The Health Care Test

The health care law's fate will help define government reach for years to come.

In the 235-year-old struggle to define the role of government in our country, the Patient Protection and Affordable Care Act enacted in March 2010 looks to be a milestone. From every corner of the constitutional landscape, it is attracting the kind of attention rarely seen since Franklin Roosevelt's New Deal produced novel theories of government power that were challenged repeatedly in Congress and the Supreme Court.

Now an epic struggle to kill the health care law will be the leading edge in a broader attack on federal powers to regulate other key sectors of the nation's economy. Also in the crosshairs are the new financial regulatory law, the huge federal institutions propping up the housing markets and government efforts to curb greenhouse gases. The Affordable Care Act is so important in this debate because the law does, as its critics say, move the United States further toward a welfare state. To be sure, we already have programs that give people cash grants and subsidies, but we do not have the kind of cradle-to-grave approach found in Europe. We take care of seniors and veterans, and offer tax credits for the working poor, and occasionally single out special groups as Congress did in December 2010 with Sept. 11 first responders, but we haven't said to the middle class that government will step in broadly to assure their health, education and welfare.

The Affordable Care Act seeks to promote the welfare of middle- and lower-income citizens by providing subsidies and offering peace of mind about the unaffordable health care bills people fear they might face.

Is this "socialism," as critics charge? Or is it government fulfilling its obligation to shore up the middle class?

It's instructive to look back on what is often considered the most successful of programs to build the middle class, the 1944 Servicemen's Re-adjustment Act, known as the GI Bill. When it was under debate in Congress, opponents beat back proposals to extend its benefits to more people through a British-style welfare agency. But as University of California-Berkeley assistant professor Kathleen J. Frydl observes in The GI Bill (Cambridge University Press, 2009), the broad menu of loan guarantees for a house, business or farm, tuition, unemployment compensation, and no-cost health care, constituted a welfare regime for a large class of people. Thus, she writes, "Over a discrete period of time, for veterans and their families, there was a strong welfare state, a provisional but impressive victory of social policy and federal power [but which] came at the expense of more universal coverage."

The GI Bill helped create the American middle class. But since it ended, there has been no other program to bolster this group-the current White House's middle-class task force notwithstanding.

Frydl observes the GI Bill found support in Congress in part because an important institution, the Veterans Administration, already was in place to provide an administrative home for all the new programs. "The creation of policy is, in the United States, only the beginning of the story," she writes. "Regulatory power, those countless decisions made by agencies during implementation, or remedial schemes designed to rectify faults of the original policy, are both tremendous reservoirs of state power."

As with the GI Bill, the Affordable Care Act confers sweeping regulatory duties to government agencies. While the law's big-government philosophy is under attack in Congress, the health care program seems more vulnerable at the moment in the regulatory arena. House Republicans have said they will examine "every dime the administration is seeking to spend on implementation." And a key provision of the law is headed for review by the Supreme Court after a Virginia judge ruled the requirement that individuals buy health insurance fails to pass constitutional muster.

As National Journal reported in December, the newly powerful GOP contingent in Congress will "lay an oversight paper trail" critical of many administration policies, and then will move, as GOP majorities did in the 1990s, to defund or block steps agencies must take to implement laws and regulatory strategies.

All of this will constitute an attack on the power of government. But in defining the scope of the U.S. welfare state, no battles are more important than those under way in Congress and the courts to decide if the new, fragile health care law can long survive.

Stay up-to-date with federal news alerts and analysis — Sign up for GovExec's email newsletters.
Close [ x ] More from GovExec

Thank you for subscribing to newsletters from
We think these reports might interest you:

  • Sponsored by Brocade

    Best of 2016 Federal Forum eBook

    Earlier this summer, Federal and tech industry leaders convened to talk security, machine learning, network modernization, DevOps, and much more at the 2016 Federal Forum. This eBook includes a useful summary highlighting the best content shared at the 2016 Federal Forum to help agencies modernize their network infrastructure.

  • Sponsored by CDW-G

    GBC Flash Poll Series: Merger & Acquisitions

    Download this GBC Flash Poll to learn more about federal perspectives on the impact of industry consolidation.

  • Sponsored by One Identity

    One Nation Under Guard: Securing User Identities Across State and Local Government

    In 2016, the government can expect even more sophisticated threats on the horizon, making it all the more imperative that agencies enforce proper identity and access management (IAM) practices. In order to better measure the current state of IAM at the state and local level, Government Business Council (GBC) conducted an in-depth research study of state and local employees.

  • Sponsored by Aquilent

    The Next Federal Evolution of Cloud

    This GBC report explains the evolution of cloud computing in federal government, and provides an outlook for the future of the cloud in government IT.

  • Sponsored by Aquilent

    A DevOps Roadmap for the Federal Government

    This GBC Report discusses how DevOps is steadily gaining traction among some of government's leading IT developers and agencies.

  • Sponsored by LTC Partners, administrators of the Federal Long Term Care Insurance Program

    Approaching the Brink of Federal Retirement

    Approximately 10,000 baby boomers are reaching retirement age per day, and a growing number of federal employees are preparing themselves for the next chapter of their lives. Learn how to tackle the challenges that today's workforce faces in laying the groundwork for a smooth and secure retirement.

  • Sponsored by Hewlett Packard Enterprise

    Cyber Defense 101: Arming the Next Generation of Government Employees

    Read this issue brief to learn about the sector's most potent challenges in the new cyber landscape and how government organizations are building a robust, threat-aware infrastructure

  • Sponsored by Aquilent

    GBC Issue Brief: Cultivating Digital Services in the Federal Landscape

    Read this GBC issue brief to learn more about the current state of digital services in the government, and how key players are pushing enhancements towards a user-centric approach.

  • Sponsored by CDW-G

    Joint Enterprise Licensing Agreements

    Read this eBook to learn how defense agencies can achieve savings and efficiencies with an Enterprise Software Agreement.

  • Sponsored by Cloudera

    Government Forum Content Library

    Get all the essential resources needed for effective technology strategies in the federal landscape.


When you download a report, your information may be shared with the underwriters of that document.