If Hillary Clinton takes the oath of office on January 20, 2017, she’ll inherit a health care reform law that will be already seven years old and likely deeply entrenched, thanks in part to Thursday’s Supreme Court ruling upholding the subsidy system for state-based exchanges.
Health care has been one of the defining issues of Clinton’s long career in public life, capped by an ambitious but ultimately doomed effort to create a universal health care system under her husband’s administration in 1993. By securing the future of the Affordable Care Act, the court’s ruling could allow Clinton to complete one of the biggest unfinished goals of her career by building on the law that bears her one-time rival’s name.
“This morning, the Supreme Court sided with common sense and America’s families, and confirmed again that the Affordable Care Act is the law of land — and it’s here to stay,” Clinton said in an email to supporters. “The next president will either protect and expand health care for every American, or undo the progress we’ve made.”
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Clinton has already telegraphed that she’d work hard to overhaul the mental health and addiction treatment systems, vowing to make the heroin and pharmaceutical epidemic “a big part” of her campaign. And she’ll likely be forced to confront a host of other health care issues, like rising health care costs.
Politically, the ruling preserves the status quo. While Republicans will keep talking about repealing Obamacare as long as it motivates their base, most probably know it’s now practically infeasible. And the GOP remains deeply divided on how to replace the law, making it unlikely the party will unite behind an alternative.
Clinton will likely not feel much pressure to endorse major changes to the law. While only eight percent of Americans think the Affordable Care Act is working well, according to a new NBC News/Wall Street Journal poll, most say the want the law preserved and improved rather than nixed. Among Democrats, whom Clinton will need to win over in the primary election and turnout in the general election, more than three-quarters think the law is working.
Obamacare didn’t sink Obama in 2012 and will likely be even less of an issue in 2016, when repealing it would mean actively taking away healthcare from millions of Americans.
In his remarks in the Rose Garden Thursday, Obama said it was time to switch from defense to offense on health care. After five years of relentless attacks, three elections, a mismanaged roll out, and two legal challenges that went all the way to the Supreme Court, the existence of the law is finally secure.
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“The Affordable Care Act is here to stay,” he said. “There will be parts of the law that will still need to be improved. And if we can stop refighting old political battles that keep us gridlocked, then we could actually make the law work even better for everybody.”
White House Press Secretary Josh Earnest said that in its waning days, the Obama administration will focus on implementing the law to maximize its impact. That will include pushing more governors to expand Medicaid and create their own exchanges.
But improvements on top of the existing statute will likely have to wait until the next presidency.
When asked Obama, Clinton has often spoken of her potential presidency as finishing some of the big projects Obama started, noting that his administration had to prioritize saving the country from the Great Recession.
“I think the president has done an extraordinary job in dealing with a terrible set of issues he inherited,” Clinton said in a response to question from msnbc on the economy in New Hampshire last week. “There’s a lot more work still be done, but boy am I glad where we are now than where we were.”
During the 2008 Democratic presidential primary, it was Clinton who pushed the other candidates to come up with comprehensive health reform plans. And hers included the controversial mandate for individuals to hold health care, which Barack Obama slammed then before ultimately making it a cornerstone of his own health law.
Now, she might finally have the chance to not only defend a national health law that strives for universal health access, but to expand it.
And thanks to the Supreme Court, she won’t have to fight Obama’s battles on Obamacare.
Alex Seitz-Wald