In the next week or so you can expect the Congressional Budget Office to re-score Obamacare. The CLASS Act is gone, as are the two years of ramp-up time that allowed the original 10- year scoring to disguise the extent of the taxes and spending in the bill.
More important, now that states can opt out of Medicaid without penalty, there is going to be a massive dumping of patients into the exchanges. That is more expensive, and unlike Medicaid, a cost footed entirely by the federal government. The CBO should reflect that bigger cost to the feds. (Likewise, if the public starts opting for the tax, the mandate becomes less effective and the healthy people needed to keep costs down in the exchanges don’t show up in such force. It is unclear if this can be predicted/scored.) The bill post-Roberts is hugely more expensive than in its original form.
Once this is done you may see House Budget Committee hearings. On July 11 the House will again vote to repeal the law as it stands now.
And this is key: Would Democrats have voted for a “tax” and a health-care bill with billions in additional costs (due to the Medicaid provision’s alteration)? As a factual matter I doubt it. And this is the great mischief in Chief Justice John Roberts’s decision: “His” law wouldn’t have passed Congress.
But this is now a political matter. Will Sens. Claire McCaskill (D-Mo.), Joe Manchin (D-W.Va.) and Jon Tester (D-Mont.), to name three, stand by the law in its altered form? They said they’d never vote for a “tax” or a budget buster, but the Roberts-ized law is both. Every Democrat will have to make the decision to stick with a bill even more politically repugnant than the one they voted for or try to save their own skins.
As for the presidential race, Mitt Romney will get to run against a president who said one thing to the voters (no tax!) and another to the court ( it’s a tax!); who promised not to add to the debt; and who said Americans would get to keep their existing coverage. We now know none of that is true of the current law.
Whoever wins in November is going to have to fix this mess. At this point, doesn’t Romney have the winning argument that he’s the superior dealmaker to figure out what sensible health-care reform is possible? President Obama has already shown us that he can’t make a deal with Republicans to save his (political) life.