For two years, Republican candidates for Congress and the presidency have campaigned on a platform of dismantling President Obama's health care overhaul.
By upholding the individual mandate that is the law's linchpin, the Supreme Court has rebuffed Republicans who had hoped to accomplish their goal through the judiciary. Opponents of the Affordable Care Act may continue to inveigh against the bill as a costly boondoggle, but they will be less able to dismiss it as unconstitutional.
Congress has been unsuccessful in altering the law. Republicans laid out their health care priorities by adopting a mantra of "repeal and replace," but so far their emphasis has been almost exclusively on the repeal part. The House has voted numerous times to eliminate or scale back aspects of the Affordable Care Act, but a bill to replace elements of the law has yet to make it to the House floor.
The party's hopes now rest with Mitt Romney, who has reversed his previous support for an individual mandate (he embraced the idea enthusiastically while serving as governor of Massachusetts) and has made a vow to begin repealing the health care law on "day one" of his presidency a centerpiece of his campaign.
"Our mission is clear: If we want to get rid of Obamacare, we have to replace President Obama," Romney said on Thursday.
To repeal the law, Romney would issue waivers exempting states from complying with certain provisions. The Affordable Care Act does contain a waiver requirement allowing states to craft their own health care proposals, but states would only be granted those exemptions if they came up with plans that guarantee as many people get high-quality coverage as would have been the case under the federal law.
Romney's camp interprets the measure to give states broader flexibility. But whether a President Romney could in fact use state waivers to gut the Affordable Care Act (as Obama has done with the No Child Left Behind Law) will not matter on the campaign trail.
Expect the Republican standard-bearer to continue pushing his opposition to the law Republicans have derisively dubbed Obamacare. In 2010, opposition to the bill helped create the Tea Party movement, energized conservative voters and propelled Republicans into power from Capitol Hill to statehouses across the country.
It will be difficult for Romney to foment that kind of energy again, but the issue is certain to animate the campaign. Even if Romney is not attacking the specifics of the health care overhaul, he will argue -- as he has already -- that Obama was so preoccupied with tackling health care reform that he neglected the sputtering economy.
"His policies were not focused on creating jobs. They were focused on implementing his liberal agenda. There's nothing wrong with people having an agenda, but when the country's in crisis, you have a moral responsibility to focus on helping people come out of that crisis," Romney said during a Wednesday speech in Virginia. "So it's not just bad policy, it was a moral failure to put forth a piece of legislation that wouldn't help Americans get back to work and to focus the energy of the White House on Obamacare."
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