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Political gain at stake in health care case

WASHINGTON -- Their positions are clear.

President Barack Obama ardently defends his federal health care overhaul. Republican challenger Mitt Romney adamantly opposes it. But this coming week, when the Supreme Court rules on the constitutionality of the law, both sides will be scrambling for political gain no matter the outcome.

If the court upholds the law, Obama will get vindication for his signature legislative accomplishment. Romney will have a concrete target for his pledge to repeal it.

If the court rules against part or all of the law, Obama could blame Romney, congressional Republicans and a conservative-leaning court for denying health benefits to millions of people in the United States. Romney could claim victory for his assertion that the government overreached.

Striking down all or part of the law less than five months from Nov. 6 election also could mean much political uncertainty for both campaigns. That could force them to reshape long-held strategies and try to satisfy voter demands for Washington to start anew on fixing a broken health care system.

Just one-third of those questioned back the law, according to an AP-GfK poll this month. But there is overwhelming backing among both supporters and opponents for Congress and the president to find a new remedy if the high court strikes down the 2-year-old law.

Obama, in campaign appearances, promotes the law's more popular elements, such as a provision allowing children to stay on their parents' insurance up to age 26. The administration also has pumped out a steady stream of positive news, including a report this past week that nearly 13 million people would receive health insurance rebates averaging $151 per household.

Romney has emphasized his repeal pledge, a central pillar of his agenda that so far offers voters few other specifics. He released a TV ad Friday stressing that the elimination of the health care law will be the top priority in his administration's first 100 days. "Day One, President Romney moves to repeal Obamacare and attacks the deficit," the narrator says in the ad set to run in Virginia, North Carolina and Iowa.

Obama aides have refused to discuss contingency plans to avoid creating the impression that they are preparing for the court to rule against them. "We do believe it's constitutional," top adviser David Plouffe said. "We obviously will be prepared for whatever decision the court renders."

In the event of a partial repeal, the administration would move ahead with those parts of the law that do survive and could still put coverage within reach of millions of uninsured people, lay new obligations on insurers and employers, and improve Medicare benefits.

Democrats could try to raise the Supreme Court itself as an election-year issue, casting the court's decision as politically motivated.

Top aides at Romney's Boston headquarters have been working through their potential responses for several weeks. The campaign has sent health care advisers to Capitol Hill in recent days to discuss strategy with Republican lawmakers.

Romney's repeal refrain could become increasingly attractive to the opponents of the overhaul, and his campaign could make the case that a Romney victory is the next best chance to dismantle a law that's deeply unpopular with millions of people.

That's despite Romney's own support for the "individual mandate" in Massachusetts, where as governor he signed into law a measure that ultimately helped serve as a model for the president's.

Romney may face big challenges even if the court strikes down all or part of the law. Attention would turn quickly to what he would do to help 50 million uninsured people get coverage and bring down the nation's spiraling health care costs. He has promised to replace the measure with a handful of "common-sense" reforms.


A CENTURY OF DEBATE

The Supreme Court's upcoming ruling the president's health care overhaul law comes after a century of debate over what role the government should play in helping people in the United States afford medical care. A look at the issue through the years.

1912: Former President Theodore Roosevelt champions national health insurance as he unsuccessfully tries to ride his progressive Bull Moose Party back to the White House.

1942: President Franklin D. Roosevelt establishes wage and price controls during World War II. Businesses can't attract workers with higher pay so they compete through benefits including health insurance.

1965: President Lyndon B. Johnson's legendary arm-twisting and a Congress dominated by his fellow Democrats lead to creation of two landmark government health programs: Medicare for the elderly and Medicaid for the poor.

1986: President Ronald Reagan signs COBRA, a requirement that employers let former workers stay on the company health plan for 18 months after leaving a job, with workers bearing the cost.

1988: Congress expands Medicare by adding a prescription drug benefit and catastrophic care coverage. It doesn't last long. Barraged by protests from older Americans upset about paying a tax to finance the additional coverage, Congress repeals the law the next year.

1993: President Bill Clinton puts first lady Hillary Rodham Clinton in charge of developing what becomes a 1,300-page plan for universal coverage. It requires businesses to cover their workers and mandates that everyone have health insurance. The plan meets GOP opposition, divides Democrats and comes under a firestorm of lobbying from the health care industry. It dies in the Senate.

2003: President George W. Bush persuades Congress to add prescription drug coverage to Medicare in a major expansion of the program.

2009: Obama and the Democratic-controlled Congress spend a year ironing out legislation to require most companies to cover their workers; mandate that everyone have coverage or pay a fine; require insurance companies to accept all comers, regardless of any pre-existing conditions; and assist people who can't afford insurance.

2010: With no Republican support, Congress passes the measure, designed to extend health care coverage to more than 30 million uninsured people.

-- AP

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