Next Battleground of Health Care Debate - New York Times

WASHINGTON â€" Shortly after the U.S. Supreme Court’s historic health care decision, Barack Obama and Mitt Romney appeared before the cameras to offer their spin. Neither took questions.

For weeks, both men had methodically calibrated their response to what was the most eagerly anticipated pre-election high court decision ever. The ruling settles the law, not the politics.

The outcome poses challenges for both presidential contenders. Mr. Obama’s claim that it means the country “can’t refight” the law is a pipe dream. Mr. Romney will be held accountable for his strong inconsistencies on health care and his refusal to offer serious alternatives.

The 5-to-4 decision upholding the central tenet of Obamacare, as Republicans call it, was a better result for the Democrats. If things had gone the other way, Mr. Romney could have credibly charged that Mr. Obama wasted two years on an unconstitutional measure, instead of focusing on the economy.

Yet Chief Justice John G. Roberts Jr., while handing the White House an overall victory, created new problems for Mr. Obama’s re-election, declaring the law’s requirement that most Americans obtain health insurance or face a penalty was akin to a tax. That undercuts the president’s vow not to raise taxes on working-class Americans.

It was only moments after the ruling that the Republican National Committee began condemning a “tax increase on the middle class.” Mr. Romney called it a “job killer.” Senator Marco Rubio of Florida raised the specter of Internal Revenue Service agents looking into Americans’ health care choices.

In response, the president will argue that the law is a tax cut, as it would provide tax credits as an incentive to purchase health care. Taxes are not comfortable debating terrain for Mr. Obama.

In the two years since the passage of the Patient Protection and Affordable Care Act, the legislation’s official name, the White House has done a miserable job of explaining it and enlisting public support.

The same criticism will continue: The focus on health care is a distraction from the priorities of the economy and jobs. That probably provides Mr. Romney an opening.

Still, the presumptive Republican nominee faces tough questions, too. He and most congressional Republicans have vowed to “repeal and replace” the health care law.

Mr. Romney says he will do away with it on his first day in office; Jan. 20 could be busy for him, as he also has vowed to repeal the financial regulatory law and to declare China a currency manipulator on that day.

There is a huge void with the “replace” commitment that the Romney campaign calculates it can finesse until after the election.

A vigilant news media will make that impossible, which is one of the reasons the Republican nominee is so inaccessible. An example: Mr. Romney has said he wants to make sure that Americans with pre-existing conditions do not lose their current health insurance. What he doesn’t say is that he would not keep the provision ensuring this protection in the current law. What would he do? Simply say tough luck to people with disabilities?

He still has not explained why he has shifted his views on a mandate requiring health insurance. This requirement was the defining characteristic of the plan he pushed through as governor of Massachusetts, which served as a model for Mr. Obama’s plan. Romneycare imposed stiff penalties â€" at one stage more than $1,000 per person â€" for those who could afford health insurance and did not get it. Was that a tax increase?

The Republican nominee tries to make the distinction that a mandate is fine on the state level but unconstitutional and bad policy on the national level. That is a distinction most voters do not get.

During his 1994 bid to unseat Senator Edward M. Kennedy, Mr. Romney supported the Senate Republicans’ alternative to President Bill Clinton’s health care initiative. The centerpiece of that proposal was an individual mandate. In 2007, well before Mr. Obama switched his position and backed the mandate, Mr. Romney said it was “a terrific idea.”

Former Senator Rick Santorum, a former contender for the Republican presidential nomination, said last week that “health care costs in Massachusetts are No. 1 in the country.” The program, he concluded, “doesn’t work.” Does Mr. Romney disagree?

Political calculations on both sides are oversimplified. The Democrats’ assumption that voters will give the president credit for a major achievement and overlook some of the concerns that have yet to be explained is not supported by public-opinion surveys.

Republicans argue that the renewed health care debate will energize right-wing Tea Party activists, just as it did in the 2010 elections. Before the Supreme Court’s announcement Thursday, they insisted this group was already fully energized.

Polls and conversations indicate that voters want to learn more. The majority of Americans have real concerns about the impact of this law and certainly do not relish the prospect of higher taxes.

At the same time, only a minority of hard-core conservatives â€" about a third of the electorate â€" want to see the law simply repealed; voters in the middle are more interested in hearing about the “replace” part of the Republican slogan.

Mr. Romney and Mr. Obama had a free ride last week. For the next four months, as the boxing legend Joe Louis once said, they can run, but they cannot hide.