Such a ruling would be a major win for opponents of the federal statute. But it could come with complications. First, a party that has built its health-care message on the phrase “repeal and replace” would immediately come under pressure to reach consensus on how to reform the health-care system. Second, Republicans, who benefited from a sizable enthusiasm gap in the 2010 midterm elections, could face a Democratic opposition deeply angered and newly motivated by its setback in the high court.
Republican pollster Whit Ayres summed up the political consequences of the court overturning Obama’s law in part or in whole: “If the court strikes down just the individual mandate but leaves the rest of an increasingly unstable and unworkable structure, then the GOP has an ‘I told you so’ moment and an even greater argument for repeal. If the court strikes down the whole law, then the GOP has a huge ‘I told you so moment,’ but loses one of several large targets for the fall campaign. There are plenty of other targets remaining (jobs, stimulus, fiscal irresponsibility), but it loses a big one.”
For almost three years, health care has been the energizing force inside the conservative movement. It is arguable that the new legislation, as much as Obama’s stimulus spending, created the tea party movement that helped power Republicans to victory in 2010, and there’s no doubt that it has remained the most powerful organizing message for GOP candidates. The legal battle over the law has helped bind conservatives together in common cause at a time when the Republican presidential nominating contest has been a disappointment to many in the party.
Republicans have been far more united around the concept of repeal than replace, however. Coming together around a replacement for Obama’s comprehensive solution to rising costs and a lack of insurance among about 45 million Americans will be a major challenge. Up to now, Republicans have offered generalities, not a plan.
Many of the provisions of the current law are enormously popular, among them the prohibition against denying coverage for people with preexisting conditions and the ability of young people to stay on their parents’ insurance until age 26. Some ideas that Republicans have long advocated are also popular, among them tighter limits on medical malpractice lawsuits.
Republicans favor market solutions to many of the problems of today’s health-care system. Mitt Romney, who supported an individual mandate for Massachusetts when he was governor, says states should take the lead in reforming health care, a view most shared by most Republican officials. But what uniform standards, if any, should apply to the system, and what role would the federal government have to set those standards under a Republican plan?