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Politics, precedent in Affordable Care decision
Guest editorial
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Thursday’s U.S. Supreme Court decision upholding the key provisions of the Affordable Care Act is a landmark ruling by any reasonable definition of that familiar term.

Such status does not in itself convey value judgment: “Landmark” Supreme Court cases have ranged from the reprehensible Dred Scott ruling of 1857 to the civil rights affirmation of Brown v. Board of Education in 1954; somewhere in between are still hotly debated outcomes like Roe v. Wade in 1973 or Bush v. Gore in 2000.

But the high court’s narrow (to the surprise of few) ruling will serve as a new precedent for congressional authority. Indeed, despite the public and political identification of the health care act with President Obama, the ruling has larger implications for the legislative branch of government than for the executive.

The immediate political bounce is a judicial vindication and political victory for the president: The Affordable Care Act is a centerpiece of his agenda. Long term, it will be part of his record and legacy — for better or worse.

The politics between now and November might be tougher to handicap. Polls have consistently shown a majority generally opposing the health care mandates, and an even larger majority insisting that some kind of health care reform is imperative.

If the justices have been influenced by political rhetoric about the law — and in an ideal but imaginary world they would not be — then attempts by opponents to portray the insurance mandate as “the largest tax increase in American history” might have backfired. (Every tax, at every level of government, is invariably portrayed by opponents as the largest in history, so that tack has perhaps lost some of its political sting.)

If it is indeed a tax, then it is within the constitutional authority of Congress to approve it: “Because the Constitution permits such a tax,” Chief Justice John Roberts wrote for the majority, “it is not our role to forbid it, or to pass upon its wisdom or fairness.”

The corollary, of course, is that if Congress has the authority to approve such a law, then it is also within the power of this or a future Congress to amend it, improve upon it or discard it.

It has survived a legal challenge; if it survives future political ones, then health care law in the U.S. is subject to fine tuning, which can be a good thing. When tens of millions of Americans have no affordable access to health care short of the emergency room, politicians might be well advised to tread lightly.

The law’s ultimate test will not be political, but practical. It will be measured by its real-life impact on the millions of Americans it affects — its benefits, its costs, and whether the balance between the two is reasonable and sustainable. The status quo cannot be an option.

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