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'Obamacare' Survives Again at SCOTUS   06/18 06:15

   The Supreme Court's latest rejection of a Republican effort to dismantle 
"Obamacare" signals anew that the GOP must look beyond repealing the law if it 
wants to hone the nation's health care problems into a winning political issue.

   WASHINGTON (AP) -- The Supreme Court's latest rejection of a Republican 
effort to dismantle "Obamacare" signals anew that the GOP must look beyond 
repealing the law if it wants to hone the nation's health care problems into a 
winning political issue.

   Thursday's 7-2 ruling was the third time the court has rebuffed major GOP 
challenges to former President Barack Obama's prized health care overhaul. 
Stingingly for Republicans, the decision emerged from a bench dominated 6-3 by 
conservative-leaning justices, including three appointed by President Donald 

   Those high court setbacks have been atop dozens of failed Republican repeal 
attempts in Congress. Most spectacularly, Sen. John McCain, R-Ariz., flashed a 
thumbs-down that doomed Trump's drive to erase the law in 2017.

   Along with the public's gradual but decisive acceptance of the statute, the 
court rulings and legislative defeats underscore that the law, passed in 2010 
despite overwhelming GOP opposition, is probably safe. And it spotlights a 
remarkable progression of the measure from a political liability that cost 
Democrats House control just months after enactment to a widely accepted 
bedrock of the medical system, delivering care to what the government says is 
more than 30 million people.

   "The Affordable Care Act remains the law of the land," President Joe Biden 
said, using the statute's more formal name, after the court ruled that Texas 
and other GOP-led states had no right to bring their lawsuit to federal court.

   "It's not as sacred or popular as Medicare or Medicaid, but it's here to 
stay," said Drew Altman, president of the nonpartisan Kaiser Family Foundation. 
"And it's moved from an ideological whipping boy to a set of popular benefits 
that the public values."

   Highlighting the GOP's shifting health care focus, in interviews and written 
statements Thursday, more than a dozen Republican lawmakers called for 
controlling medical costs and other changes, but none suggested another run at 
repeal. Congressional Republicans hadn't even filed a legal brief supporting 
the latest Supreme Court challenge.

   "Just practically speaking, you need 60 votes in a Republican Senate, a 
Republican president, right? And we've tried that and were unable to accomplish 
it," said Sen. Bill Cassidy, R-La., a leading voice on health care in the GOP.

   Polling shows the risks in trying to demolish Obama's law. A Kaiser poll 
showed Americans about evenly divided on the law in December 2016, just after 
Trump was elected on a pledge to kill it. By February 2020, 54% had a favorable 
view while 39% disapproved.

   House Minority Leader Kevin McCarthy, R-Calif., and other top Republicans 
issued a statement illustrating one line of attack the party is preparing -- 
trying to handcuff all Democrats to "Medicare for All," a costly plan for 
government-provided health care backed by progressives that goes beyond what 
Biden and many in the party have proposed.

   Congress should "not double down on a failed health care law or, worse, move 
towards a one-size-fits-all, socialist system that takes away choice entirely," 
the Republicans said.

   The GOP should focus on health issues people care about, like personalized 
care and promoting medical innovation, not repealing the health care law, said 
David Winston, a pollster and political adviser to congressional GOP leaders.

   "Republicans need to lay out a clear direction of where the health care 
system should go," Winston said. "Don't look backward, look forward."

   Most people have gained coverage from either Obama's expansion of the 
government-funded Medicaid program for lower-income people or from private 
health plans, for which federal subsidies help offset costs for many.

   The law's most popular provisions also include its protections for people 
with preexisting medical conditions from higher insurance rates, allowing 
people up to age 26 to remain covered under their parents' plans and requiring 
insurers to cover services like pregnancy and mental health.

   Key requirements like that are "locked in concrete," said Joseph Antos, a 
health policy analyst at the conservative American Enterprise Institute. The 
political opening for Republicans would be if Democrats push hard for things 
like lowering the eligibility age for Medicare to 60 because for many 
conservative-leaning voters, he said, "that's a sign of government pushing too 
far" into private marketplace decisions.

   Yet serious problems remain.

   Nearly 29 million Americans remained uninsured in 2019, and millions more 
likely lost coverage at least temporarily when the COVID-19 pandemic hit, 
according to Kaiser. In addition, medical costs continue rising and even many 
covered by the law find their premiums and deductibles difficult to afford.

   In response, Biden's $1.9 trillion COVID-19 relief package enacted in March 
expanded federal subsidies for health insurance premiums for those buying 
coverage. His infrastructure and jobs proposal being negotiated in Congress 
includes $200 billion toward making that permanent, instead of expiring in two 

   But his plan includes none of his more controversial campaign trail 
proposals to expand health care access, like creating a federally funded public 
health care option or letting Medicare directly negotiate drug prices with 
pharmaceutical companies. While those proposals are popular with Democratic 
voters, they face tough odds in a closely divided Congress.

   Still, Republicans gearing up for 2022 elections that will decide 
congressional control must decide where their next focus will be.

   One GOP strategist involved in House races, speaking on condition of 
anonymity to describe internal thinking, said the party should focus on issues 
like the economy and border security that register as higher voter concerns. A 
Gallup poll showed that in May, 21% of the public ranked the economy as the 
country's top problem, with health care registering at just 3%.

   Other Republicans say the Supreme Court's rejection of the latest repeal 
attempt will clear the political field for them to refocus their health care 
attacks on Democrats.

   "Now it's Medicare for All that will be a top health care issue playing a 
role in campaigns," said Chris Hartline, spokesperson for the National 
Republican Senatorial Committee, the Senate GOP's campaign arm.

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