Law of the land

Now that the Supreme Court has for the second time declined to dismantle the Patient Protection and Affordable Care Act, better known as Obamacare, one might begin to get the impression that it is the law of the land - not only because it was duly passed by Congress and signed by the eponymous president, but also by virtue of being a reasonable response to one of the country's most pressing domestic policy problems.

Of course, the landmark health-care reform has been all those things for more than five years. The greatest gift of Chief Justice John Roberts' latest opinion upholding the law is that the nation can at long last regard it as such.

Justice Antonin Scalia acknowledged that much by grousing in a vituperative dissent that "We should start calling this law SCOTUScare" (using the acronym for "Supreme Court of the United States"). Obamacare was originally a pejorative intended to delegitimize the act as a megalomaniacal "government takeover" instead of an ideologically moderate answer to a long-standing national crisis - one modeled on the policies of a well-known Republican governor of Massachusetts. Intense, prolonged legal scrutiny, along with years of uneven but ultimately salutary experience with the ACA, has taken the sting out of the insult. It isn't just Obamacare; it is indeed SCOTUScare, Romneycare, Congresscare - even Christiecare.

Though he joined other Republican presidential contenders in criticizing Thursday's ruling, Gov. Christie wisely declined to join the rearguard assault on the ACA when he accepted its Medicaid expansion. It was the earlier Roberts ruling, upholding the law's insurance mandate, that also gave governors the option of forgoing subsidized coverage of the working poor. Former Pennsylvania Gov. Tom Corbett made the mistake of doing so, attempted to split the difference with an idiosyncratic hybrid program, and soon thereafter lost his reelection bid - clearing the way for Gov. Wolf to join Christie and others in accepting the Medicaid expansion.

Wolf also took the prudent step of moving toward a state insurance exchange to preclude the extensive disruption of a high court ruling against the ACA; nationwide, that could have affected six million Americans who signed up for coverage through the federal exchange. While the court found that the federal government can continue to offer subsidies in states that don't have their own exchanges, Wolf should continue to develop a Pennsylvania exchange, which would offer more opportunities to lower costs, tailor the program, and encourage high-quality care.

Having cut the uninsured rate by nearly a third, the ACA has been a dramatic improvement over the only real alternative in Washington - doing nothing. The case at hand showed that the law's flaws include sloppy drafting and excessive complexity. But it failed to reveal the logic of a fundamentally absurd interpretation of lawmakers' intent that would have rendered the reform unworkable.

As Roberts noted in a phrase that captures the conservatism of the reform itself, "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them." Call it what you want, but the Affordable Care Act endures for good reasons.