Now it’s up to Congress

The battle over the nation’s health care system now shifts to Congress. The Republican-controlled U.S. House, as expected, promises to continue to try to repeal the 2010 reform that the U.S. Supreme Court has now largely upheld.

But the present U.S. Senate, with a Democratic majority, is most unlikely to agree on repeal.

Party leaders promptly laid down their positions. Majority Leader Sen. Harry Reid said that the matter is settled and both parties should now turn to job creation and securing the economy.

Republican leader Sen. Mitch McConnell said the decision “makes one thing clear: Congress must act to repeal this misguided law.”

With Congress divided on the issue, the outcome may depend on the November election. If Mitt Romney wins the presidency and Republicans control both houses, they will most likely attempt to repeal Obamacare, as the new law is often called. But it could hinge on whether Republicans are able to prevent a filibuster, which is very unlikely.

When Romney learned of the decision, he said: “If we want to get rid of Obamacare, we are going to have to replace President Obama.” But the Republicans then would have to come up with something to take its place.

If Obama wins re-election and the Democrats keep or extend their control of the Senate, they will carry out the current and future terms of the law and may refine some of its provisions. A win for the Democrats might even lead to converting the system into a single-payer plan, which would cover all Americans instead of leaving out a substantial number. It would be something like extending Medicaid from the elderly and disabled to all Americans.

But that vision, held by Public Citizen and other liberal groups, would depend largely on the state of public sentiment. Polls show that the American people are close to evenly divided on the Affordable Care Act.

That sharp division may continue despite the Supreme Court’s upholding of its central provisions. Public opposition has been shaped by the spending of more than $200 million by conservative groups. That total includes $27 million by the United States Chamber of Commerce, $18 million by Karl Rove’s Crossroads GPS and $9 million by the American Action Network, founded by Fred V. Malek, a figure in the 1970s Nixon Administration’s Watergate scandal and now a prominent Republican fundraiser.

In a strange turn-about, the mandate that most Americans must buy health insurance, so opposed now by conservatives, originated in 1989 in a brief by the conservative Heritage Foundation. It was intended to counter an employer mandate, a provision of President Bill Clinton’s ill-fated single-player health plan.

The individual mandate was a provision of a Republican health plan sponsored by Sen. John Chafee, R-R.I., and co-sponsored by 18 Republicans, including Orrin Hatch of Utah and Bob Dole, then the minority leader.

Hatch, the Heritage Foundation, and many other supporters of the mandate have since said they were mistaken.

Opposition to the Obama health plan is so firmly set in stone that, no matter how the election turns out, repeal efforts will be fiercely fought and any efforts to strengthen the plan will meet tough resistance.