Efforts to move toward universal health coverage are complicated, with potentially high costs, difficult policy trade-offs and the risks of industry opposition.
Even policies with widespread support in Congress could face intense lobbying campaigns from opponents who fear additional government intervention and loss of revenue. One example is a proposal to eliminate surprise medical billing. It enjoyed bipartisan political support but faced an avalanche of industry opposition. Its success was not assured, but it passed in December.
Just this week, Senate leadership is considering a legislative package that could include an expansion of Medicare to cover more middle-aged Americans and to provide dental, vision and hearing benefits. The provision would be costly, and will probably face resistance from health industries. Other ideas, like President Biden’s campaign proposal of a government-run “public option” that Americans would have the choice to purchase, are at the earliest stages of conception.
And the post-Obamacare dream of many progressives, “Medicare for all,” continues to divide the party. Such a policy would face fierce opposition from hospitals, doctors and insurers, who already have an advocacy group to combat further government involvement in health care.
The Affordable Care Act still has holes that have proved challenging to fix. The 2012 Supreme Court decision that upheld the individual mandate also made the law’s Medicaid expansion provisions optional. Twelve states do not participate in that program, leaving millions of low-income Americans without coverage. Generous incentive payments included in the most recent stimulus package have not been enough to convince any of the holdout states to join.
Some political voices are still calling for the end of Obamacare, but they are growing rarer. In 2012, nearly every leading Republican politician expressed disappointment or anger at the first Supreme Court decision upholding the core of the law. On Thursday, few commented.
Ted Cruz, the Texas senator who once helped drive a government shutdown demanding an Obamacare repeal bill, issued a statement that reiterated his objections to the law. Josh Hawley, a Republican senator from Missouri who had helped bring the suit as his state’s attorney general, said in response to a reporter’s question that the Supreme Court had made its stance clear. (He did tweet about another Supreme Court case decided Thursday.)
