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Healthcare Reform in 2015: The Republican View

One of the main programs associated with Obama’s presidency thus far is surely his sweeping reform of the healthcare system. However, this program (colloquially known as “Obamacare”) has been highly controversial since the beginning and subject to numerous challenges on both ideological and legal grounds. This essay provides an example of the benefits of working with a professional writer at Ultius.

The pros and cons of Obamacare

One of the main challenges against Obamacare has consisted of the assertion that the program’s requirement that all Americans be required to purchase health insurance (at the pain of financial penalty for failing to do so) is flatly unconstitutional. This challenge made it to the Supreme Court, at which point it was evaded through the clever framing of the individual mandate of Obamacare as a tax.

As Shapiro has pointed out, however, this does not necessarily improve the long-term prospects of Obamacare, insofar as the kind of tax represented by the individual mandate may itself be unconstitutional: more specifically, it may violate a provision known as the Organization Clause, which specifies the ways in which new tax legislation must be passed into law. The main idea here would be that insofar as the individual mandate was, in fact, a tax, it did not adhere to the guidelines established by the clause.

The Constitutional ramifications of tax subsidies

Currently, another challenge has been raised regarding the constitutionality of provisions regarding subsidies for certain low-income insurance buyers. As Mathis and Boychuk have indicated, a Supreme Court ruling against this provision would cause an immediate change in healthcare costs and a financial harm to a large number of Americans:

“if the Court does rule that way, more than 4 million people will see their insurance costs rise dramatically and suddenly, and more than a few will give up insurance altogether” (paragraph 15).

It would seem that the Republicans themselves are thus somewhat wary of actually challenging all of Obamacare in such a direct way, because Obamacare does, in fact, offer concrete protections for many citizens, including protections that most Republicans would, in fact, agree with.

State opposition to Obamacare

Setting aside legal conflicts at the national level, though, a key conservative strategy of resistance against Obamacare has been adopted at the level of individual states. This essentially consists of non-compliance, or of passing state laws that would make it very difficult to fully implement the national-level provisions of Obamacare. For example, Schult has pointed out:

“more than 200 bills, most sponsored by Republicans, have attacked Obamacare’s foundations from different flanks. At least 25 bills seek to repeal or ‘nullify’ it. A ‘model’ bill considered in at least 11 states would forbid state employees from enforcing any part of the law. Most didn’t pass” (paragraph 13).

In any event, the most important point for present purposes is that the reception of Obamacare by individual states has not been homogeneous. Rather, different individual states have reacted to Obamacare in radically different ways, ranging from taking efforts to bolster and expand on the provisions of the national-level legislation on the one end to taking efforts to radically undermine the national-level legislation on the other. Aside from national-level constitutionality, then, a key front of political struggle that has emerged consists of state-level compliance.

Ideological analysis and Republican views

At the ideological level, this Republican views on health care reform are in stark contrast to Obamacare policies; and moreover, it would seem to have strong constitutional foundations. The Tenth Amendment to the Constitution of the United States of America (i.e. the last right delineated in the Bill of Rights) clearly indicates that any powers that have not been specifically assigned to the national government are reserved for the people and individual states of the United States.

Naturally, this provision has been interpreted in various ways over time; but when significant conflicts emerge between national-level policy and state-level implementation, this has usually been the result of a popular sentiment that the national government has overstepped the legitimate bounds of its power and infringed upon the jurisdiction of individual states.

An excellent liberal example from American history would be the response of Northern states to fugitive slave law in the 19th century: many states simply refused to acknowledge the legitimacy of such laws and thus engaged in concerted non-compliance against the laws (see State of South Carolina). Historically, then, this has been a more or less legitimate strategy for maintaining appropriate checks and balances between the national and state governments.

Power of the people

Moreover, as Deville and Novick have pointed out regarding health care, in particular, most Americans tend to adhere to an ethos of “rugged individualism” that is strongly libertarian at the level of concrete practice if not theory. In essence, the people of the United States have also been deeply suspicious of big government; and the Bill of Rights was explicitly designed in such a way that it would be very difficult for the national government to engage in abuses of power or excessively expand its jurisdiction over the American people.

In this context, it can be suggested that the Republican backlash against Obamacare, including efforts at the state level to hinder the full implementation of the program, falls within a broader tradition of resistance in American history against the powers of the national government. Of course, much of Republican discourse on this subject may be motivated by far shallower reasons and desires.

