Despite the nation's laserlike focus on the Supreme Court and the Affordable Care Act, we shouldn't pretend that the White House's law is the only game in town.
pending Supreme Court decision has brought attention to the Affordable Care Act
(ACA) to a near boil once again. The country is almost perfectly divided on the
law along partisan lines, signaling that the law has become a symbol of ideological
and partisan differences that have little to do with substantive disagreements
about the details and the merits of the legislation itself.
Decisions about the
future of the ACA in the Court or by the next president and Congress will have
enormous consequences--for one thing, it is hard to imagine returning to a
world where we leave fifty-plus million Americans uninsured. But it is a
mistake to treat the ACA as the only game in town when it comes to big, looming
health policy questions. In fact, what is unique about the current era is how
many big questions about future directions may be up for grabs. The answers to
these questions will profoundly shape the future of American health care.
First, there will no doubt be a
debate after the election about converting Medicaid into some form of a
block grant program. The fundamental issue: should we as a nation
guarantee health coverage to most low-income people as a matter of
national policy, or is it better to leave that decision to each of the
states? Resolution of this issue could radically change health coverage
for more than 60 million low-income and disabled people, and affect both
state and federal budgets.