Supreme Court health care ruling increases the probability of second term for Obama

The ruling is likely to make the law much more popular among dubious independent voters.

If there was news before last Thursday, no one in the United States remembers, because all we have been talking about since then is the US Supreme Court's ruling on the Affordable Care Act, which is the real name for "Obamacare". The high court, in a 5-4 decision, decided that the law affecting every single American citizen is constitutional, even the much-vilified individual mandate.

For those who have better things to do than keep track of our opaque and overly complicated debate over health care, "Obamacare," as it is widely known here, is our attempt at universal health care, a feature of every rich country that has been debated in the US since the Nixon era. We have known for a long time that the cost of health care could cripple the economy, and indeed, it has outpaced the rate of inflation by double digits. Other than education and housing, no other cost of living has grown so rapidly over the past decade, but no one had been willing to bear the political risk, especially after the beat-down suffered by Bill Clinton in 1993 when he tapped his wife, that wonky First Lady Hillary Clinton, to devise a way forward.

Broadly speaking, there are two ways of achieving universal care. One is to tax people and give the money back to them in the form of health care. The other is to force them to buy health care or pay a penalty. Either way, you pay. The only difference is you pay for something (that's good for you) or pay for nothing. In procedural terms, there is no difference between these, and the end is the same — everyone is put into a risk pool so that the healthy are underwriting the sick and the sick are not subject to the inhumane whims of the free market.

The means to that end, however, are laden with politics. Because Republicans are usually allergic to the idea of taxes, they hated the Clintons' proposal, and countered with a proposal of their own that avoided the appearance of a new tax. Instead they preferred a method that forced people by law to buy health insurance — and that became known under President Obama as the individual mandate.

Yes, the individual mandate that was embraced by a Democratic president, and passed by a Democratically-controlled Congress, was originally conceived by Republicans who were countering proposals made by a Democratic president. And that's not all.

Obama had wanted to put in place a "public option," which meant more or less greater access to Medicare (old-age health insurance). But that, too, was blocked by Republicans. So Obama, being the deal-maker that he is, put on the table something he thought even the Republicans couldn't turn down — their own policy idea. He was wrong, of course, and for the past two and a half years, we have seen an enormous effort on the part of Republicans and conservatives to show they never liked the individual mandate even though they were once its most vocal champions.

Since the late 1980s, the legal test of the mandate had always been assumed to be a slam dunk. Forcing people to buy health insurance was believed be lawful as it fell under the Commerce Clause of the Constitution, which gives Congress the power to regulate interstate trade. A health care market already existed, many reasoned, so Congress would be regulating a market that was already there.

But after Obama championed, and Congress passed, the individual mandate, Republicans and their libertarian allies, some of whom are billionaires and heads of health insurance corporations who spent millions fighting the law, essentially moved the goal posts, as we say here. No, they said, a health care market does not already exist (never mind that everyone needs health care), so making people buy anything is unconstitutional or un-American. In fact, that sounds like something only an Islamist-communist-fascist dictator like Barack Hussein Obama would do.

In the end, the ruling came down to Chief Justice John Roberts, who was nominated to the bench by President George W. Bush. It had been assumed that Roberts would side with the court's conservative wing who had determined that the Commerce Clause argument vis-à-vis the individual mandate was invalid. Even though Roberts agreed, he found that the individual mandate could stand under Congress's undisputed power to tax. If you don't buy health care, you pay a penalty. Roberts reasoned that this is a tax, whether you call a tax or not.

As I said, this was the very thing Republicans wanted to avoid: universal health care that relies on a universal tax. Republicans don't like to go on record as having voted in favor of a new tax. So the individual mandate was from the start an ingenious way to avoid the appearance of a new tax even though the money people would spend on insurance would be in effect the same money they would pay in a new tax.

This, again, is why there is no difference between these methods. So it is ironic that a conservative judge nominated by a conservative president has declared that a conservative idea meant to avoid looking like a tax says, um, it looks like a new tax.

It is doubly ironic, because Mitt Romney, the Republican presidential challenger, is now using that conservative judge's opinion against the president even though Romney, when he was the governor of Massachusetts, implemented the ingenious Republican idea of an individual mandate in that state.

If your head is swimming, hold on. It gets worse.

Romney's record on health care in Massachusetts, however admirable, is a liability among the GOP's conservatives, who already believe universal health care is code for "creeping communism". That Obama modeled his health care legislation on Romney's has always carried the unfair implication that Romney wasn't a real conservative. Obamacare, rightly or wrongly, has been very unpopular, mostly because most people don't understand it and the president has done a poor job of selling it. Romney can satisfy his base while making a legitimate bid for independent voters by vowing to repeal Obamacare.

But the Supreme Court ruling complicates matters. First, its seal of approval is likely to make the law much more popular among dubious independent voters, especially as its components become better understood, so that the more Romney vows to repeal it, the more he seems to be rehashing a settled issue.

Second, the Republican leadership is making a lot of noise over mandate as a tax, claiming that Obama has just pushed through the largest tax increase in American history (which is patently false). The more they push the tax message, the more Romney has to defend his record so that he doesn't appear to be a tax-and-and spend politician much like the president.

2012 is turning out to be the year of looking-glass politics. Romney once took credit for Obama's decision to bail out the auto industry when he had nothing to do with it. Now he could legitimately lay claim to having influenced the greatest piece of domestic legislation since the Great Society of the 1960s, but he wants nothing to do with it. Such are the times for a Republican presidential hopeful and such is the rising probability of second term for Obama.
 

