“Obamacare” and “Romneycare.” If you follow politics or watch cable news, these are two terms you have probably heard thrown around often in the political arena. “Obamacare,” is the slang term often used to refer to the Patient Protection and Affordable Care Act (PPACA) (P.L. 111-148), which was on trial before the U.S. Supreme Court last week. “Romneycare” refers to the Massachusetts health care reform law, which passed under then-Governor Mitt Romney and reportedly served as an inspiration for PPACA.
Considering the two laws’ similarities, what will happen to the Massachusetts law if PPACA is struck down, as many legal observers believe it will be? Like PPACA, Massachusetts requires all state residents to obtain health insurance; so, if PPACA’s mandate is found unconstitutional, wouldn’t it make sense that, by extension, the Massachusetts mandate is unconstitutional as well?
It appears that the answer is “no.” Even if PPACA’s mandate is struck down, Massachusetts’ mandate will still stand.
According to Brian Fitzpatrick, a law professor from Vanderbilt, “If the federal mandate fails, it’s going to go down because the Congress didn’t have the power to do it” under the Commerce Clause of the Constitution. Since the Court is only considering the issue of whether the federal government has overstepped its power, the state law will remain unaffected–but that does not mean that the Massachusetts health program itself will not suffer collateral damage.
The Massachusetts program is dependent on federal funding to keep its plan afloat. “Right now…the state pays for half of the plan, and the federal government pays for the rest,” says Jonathan Gruber, an MIT economics professor who worked on both the state’s and federal government’s health plans. He stated that if the state lost the federal funding component due to the striking of PPACA, Massachusetts would be left with a $350 – $400 million bill to ensure the continued health care coverage of the state’s poor residents. Additionally, health care providers in the state would not receive the benefits they expect to see out of the continued implementation of PPACA provisions, which would cripple planned attempts at reform in health care delivery.
The Court’s rejection of PPACA’s mandate would likely open the door for state-specific challenges to the Massachusetts law. It is possible that opponents of the state’s mandate would put the issue on a ballot or initiate a lawsuit in the state’s court system. However, given the increasing wide support of the state’s law, with 51 percent of residents in favor of the mandate, a referendum on the mandate may face challenges of its own.