Now the debate over the Affordable Care Act (ACA) moves back into the political arena, where it rightly belongs. With the U.S. Supreme Court having largely upheld the constitutionality of the health care reform law, the decision whether to continue moving forward with its implementation or repeal it rests with voters.
To his credit Chief Justice John Roberts, writing the majority 5-4 opinion, recognized it was not the court's job to supplant its policy opinions for that of the elected representatives of the people - Congress and the president.
"The Framers created a Federal Government of limited powers, and assigned to this Court the duty of enforcing those limits. The Court does so today. But the Court does not express any opinion on the wisdom of the Affordable Care Act. Under the Constitution, that judgment is reserved to the people," wrote the chief justice in the closing lines of the opinion.
Chief Justice Roberts showed great integrity in sticking to his ideology of judicial restraint, rather than joining his fellow four conservative justices, Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito, who made it clear in their dissenting opinion they were prepared to throw the entire law out, using logic built on a flimsy constitutional structure.
Receiving much of the attention was the individual mandate. Beginning in 2014, those who can afford it, and do not have coverage through work or other means, must purchase minimal insurance coverage or face "a shared responsibility payment," or penalty. This provision recognizes that the more popular parts of the health care law - making it unlawful to deny coverage to individuals because of prior health conditions, or cancel policies when people get sick or place lifetime caps on benefits - cannot work if people choose not to seek coverage, and pay premiums, until they get sick.
We disagree with Chief Justice Roberts' conclusion that Congress did not have the authority under the Commerce Clause to impose the mandate. He argues the law sought to impose commerce, rather than regulate it. But the fact is everyone at some point engages in the commerce of health care, and Congress should be free under the Commerce Clause to regulate how it is paid, including by requiring individuals to have insurance.
Yet we recognize this conservative jurist's reluctance to expand congressional power and applaud the chief justice for recognizing that the penalty is constitutional under another legislative power - the imposition of taxes. Chief Justice Roberts rightly notes that an individual will have a "lawful choice to do or not do a certain act (purchase insurance), so long as he is willing to pay a tax levied on that choice."
The court ruled, however, that Congress went too far in threatening states' existing Medicaid funding for declining to go along with the Medicaid expansion called for by the ACA. Yet states will be under pressure to participate in the federally backed Medicaid expansion, even without that coercive penalty, because citizens will not accept for long second-rate status when it comes to the health care access that their fellow citizens receive in cooperating states.
By 2014 all citizens with pre-existing conditions will be protected from being denied coverage. The 30 million to 40 million citizens without coverage will have access to it through insurance exchanges. Those who cannot afford the premiums will receive tax credits that help pay for it. And more of the poor will become eligible for Medicaid.
The law is complex and adjustments will be necessary. But does America really want to go back and start the debate anew?
Voters have that choice. They can elect presidential candidate Mitt Romney and his fellow Republicans who vow to repeal the law. Then what? Mr. Romney is void of ideas, saying he'll leave it to the states.
And voters have to think about what they will give up if they back Republicans and repeal. In eastern Connecticut in the last year 4,600 young people were able to remain on their parents' health policy until age 26. In 2011 about 7,700 seniors in this part of the state collectively received more than $5 million in prescription discounts, a number that will grow as the law closes the Medicare D doughnut hole entirely. And 88,000 eastern Connecticut seniors have taken advantage of free preventive care required by the act, including cancer and heart disease screenings.
In Connecticut, which has proactively prepared for full implementation in 2014, the ACA has allocated $192 million in federal implementation funds. And because the law primarily utilizes the private sector to provide coverage, it is good news for one of the state's major industries - insurance.
The Democrats can run and win on this referendum.