Health Care: Now Comes Substance?

Photograph by Jamie McCarthy/Getty Images

A kidney transplant at Johns Hopkins Hospital June 26, 2012 in Baltimore, Maryland.

It’s just possible that the debate could turn to substance now.

OK, that’s probably pushing it.

Yet, now that the Supreme Court has upheld the core of President Barack Obama’s Patient Protection and Affordable Care Act, the president will have more time to talk about patient protection and affordable care.

Republican Mitt Romney has quickly pivoted to the rationale that Chief Justice John Roberts cited in writing the 5-4 majority opinion upholding the law: The health-care mandate is a tax, and Congress has a right to tax people.

It’s a tax, Romney maintains. 

Yet Romney and fellow Republicans, campaigning with a pledge to start repealing the law on “Day One” of a Romney presidency, will be compelled to start spelling out an alternative that protects patients and offers affordable care.

Romney has a certain hurdle to overcome — his own support for a personal mandate in the insurance law he pushed through as governor of Massachusetts. Obama was ready to point this out in his remarks following the Supreme Court ruling.

Romney argues that that was Massachusetts, and this is the United States, and one size does not fit all.

Still, the president signaled with his remarks from the East Room of the White House yesterday that he is ready to start explaining the benefits of the law — offering health coverage to at least 30 million Americans lacking it, guaranteeing coverage for people with pre-existing conditions, covering young adults on their parents’ policies, cost-savings in Medicare — benefits that the administration probably should have spent more time promoting after the law’s passage.

And Romney, while pressing for repeal and campaigning against taxes, will be asked time and again about the alternative — leading us back to the starting premise that some substance just may be injected into the campaign debate. House Majority Leader Eric Cantor of Virginia, also on the repeal campaign — promising a House vote on July 11 — was pressed about that alternative plan in questions from NBC News’ Tom Brokaw today, and Cantor came up short on details.

“Romney has lost the argument that Obama engaged in unconstitutional policy-making,”says Darrell West, vice president and director of governance studies at The Brookings Institution in Washington.

“Now he is back to the substance of health care, and he is the wrong messenger for the Republican message on that subject,” West said in an e-mail today. “Obama can move the conversation from the abstraction of health care to how particular provisions benefit individuals. That is a major reset for the campaign.”



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