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Keep ObamaCare

Keep ObamaCare

The arguments last week before the U.S. Supreme Court over the Patient Protection and Affordable Care Act affirmed what became clear when the health-care reform statute was passed two years ago: The act, including its so-called individual mandate, is good public policy and should remain law.

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The constitutional arguments addressed several basic questions about the law: Can Congress properly require Americans who do not qualify for public safety-net programs such as Medicare and Medicaid to buy private health insurance or pay a penalty? Is that penalty a tax? If it is, can the high court rule on the legality of the individual mandate before it takes effect in 2014 and penalties are actually collected?

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Can justices strike down the individual mandate without nullifying the entire law? Does the law's proposed expansion of Medicaid coverage for poor and disabled Americans impose an unreasonable new burden on states?

The justices showed little patience for the idea that they should kick the constitutional can down the road, and correctly so. The health-care law is the centerpiece of President Obama's legislative agenda, while Republicans demand its repeal without offering a better alternative for what they call "real" reform. The court owes it to voters to rule on the case before this year's presidential and congressional elections.

The Obama Administration says the penalty attached to the mandate is not a tax. Justice Stephen Breyer noted during last week's arguments that "Congress has nowhere used the word 'tax.'" Justices should reject semantic tax-or-penalty debates and concentrate on the merits of the case.

Supporters of the law made a persuasive argument to the court that the individual mandate -- an idea that emerged from conservative think tanks -- is an appropriate expression of the Constitution's commerce clause. Health care accounts for one-sixth of the U.S. economy; medical care and health insurance are elements of interstate commerce.

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People who lack health insurance still can get urgent medical care in places such as hospital emergency rooms; its cost is shifted to taxpayers and those who have insurance. The typical family pays more than $1,000 a year in higher premiums to pay for someone else's care.

Requiring young, healthy consumers to obtain health insurance -- just as motorists must buy auto insurance and some homeowners must buy flood insurance -- fairly spreads the risk. Sooner or later, they will need health care, and should be expected to pay for it. Personal irresponsibility is not a constitutional right.

If the Supreme Court strikes down the mandate, Mr. Obama warns that key provisions of the reform law could become unaffordable. They include the law's requirement that insurers cover people with pre-existing medical conditions without raising premiums excessively, and the establishment of state exchanges that would create competitive new private markets for health insurance.

Those losses would be serious blows, and the individual mandate deserves to survive. But even if it doesn't, that should not invalidate the rest of the reform law.

Finally, states such as Ohio and Michigan complain that the law's expansion of Medicaid to cover more people amounts to unconstitutional coercion, because it would force them to pay higher costs or risk losing all their federal Medicaid funding. That argument is overblown.

The state-federal Medicaid program is voluntary; any state that does not want to comply with the new standards can abolish its program. No state will do that, because it won't want to lose so much aid from Washington. But that is a political and policy, not constitutional, question.

In any event, the added cost to states for the expansion will be slight -- an estimated 1.4 percent a year on average. States can find economies elsewhere in Medicaid programs to absorb that cost.

The Affordable Care Act is the most important federal health-care legislation since the creation of Medicare. It already has done a lot of good -- fully covering pre-existing conditions and preventive care, allowing young adults to remain covered by their parents' insurance through age 25, eliminating lifetime coverage limits, and taking effective steps to contain the growth of medical costs.

Its subsidies and other provisions will help make health insurance available to 30 million Americans who now lack coverage, and protect many others who face the loss of coverage because of unemployment or medical catastrophe. These are real achievements reached within the context of preserving the private market for health care, in contrast to the cliched appeals to "freedom" and warnings of "socialism" offered by opponents.

The critics who use "ObamaCare" as a term of derision do so at their peril. The reference reminds voters that the President has worked to expand access to health care in this nation, while limiting its cost and maintaining its quality. That's a lot more than the law's carping, I-got-mine detractors can claim.

First Published April 1, 2012, 4:00 a.m.

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