Could the Courts Cripple Health Reform?

— By Suzy Khimm

| Mon Nov. 29, 2010 9:38 AM PST

Congressional Republicans aren't likely to get very far in their attempt to repeal the entire health care law. But there are growing signs that the courts could end up doing the lifting for them. A federal district judge in Virginia has promised to rule on the constitutionality of the bill's requirement that individuals purchase health insurance (the so-called "individual mandate") by the end of the year. The New York Times explains why the Obama administration is so concerned:

Lawyers on both sides expect the issue eventually to be decided by the Supreme Court. But the appellate path to that decision could take two years. In the meantime, any district court judge who rules against the law would have to decide whether to block enforcement of one or more of its provisions, potentially creating bureaucratic chaos.

The administration is already facing enormous hurdles in trying to put the federal health law into effect, receiving pressure from industry lobbyists who want to water down the new regulations and states that don't want to comply. Unfavorable court rulings will only complicate matters. Moreover, there are major parts of the health law that simply won't work unless the individual mandate is enacted. And finally, there's the concern that court rulings against the law—even if they don't ultimately hold up—could add to public animus against federal health reform:

"Any ruling against the act creates another P.R. problem for the Democrats, who need to resell the law to insured Americans," said Jonathan Oberlander, a University of North Carolina political scientist, who wrote in The New England Journal of Medicine last week that such a ruling "could add to health care reform's legitimacy problem."

Most of the biggest changes under the law, including the individual mandate and the insurance exchanges, won't be fully enacted until 2014. But the more obstacles the Democrats face in putting the law into effect, the harder it's going to be to convince the public that the earliest reforms are actually helping ordinary Americans—and that the bigger reforms down the road are worth the investment. Though their GOP antagonists in Congress are more bark than bite, the Affordable Care Act still faces a real threat. The Democratic leadership needs to ramp up its own offensive to sell health reform to the public now if they want to preserve the law's future integrity.