ObamaCare Upheld, But The Fight Ain’t Over [Op-Ed]

President Obama’s controversial Affordable Care Act was upheld today in the long-awaited Supreme Court decision. Though it is unquestionably a victory for Big-O, the healthcare battle is hardly over, and the law has to face quite a few more challenges before the president can rest and reflect on his legacy.

There are basically three main challenges ObamaCare must survive despite the SCOTUS ruling, notes Newser: pushback from the states, negative public opinion of the controversial law, and the November election.

The states arguably have to do the most heavy lifting when it comes to upholding ObamaCare. The law kicks in full-time in 2014, and as of the now, some states have already begun implementing parts of it. Others haven’t done anything. Today’s decision will encourage fast-moving states to move faster, but not much can be done about the states who haven’t implemented any of it yet. Some were waiting for the decision. Others are waiting until the November election is over. Some simply refuse to implement the law altogether. New Jersey Gov. Chris Christie commented on the Supreme Court decision, appropriately summarizing the onus of the states in implementation of the law:

“I’ve been clear from the very beginning that I do not believe a one-size-fits-all health care program works for the entire country and that each governor should have the ability to make decisions about what works best for their state. Today’s Supreme Court decision is disappointing and I still believe this is the wrong approach for the people of New Jersey who should be able to make their own judgments about health care. Most importantly, the Supreme Court is confirming what we knew all along about this law – it is a tax on middle class Americans.”

Good public perception of the law would ease some of the troubles ObamaCare must face as well, but the reality is that most Americans just plain don’t like it – at least the individual mandate. Polls have consistently shown that the American people are largely against such a dramatic and comprehensive overhaul of the healthcare system, despite promises that they can keep their coverage if satisfied. The individual mandate was the most unpopular aspect of the bill, but since it stands with the rest of the law as of today, public opinion will either stay the same (bad) or sour (worse).

“There’s certainly a risk that a large opposition could mitigate the effects of the mandate,” said MIT health care economist Jonathan Gruber, who worked on both the Massachusetts and the federal law. “I could see some resistance, where people decide to pay the fine.”

If healthy people opt to pay the fine and only people anticipating high medical costs enroll, premiums will rise, notes the Washington Post.

Of course, the law has to survive the November election. “If it stands, we are going to get rid of Obamacare, and I’m going to stop it on Day 1,” Mitt Romney told a crowd in Salem, Va., on Tuesday. Combined with a negative public opinion of the law, the decision could give an unexpected boost to Romney’s campaign. Whether not he can repeal the law (or will) if elected doesn’t matter. The decision could cost President Obama the White House, even though Romney now has added pressure to explain how he would repeal ObamaCare all the while haunted by his similar healthcare reforms in Massachusetts, notes NY Times blogger Michael Shear.

Though Democrats are wisely towing a line of, “it’s in the past, congress passed it, SCOTUS upheld it, your fight is over,” the Republicans are answering the decision in force, starting with the Twitter-based hashtag #FullRepeal (click for more details on that).

“It’s a boost for the president, but it doesn’t make the controversy go away,” said Republican strategist Karl Rove on Fox News moments after the announcement. “In fact, it probably enhances the controversy.”

The president may have set the 2014 deadline in his hypothetical second term to help ensure that he’d get one, but he may have also hoped that the law wouldn’t get as negative a reaction as it has. Whatever his plot, it may backfire on him – now he has to run on an already controversial law that isn’t even fully implemented yet. No one knows if it even works.

You may or may not agree with the Supreme Court’s decision. Maybe you love Obamacare and want to see it implemented. Maybe you want to see it fully repealed. The Supreme Court decision only really guarantees one thing:

It’s going to be an interesting election.