The U.S. Supreme Court volleyed its decision on President Barack Obama's health care bill back to voters in November, onto political turf that now looks better for Republicans.
Whether the federal government should exert more or less power is an essential difference between America's two political parties. If the Nov. 6 election becomes a referendum on that question in the wake of the court's approval of Mr. Obama's landmark legislation, it should make the GOP rank-and-file impassioned and Democrats worried.
Pittsburghers react to health care decision
David Herring, University of Pittsburgh School of Law professor, and others react to the U.S. Supreme court's decision upholding President Obama's health care law. (Video by Brian Batko, Nate Guidry and Carl Romanos; 6/28/2012)
The court's 5-4 decision was a historic policy victory for the president but not a political one, as he admitted himself.
"I respect the very real concerns that millions of Americans have shared. And I know a lot of coverage through this health care debate has focused on what it means politically," Mr. Obama said Thursday. "Well, it should be pretty clear by now that I didn't do this because it was good politics. I did it because I believed it was good for the country. I did it because I believed it was good for the American people."
Mr. Obama's re-election effort against Republican Mitt Romney is likely to turn on economic issues and other major factors over the next four months, including Mr. Romney's choice of running mate, party platforms, debate performances and unprecedented levels of advertising and fundraising.
It will now get a turbo burst of GOP anger at the court's move, with the encouragement of Mr. Romney and other Republican leaders.
The presidential election will allow voters to decide "whether you want to have a larger and larger government, more and more intrusive in your life," Mr. Romney said Thursday.
The court decision will also affect U.S. Senate and congressional races. "Everyone who voted for the health care plan voted for the largest tax increase in our planet's history," said Pittsburgh consultant John Brabender, an adviser to former GOP presidential candidate Rick Santorum and a slate of other Republicans nationwide. In federal races, "health care repeal will be front and center this fall. The decision doesn't put a period on it; it puts on a question mark."
Democrats have some cover in that the 2006 health care package Mr. Romney approved in Massachusetts also contained tax penalties for those without coverage.
"[Mr. Romney] owes the American people a clear, non-parsed explanation of why he believes his decisions in Massachusetts are wrong for the country, and exactly what he would do to help the American people get the health care they need," Obama campaign manager Jim Messina said in a statement.
Health care has crept up to become the No. 2 issue for voters -- after the economy -- in many recent national surveys, but not because of the debates on insurance mandates, preexisting conditions and the like.
A study by National Journal found that voters were focused on the issue as a reflection of their partisan feelings about government rather than common worries about paying medical bills. The partisan divide extends to Pennsylvania, where 80 percent of Republicans oppose Mr. Obama's bill to 20 percent of Democrats, according to Franklin & Marshall polling.
The issue is further complicated by the fact that while most voters nationwide do not approve of the president's health overhaul, they do not like their current health care options either. Expect Mr. Obama's opponents -- from the Romney campaign to free-spending GOP Super-PACs and nonprofits -- to make the most of that confusion with TV spots targeting Obamacare through the fall.
Since the president signed the bill into law in March 2010, opponents have spent $235 million nationwide on television ads and supporters spent $69 million, according to data from the Campaign Media Analysis Group. Pittsburgh and Philadelphia were among the top five markets targeted for critical ads, along with Orlando, Tampa and Denver.
The court's approval of the bill should naturally inflame Tea Party conservatives, as the decision's taxing interpretation of insurance mandates connects tidily to the 1773 tea levy protests that gave them their name. The movement that started in 2009 to protest federal bailouts helped cause the wave mid-term election for Republicans in 2010, aided by right-wing outrage over the health care bill.
The health measure "motivated a whole new group of people who had not been active in politics beforehand," said Mark Harris, lead consultant to Republican Tom Smith's campaign against Democrat Sen. Bob Casey. "For a lot of soft Republicans and conservative Democrats the party lost in the Bush administration, it brought a lot of those people out of [supporting] Obama and back to being swing or Republican voters."
While the ruling gives the Obama administration "something to crow about," said fellow GOP consultant Charlie Gerow of Harrisburg, "it also extends the debate into the presidential contest in a way that may ultimately not benefit him. It certainly invigorates a base of Republicans who find this individual mandate reprehensible, repulsive and repugnant."
If the court had rather overturned some or all of the health care bill, Democrats would have been the ones energized to avenge the move. "I gotta believe while the White House policy makers were elated, the political people are a little depressed," said Democratic consultant Larry Ceisler of Philadelphia.
"When I see what [Chief Justice John] Roberts did [in writing the majority opinion], the cynic in me -- the Karl Rove in me -- thinks if the Supreme Court would have knocked down part of health reform, especially the mandate, that would have revved up the Obama base, which up to now has been somewhat dormant."
In his opinion, Chief Justice Roberts, nominated by President George W. Bush in 2005, all but says the fate of the health law and other Obama priorities is up to voters.
"Members of this Court are vested with the authority to interpret the law; we possess neither the expertise nor the prerogative to make policy judgments," he wrote. "Those decisions are entrusted to our nation's elected leaders, who can be thrown out of office if the people disagree with them."
• Individual insurance mandate requiring Americans to get coverage by 2014 or pay a tax, although there are exemptions.
• Pre-existing conditions rule barring insurers from blocking coverage.
• Lifetime dollar limits rule.
• Creation of health insurance exchanges, competitive marketplaces where individuals and small businesses can buy coverage.
• Prescription coverage for seniors to cover the so-called donut hole.
• Adult children staying on parents' insurance until 26.
• Medicaid coverage extension to more low-income people -- Court says federal government cannot withhold existing funding from states that don't comply with push to cover people with incomes up to 133 percent of the federal poverty level.
Tim McNulty: email@example.com or 412-263-1581. Follow the Early Returns blog at earlyreturns.sites.post-gazette.com or on Twitter at @EarlyReturns. First Published June 29, 2012 4:00 AM