For example, perhaps many Republicans are just in close alliance with big insurance companies and will thus advocate for whatever policies are congruent with the interests of those stakeholders, even at the expense of the American people in general. However, the important point here is that there is in principle a legitimate ideological foundation for Republican opposition to Obamacare; and this consists of opposition to encroachments by the federal government into the jurisdiction of individual states and the liberty of the American people.

Future of Obamacare and health care reform

Framed in this way, it becomes clear that the political conflict regarding Obamacare conceptually resembles several other issues on the American political scene today. These issues include gun rights, same-sex marriage, and marijuana. In all these issues, individual states are taking initiatives that are either above and beyond anything specified by the national government or even in open contradiction to what has in fact been specified by the latter.

Moreover, it would seem that significant majorities of Americans all over the nation tend to support the empowerment of individual states to deal with these issues as they see fit. In Barone’s formulation, this essentially means:

“Americans [are] becoming more libertarian on cultural issues” (paragraph 1).

In other words, the tendency is to support a policy of devolution, through which contentious issues are resolved at the level of more local communities (i.e. at the state level) and not at the level of the nation as a whole. This would seem to be motivated both by an ethical acknowledgment of the difficulties of reaching any consensus on these subjects as well as the practical acknowledge of the difficulties of actually implementing any consensus at the level of law.

Other aspects of the Obamacare debate

In this context, at least a substantial portion of the Obamacare debate indicates that this may be yet another issue in which a more libertarian ethos is taking precedence over a more federalist ethos. This issue would be different from the issues of same-sex marriage and marijuana insofar as libertarianism regarding these issues tends to favor the Democrats. However, it could perhaps be meaningfully compared to gun rights, insofar as libertarianism in this regard tends to favor Republicans.

And, in any case, all four issues can be understood to be conceptually related in a very close way, irrespective of the concrete political implications of libertarianism in any given case. Of course, resistance to Obamacare has thus far not been primarily conceptualized as being related to these other issues. However, at the sociological level, it is quite apparent that there are parallels between the principles that underlie this specific issue and those that underlie the other issues discussed above.

Conclusion

In summary, this essay has consisted of a discussion of the prospects of Obamacare for the year 2015 from a Republican perspective. The essay began by considering the present situation of Obamacare, proceeded to discuss the ideological foundations of Republican opposition, and then reflected on one possibility of what may be likely to occur over the coming times. The main point that has been made here is that conflict over Obamacare seems to structurally resemble conflict over several other issues in the contemporary United States; and that insofar as the emerging practical solution to those issues is devolution and libertarianism, this may emerge as a solution to the conflict over Obamacare as well.

Works Cited

Barone, Michael. “Americans Shift toward Liberty on Marijuana, Same-Sex Marriage and Gun Rights.” Real Clear Politics. 17 Jun. 2013. Web. 28 Jan. 2015. http://www.realclearpolitics.com/articles/2013/06/17/a_libertarian_turn_on_marijuana_legaliza tion_same-sex_marriage_and_gun_rights__118831.html.

Deville, K., and Novick, L. “Swimming Upstream? Patient Protection and Affordable Care Act and the Cultural Ascendancy of Public Health.” Journal of Public Health Management and Practice 17.2 (2011): 102-109. Print.

Mathis, Joel, and Ben Boychuk. “Debate: Can Obamacare Survive a Republican Senate and Another Supreme Court Challenge?” Newsday. 13 Nov. 2014. Web. 28 Jan. 2015. http://www.newsday.com/opinion/oped/can-obamacare-survive-a-republican-senate- and-another-supreme-court-challenge-debate-1.9613792.

Shapiro, Ilya. “The Obamacare ‘Tax’ that Chief Justice Roberts Invented Is Still Unconstitutional.” Forbes. 12 May. 2014. Web. 28 Jan. 2015. http://www.forbes.com/sites/ilyashapiro/2014/05/12/the-obamacare-tax-that-chief- justice-roberts-invented-is-still-unconstitutional/.

Schulte, Fred. “War Over Obamacare Heats Up in States.” NPR. 21 Jan. 2015. Web. 28 Jan. 2015. http://www.npr.org/blogs/health/2015/01/21/378641761/war-over-obamacare- heats-up-in-states.

State of South Carolina. “Declaration of the Immediate Causes Which Induce and Justify the Secession of South Carolina from the Federal Union.” Avalon Project, 1860. Web. 22 Jan. 2015. http://avalon.law.yale.edu/19th_century/csa_scarsec.asp.

United States of America. “Constitution of the United States: Bill of Rights.” The Avalon Project. 1789. Web. 28 Jan. 2015. http://avalon.law.yale.edu/18th_century/rights1.asp#5.

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