The New England Journal of Medicine published a nice article on the constitutuionality of the Affordable Care Act. In it, there is a lot of information regarding the rhetoric versus the reality.

On the possibility of repeal

However, legislation that overturns the ACA has no chance of becoming law during the next 2 years; in the short term, congressional repeal is a symbolic cause, rather than a realistic possibility

On the politics of repeal

Pushing for repeal nonetheless allows Republican congressional leaders to assuage their conservative base. But it also represents a risky political strategy. Overturning the law would effectively deinsure 32 million Americans, deregulate the insurance industry, strip insured persons of coverage protections and enhanced benefits, and worsen the projected federal budget deficit – all while the number of people without insurance gallops upward, along with premium prices. A campaign to repeal health care reform could enable Democrats to paint Republicans as doing the bidding of the insurance industry.

Where things stand now

Moreover, parts of the ACA have already gone into effect. Repealing the entire bill would mean that some Americans would lose benefits – including insurance reforms that allow parents to keep children on their plans until the age of 26 and that prohibit insurers from imposing lifetime limits on coverage.

On the mandate

Most legal scholars believe that the mandate is constitutional, and another federal judge in Michigan agreed in a recent ruling.

Why the law seems unpopular

The dilemma for reformers is that too many Americans believe in controversial provisions of the law that don’t exist, such as the imaginary “death panels,” whereas not enough Americans are familiar with or identify as part of the law popular provisions that are real, such as enhanced Medicare coverage of preventive services and new consumer protections for Americans with private insurance.

Why it will likely succeed

Government health insurance programs, once they are in place, often prove enormously popular regardless of the controversy surrounding their enactment; Medicare is an important case in point. The ACA may yet overcome partisan polarization, its amorphous structure, and public skepticism and thereby follow a similar course. But for that to happen, the law’s key provisions must first be fully implemented.

So what is going to happen? As I told a group this past week, the real problem is trying to provide seamless coverage so that folks who develop an illness are not left dying in the street because everyone tries to dodge responsibility for paying for the care required.  Senators from Massachusetts and Oregon have proposed a revision to the Act that would allow states to opt out if they can demonstrate their plan offers equivalent coverage to that required by the  Affordable  Care Act. As a person living in a state that continued building schools intended for a single race for at least 15 years following “Brown vs the Board of Education of Topeka,” I would like to see how they will determine equivalency before I feel good about revision. Let’s move ahead.