Commentary: Congress isn't ready to act on Supreme Court's health care decision

An audience member hold up a small sign with the words "Public Option" as President Barack Obama spoke at a rally on health care reform.
An audience member hold up a small sign with the words "Public Option" as President Barack Obama spoke at a rally on health care reform. AP Photo/Charles Dharapak

It surprised no one this week when the U.S. Supreme Court said it would review constitutional questions about the Patient Protection and Affordable Care Act. President Barack Obama's signature 2010 healthcare overhaul was headed for the high court from the moment he signed it.

U.S. Rep. Michael Burgess, R-Lewisville, knows the bill well. It's an understatement to say he doesn't like it. Having practiced medicine (delivering babies) for nearly 30 years before being elected to Congress in 2002, he qualifies as an expert.

He wrote about his impressions of the new law, his firsthand account of what he views as an underhanded push to get it through Congress and what he believes should have been done instead in his book released earlier this year, Doctor in the House: A Physician-Turned-Congressman Offers His Prescription for Scrapping Obamacare ... and Saving America's Medical System.

It's no surprise to anyone that a conservative Republican like Burgess opposed and still dislikes the healthcare bill. But what I found most intriguing when we sat down to talk recently was another of his strongly held views.

Congress isn't ready for a Supreme Court ruling on Obamacare, Burgess says. Every member -- Republicans and Democrats -- and every relevant committee should get to work preparing for the day that ruling is announced.

The court has scheduled arguments on the case in March, and a ruling is expected by June.

There are not many ways this could go, but all of them would require that Congress be ready to move, Burgess says.

Two possible outcomes would require a similar response: The court could say the new law completely passes constitutional muster, or it could say the challenges to it are premature and must wait until someone or some state can claim actual harm has been done.

Here's an example of that second possibility: Perhaps the most controversial part of Obamacare is the "individual mandate," the requirement that everyone in the U.S. purchase health insurance or pay a penalty. That provision doesn't go into effect until 2014, so the court could say no one has been harmed by it yet and the case against it is premature.

The "fully constitutional" and the "not ripe" scenarios both would leave the new law intact, at least for now. In that case, Burgess says, Congress has a lot of work to do to oversee implementation of the law. Important policy decisions are still to be made, and a lot of federal dollars are on the line. The elected representatives of all those fine folks back home can't just wait.

Other possible court outcomes could require even more congressional work.

The court could strike down part of the law, in which case Congress would have to come up with ways to fill the gap -- plus oversee all the implementation I've mentioned.

Finally, the court could make Republican dreams come true. It could say at least part of the law is unconstitutional and that makes the whole thing collapse.

What's the bad news side of that for committed Obamacare opponents like Burgess? It's that what he calls in his book the "endemic and systemic problems" of our healthcare system would remain.

"The vast majority of what Obamacare put in place needs to be undone," he says. "But that will still leave us with the task of accomplishing the kind of real reform that our nation needs in order to advance healthcare innovation, delivery and access -- for all Americans."

Burgess believes he knows many of the things that need to be done for that "real reform," including things like changes in insurance laws, tax laws and Medicaid payments to doctors. He says some of his colleagues have drafted good bills aimed at those goals.

But even if you feel you know what needs to be done, it still takes a lot of work to make it happen in Washington. Waiting for a Supreme Court wake-up call in June wouldn't be smart.