Healthcare reform is a marathon, not a sprint

King v. Burwell will be argued before the Supreme Court this week. It won’t be decided, just argued. Then, we’ll parse how well the arguments went, and whether we can predict what will happen from that show. Last time, by the way, we couldn’t. Then, in June, we’ll get a decision.

I know lots of people (including possibly everyone else at this blog) think the plaintiffs will win. Putting my cards on the table – I’m not one of them. I think the Justices will rule for the government, but I admit that’s a gut feeling. I may be wrong.

But the world won’t end overnight, and neither will the ACA. It will still function in a subset of states. I think even more will take quick action to fix their exchanges. I have a hard time believing that any state that accepted the Medicaid expansion won’t find a way to accept subsidies for their citizens who are working. So we’ll be left with a minority of states that don’t have subsidies and have a broken individual insurance market.

That’s where history comes in. I’ve said it before, but it bears repeating: All of this has happened before and will happen again. Medicare was, at one time, the death of freedom. Go read this piece on what people thought when “traditional” Medicaid was first passed in 1965. Then remember that Arizona, the last state to accept Medicaid, finally did so in 1982.

Between 1965 and 1982, we had a country where a program existed to cover all poor children, all poor pregnant women, the poor elderly, and many poor parents – but only in some states and not in others. The Earth continued to spin on its axis. The country survived. It was ridiculously unfair for some people who lived in states that refused to accept Medicaid, but eventually, all the states did.

The same can be said of the US if the Supreme Court finds for the plaintiffs. But, as with Medicaid, I think it’s likely the ACA will survive. I also believe, someday, that someday the Supreme Court will view the removal of the ACA as “coercive” as it viewed the removal of traditional Medicaid just a few years ago.


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