Health care ruling: What will White House do now?

A federal judge on Monday declared a key provision of President Obama’s health care law unconstitutional. The ruling energized Republicans who hope to repeal or limit the legislation, and ensures that health care will remain a contentious political issue for months, perhaps years, to come.

That’s not the way Obama hoped things would turn out when he signed his signature health reforms into law. Given the new political realities of health care, what’s the White House going to do now?

The first thing the administration is likely to do is push hard to write regulations and implement the law as fast as it can. Judge Henry E. Hudson’s ruling struck down only the law’s requirement that individuals obtain health insurance. He specifically said that the roll-out of health care reform can continue, given that the so-called “individual mandate” would not take effect until 2014.

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This means that with health care the White House can continue to create what the military calls “facts on the ground” – legal and regulatory changes that might be difficult to reverse once they’re in place. The administration will push forward with plans to expand Medicaid, for instance. It will oversee state efforts to create insurance exchanges – markets where individuals can more easily shop for health coverage. It will draw up federal rules governing what kind of policies those exchanges will offer.

“Absolutely” implementation of the health law should proceed, despite Judge Hudson’s ruling, said the Senate’s number two Democrat, Sen. Dick Durbin of Illinois, on Tuesday in a broadcast interview.

The second thing the administration is likely to do is decline to expedite Supreme Court consideration of the health care law.

Judge Hudson’s decision deals with just one of a number of challenges to the law now working their way through the federal court system. Two other federal judges – one in Michigan and one in Virginia – have previously found the individual mandate to be constitutional. Eventually the Supreme Court will have to consider all these cases and resolve their differences of opinion, legally speaking.

Many Republicans want that to happen as fast as possible. The second-ranking member of the current GOP House leadership, Rep. Eric Cantor of Virginia, at a press conference on Monday called on the Justice Department to agree to bypass appeals and fast-track the issue direct to the highest court in the land.

But many Democrats prefer a slower approach. They want as much time as possible to continue rolling out the law and getting US voters used to what the administration sees as its benefits (see point one, above). Absent a fast-track decision, the Supreme Court might not hear the case until 2012. The nine justices might not hand down an opinion until 2013.

The third thing the administration might do is get Obama to work harder to sell Americans on the health law. Right now, the public remains confused about what the law does, and the nation remains split on the issue. About 42 percent of respondents to a recent Kaiser Foundation poll said that they viewed the health care legislation favorably, for instance. Forty-one percent of respondents said they viewed the effort unfavorably.

Whether more appeals will generate enthusiasm for the administration’s health care changes is, debatable, though. Obama has been talking about health care reform for years. Yet the law itself barely passed, and since then the political winds have shifted to blow more favorably for the GOP.