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What now? Congress eyes new era of health policy after Obamacare survives

Democrats want to build on the law, add a public option and expand Medicare. Republicans say they still support rolling back parts of the ACA.
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WASHINGTON — Lawmakers in Congress wrestled with what the new era of federal health care policy would look like after the Supreme Court on Thursday rejected the latest existential challenge to Obamacare.

Democrats said the next step was to build on the sprawling 2010 law, which touched on nearly all aspects of the health care system, by pushing policies to lower costs.

"Let me say definitively: The Affordable Care Act has won. The Supreme Court has just ruled, the ACA is here to stay," Senate Majority Leader Chuck Schumer, D-N.Y., said on the floor of the chamber. "And now, we’re going to try to make it bigger and better — establish, once and for all, affordable health care as a basic right of every American citizen."

House Speaker Nancy Pelosi, D-Calif., called the ruling a "landmark victory" against Republicans' "relentless assault to dismantle" protections for pre-existing conditions.

"We will continue to work to lower health care costs by lowering the cost of prescription drugs," Pelosi told reporters. "That is a very important part of where we go from here."

Progressive Democrats are pushing to use President Joe Biden's economic package to allow Medicare to negotiate drug prices and to expand the program by lowering the eligibility age to less than 65 and adding benefits like dental care, eyeglasses and hearing aids.

And key Democratic health committee chairs say they're working to craft legislation to add a "public option" to the ACA exchanges, which would compete with private insurers.

Rep. Nancy Mace, R-S.C., said it's unclear where Republicans will go next on health care, an issue the party struggled with under former President Donald Trump.

"I don't know what the next step is," she said on MSNBC. "I do know that Republicans will come up with solutions," she added, to "repeal some of the regulations" in the 2010 law.

Asked if there may be more legal challenges to ACA, Mace said: "I hope it's not the end of the road."

Long-serving Republicans appeared less eager to weigh in on the ACA ruling, having been burned by the issue in recent years after Democrats mounted a campaign accusing them of trying to take away insurance coverage for millions of Americans. The fight, which led to a failed attempt to repeal the ACA in 2017, has dogged GOP candidates at the ballot box in recent elections.

For now, there's no consensus among Republicans on what an alternative health care system should look like. But there remains an appetite to roll back portions of the ACA.

"I'd like to see an adjustment to the ACA program. Frankly, I'd like to see it replaced, and allow states to craft their own programs in the way they think best," said Sen. Mitt Romney, R-Utah, the party's 2012 presidential nominee who ran on repealing the ACA. "That's not something that was acceptable to the people in 2012 when I ran on that platform, but I still think that's the right way to go."

Romney said that while he couldn't predict future lawsuits, any major health care changes in the near term would likely have to come from Congress.

Some scholars believe it is probably the end of big ACA challenges after the Supreme Court rejected one in 2012 by a 5-4 vote, another in 2015 by a 6-3 vote, and the latest by a 7-2 vote.

"It's hard to see how you get really big Obamacare cases going forward. Because there's really not much to challenge in terms of a frontal constitutional challenge," said Jonathan Adler, a professor at Case Western Reserve University's law school who has stood on both sides of ACA litigation over the years.

Adler said it's possible that there are smaller lawsuits around the implementation of the sprawling law, but "not things that'd threaten to undo or tear down the architecture of this law."

"If this law's going to be dramatically altered in any direction, it's going to be done by Congress," he said.