Skip to main content

For health reform, now the tricky part

By Julian Zelizer, CNN Contributor
updated 7:50 AM EDT, Mon July 2, 2012
Rep. Steve King, R-Iowa, tears a page from the national health care bill at a March press conference.
Rep. Steve King, R-Iowa, tears a page from the national health care bill at a March press conference.
STORY HIGHLIGHTS
  • Julian Zelizer: Health reform upheld, now must find support, fend off GOP bids for repeal
  • He says GOP will try to attack its funding; other challenges are in implementing, enforcing law
  • He says other federal programs, like Social Security, Medicare, had tough starts
  • Zelizer: Congress now must make law work; 2012 election could threaten it more than court

Editor's note: Julian Zelizer is a professor of history and public affairs at Princeton University. He is the author of "Jimmy Carter" and of the new book "Governing America."

(CNN) -- White House officials rightly breathed a sigh of relief when the Supreme Court upheld the Affordable Care Act. President Obama and his supporters are optimistic that his re-election prospects are stronger and his lasting impact on domestic policy will be much greater.

But the battle has only begun. Even after legislation is enacted, as the political scientist Eric Patashnik says in his book "Reforms at Risk," its survival is not assured. The key to success is whether a program lasts over time and builds strong political support to protect it from future attacks. As Patashnik and political scientist Jeffrey Jenkins wrote in a recent blog post, before the Supreme Court ruled: "The partisan and ideological struggle over health-care reform is likely to continue under any scenario."

Opinion: Health care victory, but still a long way to go

Julian Zelizer
Julian Zelizer

Congressional Republicans will likely continue attacking the program's funding. House Speaker John Boehner has vowed to push for its repeal.

Mitt Romney has said he will do the same if he is elected president.

Congressional Republicans will use the budgetary axe to make sure that ACA does not have a smooth path to success. The Supreme Court's decision on Medicaid has opened up questions about whether red state governors will follow through with an essential expansion of the program.

There are also challenges in making the law work. Who will enforce penalties on those who refuse to buy insurance? How effective will the cost controls be? States setting up their health care exchanges will need to take tremendous care so that consumers really receive the best choices about where to purchase their insurance. Some state officials, in Idaho and South Dakota for example, are refusing to implement the law until after November. Will the federal government step in to set up these states' health care exchanges?

'Obamacare' myths and truths revealed
How health reform will affect you
Health care budget claims explained

The good news for Obama is that many sturdy, well-regarded federal programs did not start out that way. Social Security did not do well at first. A freeze on taxes during World War II jeopardized the program, and there were real concerns that it would not survive, given that other programs for the elderly were more popular.

But Congress made adjustments, expanding coverage to include groups such as widows, increasing benefits and revising the tax system to a pay-as-you-go basis, with monthly benefits funded by monthly taxes. By 1950, the program was sound and received bipartisan support.

Opinion: Health care ruling will help Romney

When the Supreme Court struck down an agricultural-processing tax that supported a farm subsidy program in 1936, Congress reworked it, resolving the constitutional problems and protecting farmers.

Other periods have seen similar adjustments. Congress passed a watered-down voting rights bill in 1957, one that frustrated liberals.

Lyndon Johnson, then the Senate majority leader, promised it would be improved upon and expanded in future years.

"It's just a beginning," he told liberals. "We've shown that we can do it, we'll do it again."

He was right. In 1964 and 1965, Congress passed far bolder legislation.

Medicare, which Congress enacted in 1965, has faced the chronic challenge of cost control. In the 1980s, Congress imposed regulations on what hospitals could charge the program to help contain rising costs.

Congress has taken similar action with taxes. When President Ronald Reagan's 1981 tax cut and increased military spending made the deficit balloon, Congress -- with the support of key Republicans like Sen. Robert Dole of Kansas -- raised taxes in 1982 and 1983.

Congress' job is not just to make new laws, but also to fix existing ones. The question now is whether Congress can overcome polarization and gridlock to refine and improve the health care law to make sure it works. In many respects, the 2012 election will be a much bigger moment for health care than the Court decision. If Democrats don't make sure this law works well, a future Congress might use its power to repeal the legislation and finish the job they wish the Supreme Court had done.

