Supreme court review of the ACA and political gamesmanship

Abstract

Since the Affordable Care Act (ACA) was signed into law on March 23, 2010, it has been tested by the courts and electorate. On June 28th, the Supreme Court handed down a ruling on the legal basis of certain key provisions of the new law. Speculation and prognostication on how the court would rule was widespread but often inaccurate. The court upheld the constitutionality of Congress’ power to enact the individual mandate, although the Justices were divided in their rationale. In a surprising decision, the court ruled that the Federal government may not set terms for the ACA Medicaid expansion that would tie a state’s decision to expand to a total loss of Medicaid funds. Within a few months of the Supreme Court ruling, the 2012 Presidential election tested the fate of the ACA yet again. When Congress undertakes major policy innovation, as in the ACA, the fate of its decisions remains somewhat uncertain as the courts or future Congress can overturn them. Despite uncertainty, Congress passes laws anyway, knowing that no law is perfect or immune from change. Continued controversy over the ACA reflects not only recent disagreements over the law but a long-standing dispute over the goal of providing universal or near-universal coverage in the USA that has been over 100 years in the making.