A Cleared Bill of Health

Flickr/Robert F. W. Whitlock

There have been few more consequential years in the history of health care in America than 2012. This year saw disasters averted, new problems identified, and hope triumphing over despair. The biggest health-care news in 2012 was the dramatic and surprising decision by the Supreme Court in late June to uphold (for the most part) the Affordable Care Act (ACA). Chief Justice John Roberts shocked his Republican admirers by siding with the liberals on the Court to affirm the constitutionality of the law's individual mandate as a tax, though he also gave Republicans a way to fight back by saying the federal government couldn't force states to accept what is arguably the law's most significant feature: its dramatic expansion of Medicaid.

So, as the ACA began moving toward full implementation in January 2014, governors and legislators in Republican-dominated states did whatever they could to undermine its future success, or at the very least not contaminate themselves by contact with a law that has repulsive Obamaness all over it. One Republican state after another refused to set up a health-insurance exchange, leaving the task to the federal government. Most were probably doing their citizens a favor—if you lived in Mississippi, would you trust your Republican state government over Obama's Department of Health and Human Services to create an exchange that actually works?—but they were after the symbolism of the refusal, and at least their action won't limit anyone's access to an insurance exchange. The consequences will be more severe when it comes to the expansion of Medicaid, which many Republican states are also refusing. These states are already the stingiest with Medicaid benefits, and would rather leave their poor citizens with no health insurance than allow them to get that insurance (and all the benefits that the state would gain from an insured population) through Obamacare.

Speaking of which, Barack Obama himself finally embraced the term "Obamacare," though the public continued to be unaware of just how much they like the component parts of the law. Meanwhile, Republicans gave up on the "repeal and replace" strategy, probably because they didn't care enough about the issue to think of something to replace it with.

And of course, 2012 was a presidential election year, which guaranteed that the discussion around health care would be sober and substantive. Or perhaps not. Instead, the campaign revealed nothing so much as Republicans' conflicted relationship with government health care. After a primary campaign in which every Republican candidate pledged to repeal the ACA, the Obama campaign predictably attacked Mitt Romney and Paul Ryan for wanting to end Medicare as we know it. So Romney responded by hitting Obama for allegedly cutting $716 billion from Medicare, promising that he and Paul Ryan would be the true guardians of that single-payer insurance system. Their alleged commitment to the program didn't stop them from proposing to turn it into a voucher system, and, today, Republicans are hoping that Medicare cuts will be part of a deal to avert a fiscal disaster.

The campaign also brought us the revealing spectacle of candidates like Todd Akin and Richard Mourdock drawing on their deep knowledge of female anatomy to offer insights on rape and contraception. Though Akin and Mourdock both lost, reproductive rights are still under profound threat. This year also saw the revealing Sandra Fluke controversy, in which a woman who suggested that contraception coverage ought to be part of the health insurance women pay for was attacked by a mob of enraged conservative men appalled at the idea that women might control their sex lives. And that was only the most visible episode in a conservative campaign against contraception that finally came out of the closet in 2012.

Next year will be an important one for health care, as we see whether those Republican states come around on Medicaid, and the Department of Health and Human Services feverishly fills in the details on the implementation of Obamacare. But for now, the biggest battles—at the Supreme Court and the ballot box—are behind us.

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