Thanks to the Supreme Court, healthcare reform has cleared another hurdle.  At 10:21 AM yesterday, as I was writing this week’s letter a banner appeared on my screen: NPR:Breaking News–Supreme Court Rules Obamacare Subsidies Are Legal

Just seven words but a powerful message. Later I enjoyed looking at all the YouTube commentary on CNN. In particular I enjoyed the President’s words and the brief analysis of Jeffrey Toobin.

http://www.cnn.com/2015/06/25/politics/supreme-court-ruling-obamacare/

I do not know about you but I was apprehensive to the end. Despite my rationalizations that an adverse decision would not mean the end of healthcare reform, I knew that a decision for King in King v. Burwell would do more than damage the access to care of 7 million people. A decision against the ACA would have undermined much of the emerging economics of the transformation of our industry.

The big surprise for me was that Justice Roberts joined the majority and wrote the opinion supporting the ACA. It makes little difference to me that he commented that the ACA is not a well written act. The ACA  remains a miracle and a monument to persistence. It is a wonder that it exists, even in its flawed form.

Roberts has now written both of the majority opinions that have sustained the controversial healthcare act. I know that he was appointed by the second President Bush to move the Court to a more conservative stance, but it is beginning to feel like “deja vu all over again” in comparison to the appointments of two previous justices, Earl Warren and David Souter. Both of them arrived at the court with conservative credentials and departed as progressive icons.

It is now time to begin to make the ACA better. Would it not be wonderful if the comments by Speaker Boehner and Senate Majority leader McConnell suggesting that they will not be deterred in their efforts to “repeal and replace” the ACA could somehow morph into a concept of “expand and improve” through a bipartisanship effort that supports the achievement of the Triple Aim?

Five years of resistance that includes two Supreme Court decisions and a Presidential election should suggest that it is time for a change of direction that improves the law, rather than the beginning of yet another round of expensive and detracting efforts to abolish it.