The Washington PostDemocracy Dies in Darkness

Opinion The Supreme Court confirms it: Time for the GOP to give up on destroying the ACA

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June 17, 2021 at 12:58 p.m. EDT
The U.S. health-care system is broken, but do other countries have it better? Seven leading health economists and public policy experts weigh in. (Video: James Fox/The Washington Post, Photo: Danielle Kunitz/The Washington Post)

Once again, Republicans have failed in their seemingly endless quest to have the Affordable Care Act wiped from the pages of history, this time with their third defeat at the Supreme Court. If they have any sense, this should bring that shameful crusade to an end.

The court did what it often does on complicated cases where a sweeping ruling might be politically and practically disruptive: It ruled only on a narrow legal question, in this instance whether the plaintiffs in the suit had standing to bring it in the first place.

Those plaintiffs were 18 Republican-run states, later joined by two individuals, who claimed that if you cover one eye and hold the ACA up to the light while turning it counterclockwise, it will appear to be unconstitutional.

But in order to have standing to sue, a plaintiff must establish that they were injured in some way. Seven justices ruled, quite properly, that they had not.

“Neither the individual nor the state plaintiffs have shown that the injury they will suffer or have suffered is ‘fairly traceable’ to the ‘allegedly unlawful conduct’ of which they complain,” wrote Justice Stephen G. Breyer for the 7-to-2 majority.

The question revolved around the ACA’s individual mandate, which initially required most Americans to carry health insurance or pay a fine. Congress later reduced that fine to $0; Republicans then claimed that since the mandate now effectively existed only on paper, that meant almost the entire law had to be declared null and void.

Serious people on all sides found this argument to be preposterous (even if not quite the most preposterous of the legal arguments conservatives had pulled out of the air to destroy the ACA). And the fact that even some of the court’s committed conservative ideologues (Clarence Thomas) and committed Republicans (Brett M. Kavanaugh) joined the majority in turning back this challenge says a lot about the state of the anti-Obamacare crusade.

This case is different from the prior ACA cases the court considered in an important way: You won’t see too many Republicans tearing their hair out over the fact that they lost, or declaring the conservative justices who voted with the majority to be traitors to their cause.

The desire to drive a stake through the heart of Barack Obama’s signature legislation simply does not feel as urgent as it did back when Republicans in the House were passing dozens of fruitless repeal bills. There are a number of reasons all of which have to do with the passage of time.

The incandescent loathing Republicans felt for Obama and everything he produced has lessened a bit, given that he left office more than four years ago (four years that seemed like 40). The law has grown steadily more popular, which raises the political risks to the GOP of striking it down. Most important, in all its complexity the ACA is woven inextricably into nearly every facet of our health-care system.

That means that if Congress or the Supreme Court snatched it away, the result would be nothing short of a cataclysm, with tens of millions losing coverage and the entire system thrown into chaos. All but the most foolish Republicans know this, which is why every time they fall just short of killing the ACA — with these challenges, and with their slapdash 2017 repeal bill that almost passed — they know they’re better off having failed, thereby avoiding the inevitable backlash.

So now they have to ask themselves a question: Can they finally just give up and accept the fact that the ACA is, and will remain, the law of the land?

That doesn’t mean they have to stop advocating for their version of health-care reform (though the truth is that plenty of Republicans would be more than happy to do just that; health care just isn’t a topic that interests most of them all that much). But it would do them, and the rest of us, a whole lot of good if they gave up on the dream of someone swooping in with a giant fist to crush Obama’s health-care law.

We’re not going to stop debating health care — not in the short term, and probably not ever. We have what is almost certainly the most complicated system in the world, an assemblage of private and public elements that don’t quite fit together and produce staggering inefficiency and cost. Yet there may be almost nothing in American politics that would be more difficult to achieve than the kind of wholesale overhaul of the system that could fix most or all its problems all at once.

Which means that we’ll keep trying to expand coverage, to restrain costs, to limit the miserable suffering the system allows, and to generally try to make a bad situation better with piecemeal additions and changes and reforms. Every one of them will probably be the subject of intense political debate.

But after more than a decade of battles in courts and Congress and state legislatures, the Affordable Care Act has won. It’s long past time for Republicans to accept it.

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