Health care and the US election

By John Rapley

Last week, the United States Supreme Court delivered a landmark ruling that upheld, with qualifications, the country's new and divisive health-care law. The federal law, championed by President Barack Obama, will extend health insurance to nearly all Americans, finally bringing America close to the standards of all other developed countries.

The ruling was a big victory for President Obama. 'Obamacare', as his critics labelled it, was his signature achievement. With his economic team doing little to distinguish his administration from its Republican predecessor, and his foreign policy being more militaristic than a warmonger - lots of drone attacks and Guantanamo Bay a prison, despite election promises to the contrary, still open - President Obama offered little to reassure his liberal base that he was worth turning out for in November's election.

A president who came to office signalling his desire to be transformational needed some big achievement to offer as his legacy. Health care was going to have to be it. But in recent months, court challenges to the health-care legislation appeared to suggest the Supreme Court might strike down the act. The ruling thus put President Obama on the front foot again. His re-election campaign, sputtering in recent weeks, appears back on track.

Broadly unpopular

His work is still cut out for him. First off, the legislation remains broadly unpopular. At the moment, Americans see it as an added tax, since many of the law's benefits won't begin to kick in for another couple of years. As a PR job, Obamacare was half-baked. Republican opposition is fierce, and with presidential nominee Mitt Romney leading the charge to repeal the act, conservative strategists believe the court ruling will galvanise their supporters in November's elections.

At the moment, the November poll remains poised on a knife edge. In the Congressional vote, only the House vote seems a safe call, with Republicans expected to increase their hold on the chamber. The Senate will probably tip further to the right, though Democrats may hold a sliver of a majority. In the presidential race, meanwhile, Obama has an edge. But it is anything but solid. The impact of the health-care ruling on all three races could potentially be decisive.

While Republicans enjoy popular backing in their opposition to Obamacare, opposing it too strongly is nonetheless a risky gambit. President Obama's Achilles heel in this election is the weak economy. Mitt Romney has focused like a laser on that theme, seeing this issue as the key to victory. Every minute of attention given to a health-care repeal campaign is one less minute's attention to the economy. The last thing Romney wants to do is open himself to charges that he is easily sidetracked by ideological bugbears.

Worth voting

Besides, Obama's liberal base, disenchanted as it is with his presidency, may finally feel there is something worth going to vote for. The president already has the black and Hispanic votes locked up. The fear that black voters, displeased with the president's embrace of gay marriage - and they are displeased - might stay home appears to have passed. It seems too important to African-Americans to keep Obama in office.

White liberals have not been feeling the same love, though. But they may yet hold their noses and head to the ballot boxes if they feel that doing so might determine the future of a health-care programme that, if not their ideal, is still the biggest liberal victory in a long time.

Interestingly, the law itself seems unlikely to be affected by all this. Even if a Republican tide sweeps polling stations in November, the party is unlikely to attain the 60-seat Senate majority needed to guarantee the repeal of legislation. Obamacare is the biggest US social-policy change in a generation, and the president has successfully gone where many others dared not tread. His election hangs in the balance. His place in the history books, though, may finally be secure.

John Rapley is a research associate at the International Growth Centre, London School of Economics and Political Science. Email feedback to columns@gleanerjm.com and rapley.john@gmail.com.