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Healthcare's epic battle: If the GOP wins they still lose.

Healthcare does not have the exciting back and forth discussion over federal and state control for nearly twenty years after Reagan’s term. What we witness according to Michael Sparer is, “Over the last 75 years, the nation’s economic and social welfare agenda has grown exponentially, almost always however with a mix of federal and state dollars, and a combination of federal, state, and local administration.”  (Michael Sparer) Though there was an increasing amount of federal control in healthcare throughout each presidency since Roosevelt, at the turn of the century and end of the Clinton administration that failed implementing universal care, there were 44 million Americans, 16 % of the nation, with no health insurance at all.(pbs.org) Healthcare remained stagnant for nearly a decade until President Barack Obama who campaigned on more access and better quality to healthcare who delivered on his promise.

In 2009, Congress passed the Patient Protection and Affordable Care across party lines besides the five republicans in the senate who voted in favor. It became a divisive piece of legislation that fueled talk shows and spirited debates across the country. The ACA‘s path led to the Supreme Court in the landmark case, NFIB v. Selibus. The court ruled in a 5-4 decision the legislation was constitutional. It denied Congress the right to issue an individual mandate under the Commerce Clause, but did  uphold it as a tax.(CSG) The court found the law was constitutional  due to The Power  to Regulate Interstate Commerce , The Power to Tax and  Spend  for  the General Welfare, The Power  to enact Necessary  and  Proper  Enforcement Legislation  found in Article I, Section 8 in the US Constitution.(CAC) 

After the NFIB v. Selibus ruling many thought the case was over. This was until this past month; the Supreme Court shocked the political world and agreed to listen to a case lawmakers say would cripple the ACA. The case under review is King v. Burwell that argues whether the federal government can offer health insurance subsidies to individuals in the states that opted to not create insurance exchanges. Currently, anyone who is eligible for subsidies can receive them on the state or federal plan. The Roberts court which in some cases is unpredictable could rule and interpret the law as patients who are eligible for the subsidies only receive them if they reside in a state exchange state. If in fact this happens, this would undercut a fundamental purpose of the law that helps people who are in states that denied implementing a state exchange. If the ACA is struck down it would be on purely interpretation of the writing, not the constitutionality of the law. It would also add greater pressure on states without a state exchange to enact reforms to help their citizens who will not have insurance again an estimated 11.3 million. Eighty-seven percent of people who signed up on federal-run exchange received subsidies. If states then cannot pass new reforms, this would likely push more states without choice in the ACA federal control.

With many strong supporters of the ACA, there are many that oppose the controversial law. One in particular is Congressman Steven Palazzo of Mississippi (MS-04). Congressman Palazzo has been one of the loudest opponents against the ACA since it came to the House floor in 2009. Palazzo said, “I've pledged to repeal Obamacare. I've even been endorsed by the Repeal Obamacare PAC. As a Member of Congress I will fight to repeal it, defund it and work to see it overturned in the courts. I will work to enact common sense policy that will not burden future generations with debt or tax small businesses today.”(OntheIssues) Palazzo and his Republican members voted to repeal the ACA as a whole or key measures fifty times in the past three years. (CNN)  Palazzo is a co-sponsor of twenty separate pieces of legislations that repeal the ACA. He also is a co-sponsor of the constitutional amendment the Right to Refuse Amendment that states: “Congress shall make no law that imposes a tax on a failure to purchase goods or services.”  On the Congressman’s website he says, “The significance of the Right to Refuse Amendment is that it would also permanently prevent Congress from passing legislation that forces Americans to choose between the purchase of goods and services or tax penalties” Congressman Palazzo has made the dismantling of the ACA a priority as long as he is a member of Congress. Palazzo is a firm believer in limited government. Throughout his political tenure Palazzo has held a consistent stance on the role of the federal government. Before he was elected to the House of Representatives, he authored a resolution reaffirming the 10th Amendment as a state representative, which properly defines a limited role for the federal government by reserving power for the states. (GOP)

Healthcare has evolved into the most politicized issue within recent memory. It has controlled the airwaves for television pundits, radio broadcasters, and journalists alike yelling for or against the ACA. So what is the best option for America? Should the federal government push to maintain the current system and allow states to have the option to join the exchange at their discretion or should they push for the Universal healthcare plan that was first proposed by President Truman? I believe the ACA should be upheld in its entirety because it is a step in the right direction. It is constitutional due to the fact a conservative Supreme Court upheld the law for the following reasons; The Constitution expressly grants Congress as well the authority to regulate interstate commerce, to tax and spend to “provide for the general Welfare of the United States,” and to enact legislation that is “necessary and proper” to carry out these express powers. Unlike Congressman Palazzo and his allies in Congress who are pushing for nullification and call for the ACA to be repealed because of the unconstitutionality never mention the fact that the Constitution is “the supreme Law of the Land,” which means that state nullification laws are trumped by federal law. Congress acted within its constitutional powers when it passed health care reform, and the misguided attempts by politicians to challenge the Act are more political theater than genuine constitutional argument.(CAC)

Personally, one option I support for the healthcare debate to unite would be to offer incentives to states that enter the federal exchange system. Incentives could be offering states extra federal grants for infrastructure, education, or other programs to increase quality for these states that would best suit them. Most importantly, the federal government should create a new governmental institution compiled of federal, state, and local officials that gather data on the implementation implications of the enacted reforms. This new entity could collect data on interstate variation, consider whether and when such variation is appropriate, and propose policies that are responsive to such findings. Since the inception of healthcare it has been administered by a complicated intergovernmental partnership, and has implemented in a nation in which health care systems vary significantly between and within states.  Acknowledging and responding to these variables is a critical component of a successful health reform agenda.(Michael Sparer) With these  type of consistencies, cooperative federalist and new federalist meshed identities could lead to a solution for healthcare which could succeed with a “state laboratory experiment” agenda intertwined to a three tier intergovernmental body for the proper solutions.