President and chief executive of the Kaiser Family Foundation
With the Supreme Court's decision, the Affordable Care Act's coverage expansions, consumer protections and cost-containment provisions will continue to move forward. A great deal of attention was focused on the individual mandate - so the big surprise was the court's weakening of the law's Medicaid expansion, which was to provide coverage for more than 16 million low-income people. The federal government will no longer be able to withhold all Medicaid funding for states that do not expand Medicaid to cover more of their poorest residents. The federal government will initially provide 100 percent of the funding for the state Medicaid expansion and then scale back to 90 percent - still a substantial carrot that is likely to induce most states to go forward, although some conservative governors could balk.
The (often toxic) partisan wrangling by both sides over the ACA will continue at least through the election. The decision of the conservative-leaning court is obviously a big plus for President Obama, adding legitimacy to the health-care reform law, even if it also energizes the right. But it is not a game-changer. Opinions of the ACA are dug in along partisan lines, and the ruling will reinforce views more than change them. This remains an election about the direction of the economy, not health-care reform.
After the election, Washington will change the channel, focusing on the budget deficit and health care's big entitlement programs, Medicare and Medicaid. We will shift from a debate about expanding the role of the federal government, a topic that energizes the right, to a debate about cutting government back, which could energize the left. Medicare may trump the ACA as health care's big issue in 2013.
President and chief executive of America's Health Insurance Plans
The Supreme Court provided legal clarity, but no one should underestimate the policy challenges ahead. Thursday's ruling preserves the link between the market reforms and universal coverage. The disastrous experience in states that tried to implement similar market reforms in the absence of universal coverage will not be repeated nationally.
With that uncertainty removed, now is the time to turn to affordability.
Job No. 1 should be to address provisions in the health-care-reform law that increase costs for consumers and small employers. For example, the forthcoming premium tax will increase the cost of coverage purchased by small businesses and individuals, as well as Medicaid and Medicare beneficiaries with private coverage. The essential benefits and actuarial value requirements will mean that millions of Americans have to buy more coverage. In addition, rating provisions in the law will result in young people subsidizing coverage for others, creating further unintended incentives for them not to buy insurance. Unless they are addressed, the cumulative effect of these and other provisions will result in higher costs and coverage disruptions.
We must also address the unsustainable rise in medical costs that are burdening families and employers, taking up a greater share of federal and state budgets, and threatening the long-term solvency of our nation's safety-net programs. Until we confront the nation's spending issues, the promise of health security for all will remain out of reach.
While the focus has been on insurance market reform, health plans have been leading collaborative efforts to reform the payment and delivery system to promote prevention and wellness, help patients and physicians manage chronic disease, and reward quality care.
Director of the University of Southern California's Unruh Institute of Politics; communications director for John McCain's 2000 presidential campaign
Although the next few days will be filled with fireworks from both sides, it's difficult to see how health care will remain a significant issue for the rest of the presidential campaign. Neither candidate has much incentive to talk about the issue going forward: President Obama knows that, even though the law is constitutional, it's still extremely unpopular. And Mitt Romney doesn't have much desire to spend the fall talking about why or how his health-care plan in Massachusetts differed from this one. For most voters, the conversation will be back to the economy in a matter of days.
Although health care is unlikely to matter to most swing voters, there's more than enough fodder in the court's decision to inspire the true believers in both parties all the way to Election Day. Democrats can celebrate that the law is still in place. And they can continue to use the portion of the law that allows adult children to remain on their parents' insurance plans to reach out to young people and female voters. Republicans still have a "repeal Obamacare" message to motivate their base and don't have to worry about defending the loss of the law's more popular provisions. Even better, now they have a new tax to attack.
The bottom line: more rhetorical ammunition and turnout motivation for the parties' bases. Not much difference for everyone else.
Deputy assistant to President George W. Bush and deputy White House press secretary from September 2006 to January 2009
It's hard not to see the Supreme Court's decision on the Affordable Care Act as a net victory for the White House and a net defeat for the statute's opponents. President Obama will take a victory lap in his campaign and hope that an unattractive law now ruled constitutional will earn its butterfly wings and become beautiful. The difficulty for the administration is that a majority of Americans simply don't like the policy. So the decision is a "win" for Obama, yet it also provides a political and policy opening for Mitt Romney's campaign.
The court's protection of the individual mandate under Congress' taxing authorities is also a complication for the administration and congressional Democrats, leaving them in the uncomfortable position of having imposed higher taxes - a label that the president and congressional Democrats objected to during the legislative debate.
The House has scheduled a repeal vote, but the likelihood of legislatively defeating the bill is minimal, given the balance of power in the Senate. So the nation is now stuck with an unpopular yet unrepealable bill. And that's the lesson of politics: Elections do have consequences. Take them seriously.
Senior policy adviser at DLA Piper. Former U.S. senator from South Dakota; Senate majority leader from 2001 to 2003. President Obama's initial nominee to be secretary of health and human services.
The Supreme Court's decision to uphold the health-care reform law is an enormously positive step for health care in America. Our country is just beginning to meaningfully address the cost, access and quality challenges in health care today. This ruling provides the green light to full implementation of insurance, payment and delivery reform to effectively create a high-performance, high-value health-care infrastructure with lower costs, higher quality and greater access.
The debate about the role of government in health care will go on in the chambers of Congress and in our political system through this election and, most likely, many more. But implementation can now go forward, unimpeded by questions of constitutionality, and in so doing create stability and a positive environment that will prove catalytic in bringing about meaningful change. The Department of Health and Human Services can now work with states to establish insurance exchanges. It can partner with the private sector in moving away from our volume-driven approaches to health-care finance, and it can drive meaningful improvements in the delivery of care in all health settings.
Achieving this goal demands America's best thinking and innovating. One of the primary keys to success will be public-private collaborations that create new and innovative approaches to affordable, value-based and efficient care.
The convergence of crisis and leadership brings about transformational moments in history. This is one of those moments. Now everyone, including all members of Congress, needs to work together to build on what President Obama has started.
Rachel Maddow, Donna Brazile, Douglas E. Schoen, Neera Tanden, Edwin Meese III and Howard Dean.