Ruling Boosts Obamacare and Republicans

After the Supreme Court’s decision upholding Obamacare, what next?

Politics for sure – by the afternoon of the decision Congressman Gregg Harper and others had implemented robocalls informing voters how they will repeal Obamacare. Talking heads on TV had a consistent script describing how repeal will work when voters give the GOP both a majority in the Senate and control of the White House. Contributions started pouring into Mitt Romney’s coffers and key Republican congressional races.

Continued implementation of Obamacare – while most discussion focuses on 2014 implementation of the individual mandate, expanded Medicaid coverage, insurance exchanges, and pre-existing condition prohibition, many provisions of the Patient Protection and Affordable Care Act are in place or will kick in next year. Already new insurance plans cannot drop people who get sick or enforce pre-existing condition limits on children. Children can stay on their parents’ insurance until age 26. A number of small businesses can get health insurance tax credits (more in 2014). The prescription drug “donut hole” for seniors has been partially closed. In August insurers must provide free preventive services like mammograms and colonoscopies. Next year Medicaid payments to primary care physicians can be no less than Medicare payments and funding for the Children’s Health Insurance Program will be extended two years.

Consternation – the move from our broken health care system (yes, it was broken) to the insidious Obamacare system puts doctors, hospitals, insurance companies, drug companies, and government agencies at odds. Hospitals in particular are concerned about the Supreme Court’s ruling that allows states to opt out of the Medicaid expansion.

Fact, facts, and more facts – voters will be flooded with facts about the number of uninsured people to be covered, the number to be included under expanded Medicaid, the number of businesses that will pay penalties and drop insurance, the number of options provided by insurance exchanges, the costs for this, the costs for that, and the costs if we don’t do this or that.

Facts I’ve not heard and would like to are the projected economic impact of expanded Medicaid for Mississippi and the number of jobs it would create. Would this generate enough additional tax revenue to more than cover the state’s delayed 10% share?

A final comment – some Republicans are bashing Chief Justice John Roberts for his paramount role in upholding Obamacare, but brilliance often bedazzles dim bulbs. His pithy decision reclaimed credibility for a Supreme Court seen as becoming not too conservative but too political, a boon for future important rulings. At the same time it invigorated the GOP base, cast Obamacare as a tax on the middleclass, and propped up Republicans who need to rail against Obamacare and federal expansionism but not actually propose politically difficult fixes for our health care system.

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