Another in my series of looks at 2012 campaign issues.

This one could prove to be the 800 pound gorilla in the room, or it could be a meek little turtledove cowering in the corner.

Guess what? It all hinges on what the Supreme Court does with the Affordable Care Act. Their decision is expected to be handed down by the end of the month.

A) SCOTUS upholds the law. All will be right with the world. What many consider a linchpin of Obama’s first…and possibly last…term the ACA remaining in force will deflate many of the arguments submitted against him. To date the parts of it that have become effective such as children staying on their parents’ insurance till the age of 26 and the partial elimination of the denial of coverage for pre-existing conditions are popular, as are some lesser known provisions.

United Health, one of the country’s major health insurers, has pledged to keep key reforms regardless of what the Court rules.

Retaining the ACA as is, however, is not a panacea. That law is flawed mainly in respect to not going far enough. There are some features which will lower health care costs—or at least prevent them from rising as fast. But the private insurers are not bound by these cost containment provisions and I expect them to continue raising premiums beyond the rate of inflation.

As the individual mandate is not effective until 2014, it will be some time before the distribution of costs across a wider and healthier demographic relieves the pressure to raise premiums so harshly.

I have read many assessments speculating what SCOTUS will do. Some predicting either a thumbs up or down are preposterous in their reasoning. Based on critical reasoning and Constitutional analysis and history, a validation of the law appears to be in order. But then I never in the world thought the Court would decide a Presidential election or declare fictitious entities to be human.

In spite of unresolved needs for reform, if the law is upheld Mitt Romney will be up the creek without a paddle. Since the law he introduced in Massachusetts obviously served as at least a partial model for the ACA, he will be hard-pressed to still voice opposition to it. It would be no surprise to me if he tried to spin his way into attempting to take credit for it in the same manner that he tried to take credit for the success of the bailout of Detroit though he did nothing but bad mouth the concept initially.

The downside to SCOTUS approval is that Obama will coast on that success until 2013 at the earliest when additional reforms should be proposed and debated much sooner.

B) The law is tossed out or parts are nullified. Will the repudiation of the ACA be catastrophic? Forgive me for being a weasel but…it depends.

If the entire law is thrown out that will be a serious blow not only to Obama’s re-election prospects (a veritable chorus of “I told you sos” translated into votes) but also to passing anything to replace it or addressing reform at all.

Striking down only the individual mandate would still not necessarily be fatal to the law. As I wrote above there are some aspects already in force that have been received favorably.

There will, however, be no gathering momentum to replace and/or amend it in either case. I hate to blame one party for this (Hell, you all know that’s a lie) but the Republicans, smelling blood, are adversely inclined to do anything but laugh at whatever reform bill is submitted by any of them commie Dems.

Yet, the dismantling of the ACA, in whole or in part, will add a great deal of turmoil to the mix. This HuffPo article presents one version of what the negative consequences would be.

Here are a few examples:

Better Medicare prescription benefits, currently saving hundreds of dollars for older people with high drug costs, would be suspended. Ditto for preventive care with no co-payments, now available to retirees and working families alike.

Partially overturning the law could leave hospitals, insurers and other service providers on the hook for tax increases and spending cuts without the law’s promise of more paying customers to offset losses.

In either event, the work of health care reform is far from completed. The ACA could use severe tweaking to more closely accomplish the goals that a large segment of our medical community and those dealing with health care policy believe are essential.

If that law has to be replaced we can only hope that reasonable minds can work together to create a replacement. But reading down the roster of members of Congress I find there is little justification for such  optimism.

Another facet of health care which is important, but carries its own set of concerns, is Medicare.  While intertwined in the main issue, its own eccentrities demand special treatment and those are more aligned with Social Security.

I hate the term “Entitlements” (and will review why) but that will be  next on my agenda.

In the meantime—STAY HEALTHY—OR ELSE.

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