The Patient Protection and Affordable Care Act is now the undisputed law of the land following yesterday’s Supreme Court decision narrowly upholding the Congress’s power to impose a mandate to purchase healthcare insurance under its taxation powers while more broadly rejecting the Congress’s ability to punish states that reject the expansion of the Medicaid burden that the law would impose on them. Some progressives have sniped derisively at Tea Party governors who would refuse to accept the expansion of Medicaid for which the PPACA provides. I strongly suspect that they will be very surprised and dismayed at the Democratic governors who do so. The states have fiscal problems enough without accepting significantly more of an expense that rises faster than their revenues do.
Nancy Pelosi, Speaker of the House of Representatives when the PPACA was enacted, famously remarked that we would need to wait until the law was enacted to learn what was in it. If only that were the case! As I pointed out yesterday enough of the law will be promulgated in the form of regulations many of which have not been written yet and some of which won’t be written until after the law goes into effect fully in 2014 that nobody can really say what’s in it. The best we can say is we’ll see.
When we do know what’s in it, I suspect that more people will come to the conclusion I did when the law was enacted: it’s simultaneously excessive and inadequate. It doesn’t result in everybody having healthcare insurance, it retains multiple, competing healthcare systems, it doesn’t slow the increase in costs let alone reduce them as I believe we need to do, and it expands the bureaucratization of an already too bureaucratic healthcare system.
But we’ll see.