But as President George H.W. Bush demonstrated, everyone could go through life without eating broccoli and do just fine. Health care is different and, in any case, the system of checks and balances would prevent Congress and a president from mandating that everyone eat broccoli. If it didn’t, a subsequent Supreme Court could reject a law that mandated eating broccoli on the grounds that it is different from health care.
Of course, there remain major questions about the implementation of the law after the decision.
The Medicaid part of the decision has created an opening for governors, including Republicans Rick Scott of Florida and Bobby Jindal of Louisiana, to say they will reject the Medicaid expansion in the law, which is no longer a choice that would mean elimination of existing Medicaid dollars from the federal government.
But rejection of the Medicaid expansion is counterproductive and a sharp stick in the eye to residents of these states. First, of course, it is turning down 100 percent of federal funding for three years to help the poorest get insurance and care. Second, the failure to insure these people means that they will be going to emergency rooms and urgent care facilities when they need help — and will add to the costs of health care for the rest of us.
New Orleans Mayor Mitch Landrieu reflected on this problem in a conversation at the Aspen Ideas Festival, noting the heavy burden that Jindal’s decision would place on the already-strapped city.
Then there are the continuing efforts of Republicans in Congress to repeal the law — and to divert attention away as much as possible from the equal promise to replace it.
There is a new mantra, to be sure, the rote use of Frank Luntz’s phrase, “patient-centered” health care reform, which is utterly meaningless in policy terms but is focus-group-tested and a lot better than conceding that repeal means putting those with pre-existing conditions back in jeopardy, reinstating the doughnut hole for seniors’ prescription drugs and taking 20-somethings off their parents’ insurance.
It is always possible that the pledge to repeal will suffice in the campaign. But at some point, there will be a need to come up with a serious alternative — or at least, in the aftermath of the court decision, to find reasonable ways to fulfill Congress’ sworn responsibility and implement what is now firmly the law of the land.
Norman Ornstein is a resident scholar at the American Enterprise Institute.