Obamacare supporters react to the US Supreme Court decision to uphold President Obama's health care law. Photograph: Getty Images

John Stoehr teaches writing at Yale. His essays and journalism have appeared in The American Prospect, Reuters Opinion, the Guardian, and Dissent, among other publications. He is a political blogger for The Washington Spectator and a frequent contributor to Al Jazeera English.

 

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Staying in the EU would make it easier to tackle concerns about immigration, not less

Brexit is not only unlikely to deliver the control people want, it may actually undermine people’s faith in the system even further.

As Theresa May prepares to set out her latest plan for Brexit in Florence on Friday, those on all sides of the debate will wait to see if there are answers to fundamental questions about Britain’s future outside of the EU. Principle among those is how the UK immigration system will work. How can we respond to Leave voters’ concerns, while at the same time ensuring our economy isn’t badly damaged?

We must challenge the basic premise of the Vote Leave campaign: that dealing with public’s concern about immigration means we have to leave the EU and Single Market.

In fact the opposite is true. Our study into the options available to the UK shows that we are more likely to be able to restore faith in the system by staying within Europe and reforming free movement, than by leaving.

First, there are ways to exercise greater control over EU migration without needing to change the rules. It is not true that the current system of free movement is "unconditional", as recently claimed in a leaked Home Office paper. In fact, there is already considerable scope under existing EU rules to limit free movement.

EU rules state that in order to be given a right to reside, EU migrants must be able to demonstrate proof that they are either working, actively seeking work, or self-sufficient, otherwise they can be proactively removed after three months.

But unlike other continental systems, the UK has chosen not to operate a worker registration system for EU nationals and thus has no way of tracking where they are or what they’re doing. This could be changed tomorrow, if the government were so minded.

Other reforms being discussed at the highest levels within Europe would help deal with the sense that those coming to the UK drive down wages and conditions. The UK could make common cause with President Macron in France, who is pushing for reform of the so-called "Posted Workers Directive", so that companies seeking to bring in workers from abroad have to pay those workers at the same rate as local staff. It could also follow the advice of the TUC and implement domestic reforms of our labour market to prevent exploitation and undercutting.

Instead, the UK government has chosen to oppose reform of the Posted Workers Directive and made it clear that it has no interest in labour market reform.

Second, achieving more substantive change to free movement rules is not as implausible as often portrayed. Specifically, allowing member states to enact safeguards to slow the pace of change in local communities is not unrealistic. While the principle of free movement is a cornerstone of the European project, how it is applied in practice has evolved. And given that other countries, such as France, have expressed concern and called for reform, it is likely to evolve further.

The reforms to free movement negotiated by David Cameron in 2016 illustrate that the EU Commission can be realistic. Cameron’s agreement (which focused primarily on benefits) also provides an important legal and political precedent, with the Commission having agreed to introduce "safeguards" to respond to "situations of inflow of workers from other Member States of an exceptional magnitude over an extended period of time".

Similar precedents can be found within a number of other EU agreements, including the Acts of Accession of new Member States, the European Economic Area (EEA) Agreement and the Treaty on the Functioning of the European Union (TFEU). The UK should seek a strengthened version of Cameron’s "emergency brake", which could be activated in the event of "exceptional inflows" from within the EU. We are not the first to argue this.

Of course some will say that it is unrealistic to expect the UK to be able to get more than Cameron achieved in 2016. But put yourself if in the shoes of the EU. If you believe in a project and want it to succeed, moral imperative is balanced with realism and it hardly needs pointing out that the political context has radically shifted since Cameron’s negotiation.

In contrast, a "hard Brexit" will not deliver the "control of our borders" that Brexiteers have promised. As our report makes clear, the hospitality, food, manufacturing and social care sectors heavily depend on EU workers. Given current employment rates, this means huge labour shortages.

These shortages cannot be wished away with vague assertions about "rejoining the world" by the ultra free-market Brexiteers. This is about looking after our elderly and putting food on our tables. If the UK leaves in April 2019, it is likely that the government will continue to want most categories of EU migration to continue. And whatever controls are introduced post-Brexit are unlikely to be enforced at the border (doing so would cause havoc, given our continued commitment to visa-free travel).  Instead we would be likely to see an upsurge in illegal migration from within the EU, with people arriving at the border as "visitors" but then staying on to seek work. This is likely to worsen problems around integration, whereby migrants come and go in large numbers, without putting down roots.

We can do this a different way. The important issues that most drive public concern about EU migration - lack of control, undercutting, pace of change - can be dealt with either within current rules or by seeking reform within the EU.

The harsh truth is that Brexit is not only unlikely to deliver the control people want, it may actually undermine people’s faith in the system even further.

Some will say that the entire line of argument contained here is dangerous, since it risks playing into an anti-immigrant narrative, rather than emphasising migration’s benefits. This is an argument for the ivory tower, not the real world.

There is a world of difference between pandering to prejudice and acknowledging that whilst EU migration has brought economic benefits to the UK, it has also created pressures, for example, relating to population churn within local communities.

The best way to secure public consent for free movement, in particular, and immigration in general, is to be clear about where those pressures manifest and find ways of dealing with them, consistent with keeping the UK within the EU.

This is neither an attempt at triangulation nor impractical idealism. It’s about making sure we understand the consequences of one of the biggest decisions this country has ever taken, and considering a different course.

Harvey Redgrave is a senior policy fellow at the Tony Blair Institute for Global Change and director of strategy at Crest Advisory.