Follow @CNNOpinion on Twitter.

Join us at Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Julian Zelizer.

ADVERTISEMENT
Part of complete coverage on
updated 12:53 PM EDT, Tue September 30, 2014
Jeff Yang calls Ello a wakeup call to Facebook and Twitter, and a sign of hope for fast-rising upstarts Pinterest and Snapchat.
updated 10:23 AM EDT, Wed October 1, 2014
Paul Waldman says the Secret Service should examine its procedures to make sure there are no threats to the White House--but without losing the openness so valuable to democracy
updated 10:55 AM EDT, Wed October 1, 2014
Jesse Williams says the videotape and 911 call that resulted in police gunning down John Crawford at a Walmart reveals the fatal injustice of racial assumptions
updated 7:03 PM EDT, Tue September 30, 2014
Mel Robbins says officials should drop the P.C. pose: The beheading in Oklahoma was not workplace violence. Plenty of evidence shows Alton Nolen was an admirer of ISIS.
updated 3:11 PM EDT, Tue September 30, 2014
The Occupy Central movement has already achieved much by bringing greater attention to Hong Kong's struggle for democracy, William Piekos says..
updated 3:11 PM EDT, Tue September 30, 2014
The Occupy Central movement has already achieved much by bringing greater attention to Hong Kong's struggle for democracy, writes William Piekos.
updated 10:13 AM EDT, Tue September 30, 2014
As Prime Minister Narendra Modi visits America, Madeleine Albright says a world roiled by conflict needs these two great democracies to commit to moving their partnership forward
updated 10:04 AM EDT, Tue September 30, 2014
John Sutter: Lake Providence, Louisiana, is the parish seat of the "most unequal place in America." And until somewhat recently, the poor side of town was invisible on Google Street View.
updated 9:11 AM EDT, Mon September 29, 2014
Julian Zelizer says in the run up to the 2016 election the party faces divisions on its approach to the U.S.'s place in the world
updated 10:19 AM EDT, Mon September 29, 2014
Ruben Navarrette says Common Core supporters can't devise a new set of standards and then fail to effectively sell it.
updated 9:29 AM EDT, Tue September 30, 2014
Earlier this month, Kenyans commemorated the heinous attack on the Westgate Mall in Nairobi.
updated 2:59 PM EDT, Tue September 30, 2014
David Wheeler says Colorado students are right to protest curriculum changes that downplays civil disobedience.
updated 9:58 PM EDT, Fri September 26, 2014
Sally Kohn says when people click on hacked celebrity photos or ISIS videos, they are encouraging the bad guys.
updated 7:55 AM EDT, Fri September 26, 2014
Loren Bunche says she walked by a homeless man every day and felt bad about it -- until one day she paused to get to know him
updated 9:32 AM EDT, Tue September 30, 2014
ISIS grabs headlines on social media, but hateful speech is no match for moderate voices, says Nadia Oweidat.
updated 8:33 AM EDT, Mon September 29, 2014
A new report counts jihadists fighting globally. The verdict? The threat isn't that big, says Peter Bergen.
updated 5:37 PM EDT, Tue September 23, 2014
Ebola could become the biggest humanitarian disaster in a generation, writes former British Prime Minister Tony Blair
updated 12:58 PM EDT, Fri September 26, 2014
ISIS has shocked the world. But will releasing videos of executions backfire? Four experts give their take.
updated 10:39 AM EDT, Fri September 26, 2014
Eric Holder kicked off his stormy tenure as attorney general with a challenge to the public that set tone for six turbulent years as top law-enforcement officer.
updated 9:09 AM EDT, Fri September 26, 2014
LZ Granderson says Obama was elected as a war-ending change agent, not a leader who would leave behind for his successor new engagement in Iraq and Syria. Is he as disappointed as the rest of us?
updated 5:10 AM EDT, Wed September 24, 2014
Gayle Lemmon says the question now is how to translate all the high-profile feminizing into real gains for women
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT