The battle ahead for Republicans who hope to repeal and replace the Affordable Care Act is one that will be fought on the campaign trail, even as markets move ahead with more confidence after last week's U.S. Supreme Court decision.
The ruling—a huge win for President Barack Obama and the millions of people who get to keep their subsidized coverage—means the market disruption that will accompany any future effort to dismantle the law will grow significantly larger since millions more people are likely to gain coverage through the federally run exchanges over the next two years.
The court's decision left little prospect that legal challenges will dismantle the law before 2017. Any congressional repeal effort faces the threat of a veto while Obama is still in office. And the next administration—should the GOP win the White House and keep control of Congress—will see the law's achievements further cemented in place.
“It is such a clear judgment,” said Joseph Antos, a healthcare economist at the American Enterprise Institute, a center-right think tank in Washington. “That's it. This is a clear message to Republicans if you want to change anything about the ACA, you really do have to repeal it and start all over again.”
Republicans were swift to denounce the court's 6-3 decision. Congressional leaders and presidential candidates reacted by vowing to jettison the law.
“I am disappointed in the Burwell decision, but this is not the end of the fight against Obamacare,” said former Florida Gov. Jeb Bush, who leads Republican presidential candidates in fundraising, in a Twitter post.
Markets, however, were jubilant, and the rally underscored what observers described as a growing certainty that the insurance market for millions of Americans created under the ACA will remain.
Perhaps most important, said both opponents and supporters of the law: Republicans must clearly articulate an alternative to the Affordable Care Act.
GOP plans will likely include popular ACA consumer protections, such as the guarantee that people can't be denied coverage because they are already sick. “It is political reality that we are not going to go back to the old days where people can be refused coverage,” Antos said. But alternatives would also likely not mandate purchasing coverage, which is necessary to preserve the financial viability of an individual insurance market with guaranteed issue.