It's ALL THINGS CONSIDERED from NPR News. I'm Audie Cornish.


And I'm Robert Siegel.

The Supreme Court will rule this summer on the constitutionality of the Affordable Care Act. From the beginning, the health care law has been a flash-point of partisan acrimony and debate. Much of that debate has been philosophical. But now that the law is under review by the country's highest court, politicians have to plan for the real implications of the court's decision.

NPR's Andrea Seabrook reports that that is proving especially difficult for congressional Republicans.

ANDREA SEABROOK, BYLINE: Washington is obsessive. The current object of rampant speculation is the Supreme Court's health care decision.


SEABROOK: Politicians, analysts, pundits chew over every possible outcome, every election-year implication. And, of course, partisans like House Speaker Boehner are using the case to whip up support.

REPRESENTATIVE JOHN BOEHNER: The federal government thinks it can get away with this kind of power grab, it will think it can do almost anything. That's why I am supporting the lawsuit to overturn the law.

SEABROOK: Republicans have rallied for repeal of the Affordable Care Act since the very day it was passed back in 2010. And they won a majority in the House later that fall.

But now, the GOP has a problem. In the two years since the law passed, several of its parts have become very popular with voters. Among them, the ban on denying insurance because of pre-existing conditions and parents' ability to keep kids on their health plans until age 26.

So it wasn't surprising when news leaked to the newspaper Politico last week that Republicans were making plans to try to preserve those popular parts of the act, if the Supreme Court strikes the law down.

But this isn't the first time GOP leaders have hinted at their support for those provisions. Right after Republicans first won the majority, leader Eric Cantor spoke at a forum at American University in Washington. Student Alyssa Franke, who has a chronic medical condition, asked Cantor the question that still stands today.

ALYSSA FRANKE: Will you try to preserve these two provisions as they stand, or continue to push for a full repeal of the health care bill?

REPRESENTATIVE ERIC CANTOR: You know, we, too, don't want to accept any insurance company's denial of someone because he or she may have a preexisting condition. And likewise, we want to make sure someone of your age has the ability to access affordable care, whether it's under your parents' plan or elsewhere.

SEABROOK: That was more than a year-and-a-half ago, long before last week's firestorm over the same Republican sentiment. What changed? Well, reality.

Back in 2010, the concept of repealing the Affordable Care Act was a long shot. The idea of keeping the popular provisions and dumping the rest was mostly theoretical. Now, there's a real chance the Supreme Court could strike the whole thing down. And the law is designed so that the ban on pre-existing conditions and the parents' insurance provision are paid for by the thing Republicans hate: The mandate that all Americans buy insurance.

House Democratic leader Nancy Pelosi put the Republicans quandary this way.

REPRESENTATIVE NANCY PELOSI: It's all about the guys who brung them to the dance, it's about the health insurance industry and that's the agenda that they will roll out.

SEABROOK: Insurance companies, many of which are big Washington political donors, are prepared to fight tooth and claw against any new insurance mandate that doesn't also generate new profits for them. So, Republicans may have to choose who they're going to listen to - the voters or the donors.

Andrea Seabrook, NPR News, Washington.

Copyright © 2012 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.



Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

NPR thanks our sponsors

Become an NPR sponsor

Support comes from