Barrett moves high court further right, cautiously

RULING: Activists in front of the Supreme Court in 2015 after a ruling that year in favor of the Affordable Care Act. Bill O'Leary/The Washington Post

WASHINGTON - The decision by a conservative Supreme Court to uphold the Affordable Care Act could usher in an end of a bitter, 11-year drive to get rid of the law, as both parties immediately began scrambling to recalibrate their strategies with a sense that the political reality of health care was immutably altered.

Some Republicans conceded Thursday that, after a decade of repeal votes, political campaigns and legal challenges, their quest to nullify the entire law probably is dead. Confronted with a 7-to-2 ruling that marked the third time the high court has preserved the law, some GOP members of Congress suggested that they would, instead, start plotting legislatively to trim back parts of it.

President Joe Biden and his fellow Democrats, for their part, see in the court decision a springboard to build on the 2,000-page statute. They and outside analysts say the law's survival also provides Democrats a chance to seize on health care in the upcoming congressional elections, portraying the party as protecting Americans' coverage along with defeating the coronavirus pandemic.

In the hours after the ruling, the Biden administration did not lay out specific elements of the president's agenda that it will now pursue in Congress. But potential goals include lowering the eligibility age for Medicare and the relatively controversial idea of creating a public alternative to private health plans sold through the ACA insurance marketplaces.

"We're working on it. Now that we know the Affordable Care Act has passed this last test, we know we've got our sea legs under us," Health and Human Services Secretary Xavier Becerra said in an interview. "Now we have an opportunity to talk about where we can go. Until we had this decision, it would have been folly to talk about those things."

The battle over the ACA has helped define the polarized political landscape of the past decade. It boosted the tea party in 2010, propelled Donald Trump's campaign in 2016 and created a dramatic moment when Sen. John McCain, R-Ariz., blocked his party's repeal push. More recently, the ACA's rise in popularity helped Biden's cause in the 2020 election.

Now Democrats hope to press their advantage. Sen. Patty Murray, D-Wash., chair of the Senate Health, Education, Labor and Pensions Committee, said the court's decision "is cause for celebration - but it must also be a call to further action," adding that Congress should allow Medicare to negotiate drug prices with pharmaceutical companies, allow more people join Medicare and create a "public option" for health coverage.

Becerra, who as California attorney general led a Democratic coalition fighting to preserve the ACA, noted that Biden's budget seeks to make permanent a temporary expansion this spring of ACA insurance subsidies, and he said, "We will obviously tackle prescription drug prices."

Republicans for years ran on a pledge to "repeal and replace" the health-care law, only to fail dramatically when they won control of Washington in 2016. After Thursday's ruling, they began shifting to an argument that the law needs to be changed but could not realistically be scrapped.

"The ACA is still in place. So I think what we've got to do now is think about what we can do in terms of reforms . . . that will protect people with preexisting conditions, but then also create new choices and options," said Sen. Josh Hawley, R-Mo. "Hopefully this will be a spur for some new ideas and new proposals, because pretty much all that's been on ice since I've been here, because everybody said, 'Well, let's see what happens with the court decision.'" 

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