What Didn’t Happen: A Non-Functioning Health Care System if the Entire Law Was Overruled
I teach in the summer, so I got to ditch my lesson plan for tonight and we spent an hour of class discussing the health care decision. Most of my summer students here in DC work in federal agencies, so they all had interesting takes on what they had seen today.
Here’s what I haven’t seen in the coverage — what would have happened to the entire system of federal reimbursement and health care payments if the entire law had been struck down. (Links welcome if others have covered this.)
The law was enacted in 2010, and billions of dollars have been spent in reliance on the law — systems changed, reimbursements realigned, and on and on.
The dissent clearly stated that they would have ruled null and void all the major and minor provisions in the 900-page bill. No severability.
If they had a fifth vote, what would our health care system have looked like tomorrow morning? The same Congressional gridlock that couldn’t raise the debt ceiling would have been confronted with a truly mind-bending challenge — rebuild the payment system for 17% of the economy. When no one had a draft bill ready. When we were a million miles from consensus. With no offsets to pay for it. During a close election campaign.
How do you think that would have worked out? How much uncertainty would that have caused the economy? What size dip in GDP would that have resulted in over the next couple of quarters?
So, a prediction based on pure speculation. Historians at some point will assess what Roberts was thinking when he became the fifth vote to uphold. Lots of commentators have said that he wanted to maintain the court’s legitimacy and avoid a partisan bloodbath. My prediction — he also wanted to avoid chaos in the health care system and the economy.