.
Many on the left attacked the ACA as a huge giveaway to the insurance companies, because the “mandate” expands the pool of potential insurance purchasers. However, we need to recognize that the ACA also represents a significant expansion of government regulation of the insurance companies. Yes, it does not eliminate the insurance companies, but it does require them to end discriminatory practices, cover pre-existing conditions, end lifetime coverage caps, and stop cancelling coverage for those who get ill. The ACA represents a milestone in the regulation of one of the country’s most powerful industries. We should build on this strength and defend it against the inevitable efforts of the industry to undermine it.
Finally, this ruling demonstrates, once again, the importance of keeping the Presidency in Democratic hands. The narrow 5-4 ruling is a step toward the judicial dismantling of the commerce clause of the Constitution. It is the commerce clause that has enabled almost all progressive efforts undertaken by the federal government since the New Deal. Sensible appointments to the Supreme Court and the rest of the federal judiciary are vital in the coming years. We must also work in the coming election to strengthen progressive forces in the legislative branch.
So, two-cheers for the ACA; It is as a step forward, but not a final destination.
Bob Lucore, a long-time ADA board member, is the former Director of Research and Policy for the United American Nurses and has worked for the Teamsters and the Department of Economic Research at the AFL-CIO. . He taught economics for several years at Centre College and Colorado State University and is currently studying Library and Information Science at San José State University. Bob is a member of UAW Local 1981, the National Writers Union.Back