Perspective: Legislative gridlock leaves Affordable Care Act in limbo
June 11, 2019
In a Perspective column for the New England Journal of Medicine, Jonathan Oberlander, PhD, professor of health policy and management at the UNC Gillings School of Global Public Health, explores the challenges a divided government poses for the future of the Affordable Care Act (ACA).
Oberlander’s column, “Sitting in Limbo — Obamacare under Divided Government,” appeared online in the journal May 9. At issue are the legal ramifications of repealing the ACA “tax” on individuals who lack health insurance coverage.
In 2018, Republican state attorneys general made the case, upheld in district court, that the ACA “tax” was not separate from the law and that Congress had therefore rendered the entire ACA unconstitutional by eliminating the tax. The Fifth Circuit of the United States Court of Appeals is expected to reverse this ruling, and the case eventually could go to the U.S. Supreme Court.
“That Republican officials still seek to repeal the entire ACA despite the risk of enormous electoral damage to the GOP should they prevail underscores the persistence and intensity of opposition to Obamacare in some quarters,” Oberlander states. “In this struggle, the courts have become another arena for partisan conflict. Ultimately, Texas v. Azar may reveal less about constitutional law than it does about ACA politics.”
Oberlander also writes that — outside of the courts — legislative gridlock has left the ACA in limbo, making it difficult to either improve upon or repeal it.
Obamacare has existed mostly under a government divided, Oberlander says. From 2017 to 2018, Republicans had control of both the White House and Congress, but they still could not repeal-and-replace health care legislation as they had planned. President Donald Trump promised Republicans he would develop a new plan to replace the ACA, but because Democrats have majority control of the House, a Republican health care bill could not pass Congress.
“Democrats have been unable to strengthen or build on the ACA, and Republicans have been unable to eliminate or severely weaken it,” Oberlander states. “Barring a stunning Supreme Court decision to invalidate the entire ACA, the stalemate will continue until at least 2021.”
Despite the political divide, the ACA still operates with mostly the same provisions. Enrollments in the ACA’s insurance marketplace have not declined substantially. For all the controversy that has surrounded the law, it has seen important successes and transformed the health care landscape. Though both liberals and conservatives may want to move beyond the law, enacting reform that “aims to undo the ACA and replace it with new insurance arrangements is easier said than done.”
Dr. Oberlander also is professor and chair of social medicine in the UNC School of Medicine.
Contact the Gillings School of Global Public Health communications team at firstname.lastname@example.org.