A Supreme Court decision striking down President Obama’s healthcare law would be a blow not just to Obama, but to the decades-long push for universal healthcare.

Universal coverage has been a staple of the progressive movement since Theodore Roosevelt ran for president. To finally realize that dream, only to have it taken away just two years later, would be an especially bitter defeat even for a movement that has seen its share of disappointment.

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The politics of healthcare are already treacherous. Democrats lost the House in 1994 partly because they failed to pass a healthcare bill, then lost it again in 2010 because they succeeded. Now the Supreme Court could help deny Obama a second term while also wiping out the policy that came at such a steep price.

If that happens, it’s easy to see why elected officials might view healthcare as a bad use of political capital.

“It will make the process of providing healthcare for the American people even more difficult,” said Rep. Raúl Grijalva (D-Ariz.), who leads the House Progressive Caucus.

The court is expected to rule by the end of the month on Obama’s healthcare law. The challenge has already been called the “case of the century.”

The timing of the ruling, just months before the November elections, illustrates the immediate risk to Obama. For supporters of universal coverage, the sheer magnitude of a loss before the court is tied to the magnitude of what Obama and congressional Democrats accomplished.

“It’s a huge setback. There’s no way to sugarcoat it,” said Ron Pollack, executive director of the prominent advocacy group Families USA. “You’re back at square one.”

Obama decided to tackle healthcare in the wake of an election that seemed, at the time, like a political realignment. And the White House went to great lengths to avoid the mistakes of the Clinton administration.

Democrats built support among the healthcare industry groups whose expensive advertising campaigns helped kill President Clinton’s effort. The pharmaceutical industry cut a deal to run ads supporting the legislation, and the American Medical Association lent its support.

The historic election, and Democrats’ enormous congressional majorities, made it harder to publicly oppose healthcare reform. But if the Supreme Court strikes down the law, that aura of inevitability might be harder to achieve in the future.

“I think the effort will be intense to come back, but also the opposition will be emboldened, knowing that their refuge is the courts,” Grijalva said. “So you [might] have another legislative victory, but that will always be touted as their refuge.”

Stakeholders agree that Congress certainly wouldn’t try again on healthcare this year, and probably not any time in the near future.

John McDonough, a Harvard University health policy professor who worked for the late Sen. