President Obama in 2010 introduced the Affordable Care Act (ACA), now known as Obamacare, hoping it would be the landmark achievement of his presidency whose legacy would place him among the great presidents of America. His opponents opposed it tooth and nail for a number of reasons, one of which was to sink his presidency with Obamacare and push him into the ranks of America's worst presidents. The ACA was passed in Congress in 2010 when the Democrats held both the houses. Once the Republicans won the House of Representatives in the midterm elections in 2010, they have not lost a chance to derail the Act even after it was passed into law.
The ACA was given one reprieve by the Supreme Court when its opponents wanted it to be declared unconstitutional on the controversial "individual mandate" issue that required people to buy healthcare insurance or pay a "shared responsibility payment" to the government. At that time, the Court in a 5-4 majority cleared the ACA arguing that the "shared responsibility payment" was a tax that the federal government under the constitution had the right to impose. The opponents thereafter fought the ACA at all levels outside the law. They had hoped that the people would reject the ACA. That did not and instead more people registered under the ACA. The Republican-dominated House refused to pass the federal budget in 2013 to pressure Obama to withdraw or make the amendments they wanted in the ACA. Their efforts failed to derail Obamacare because more and more people across the nation registered for health insurance under it.
The opponents finally took Obamacare to the Supreme Court a second time - this time on the issue of subsidies under the ACA. A major part of the ACA was the establishment of "marketplaces, known as exchanges, to allow people who lack insurance to shop for individual health plans". A minority of the states created these exchanges while in 36 states, the federal government established these exchanges. Eighty five per cent of those who went to these exchanges were eligible to receive subsidies. The Supreme Court by a margin of 6-3 ruled last week that Americans who bought their health insurance in exchanges set by the state who belonged to the low and middle-income groups were eligible under the ACT to subsidies. The opponents had hoped a ruling to the contrary, that those who purchased Obamacare in state exchanges that would have affected 6.4 million people, would not be entitled to subsidies that, in turn, would have struck a fatal blow to Obamacare.
The latest Supreme Court ruling removed the last obstacle to Obamacare freeing it to work for millions of Americans who before the ACA were left to the drugs available across the counter in the drug stores for their healthcare which for all practical purposes meant that for life-threatening diseases nearly 50 million uninsured Americans had nowhere to go. That in a country that is the world's only superpower, millions would be left to the elements for fighting health issues, even life-threatening ones, is unbelievable. It is even more unbelievable that no serious move was made until President Obama became the first black president of the United States to give hope to millions to live that even many third world countries give to their people.
That is not the end of the sordid story of healthcare in USA. A significant section of Americans, led by the Republicans, have gone to every length so far to stop Obamacare and thereby to deny healthcare to millions of their unfortunate fellow citizens. They have gone against the fundamental principle in the American Declaration of Independence that "all men are created equal and that they are endowed by their Creator with certain unalienable rights and that among these are Life, Liberty and pursuit of Happiness" to go into denial over the fate of millions of their fellow citizens who cannot afford health care - a denial that condemned them to die.
The US Supreme Court, in delivering the two decisions on Obamacare, has shown why it is the world's most respected judiciary. Through the centuries with historic decisions, it has given US federalism and democracy the shape and content through interpreting the constitution of the country in the manner that the Founding Fathers would have expected. The Court had given the lifeline to Obamacare in 2012 by using the right of the federal government to impose tax under the constitution. The margin then was 5-4 and to many it had appeared that the Court had not given a very emphatic nod to ACA and perhaps it had wanted to watch the course that Obamacare would take once given the lifeline.
That course has been a solid one to convince the Court and particularly the Chief Justice John Roberts who wrote the majority decision. And it was an emphatic decision he handed down. Justice Roberts argued that the spirit of the Affordable Care Act, its "larger statuary plan" was to "improve health insurance markets and not destroy them." Therefore, he further argued that although the plaintiff in the case had a strong case in contesting that people buying insurance in "exchange established by the state" should not be entitled to subsidies because it has not been clearly written into the ACA, this oversight in the Act must be overlooked because of its "larger statutory plan".
The latest Supreme Court judgment has come as a major blow to the opponents of Obamacare. The 2012 judgment was a grudging one. This 6-3 judgment in which the five other justices unanimously agreed with the Chief Justice unlike the 5-4 2012 judgment, is a solid one for ACT. The judgment is a major victory for President Obama who has now been assured that ACT will survive his presidency. In fact, from uneasy start in 2013, when there was doubt where it was headed, Obamacare is today supported by 48 per cent Americans. More previously uninsured Americans in millions are becoming first-time owners of health insurance in world's number one economy. With the issue of subsidies out of the way, millions more would now be expected to have the benefit of coming out of darkness on healthcare issues to being treated as "equals" to fellow Americans with health care insurance.
In writing the historic judgment, Chief Justice Roberts underlined the spirit behind the separation of powers in the US Constitution, a spirit that placed the three branches of the government in separate compartments to give them independence but with the expectation that they would use their independence to work for the welfare of the country because the government is in the end an organic whole. He stated that it is the duty of the Supreme Court to help the passage of an Act in legislature not to create impediments to it because in the end the members of the legislature are the elected officials that the judges are not. Unfortunately, the Congress and the Executive seem to have forgotten about this spirit where the former is unwilling to cooperate with the latter that has forced the President to use his executive powers bypassing the Congress. The Court's judgment on Obamacare has underlined the lack of the spirit behind the separation of powers in the legislature and the executive in a manner that can only be described as undesirable and perhaps unconstitutional.
The writer is a retired Ambassador.
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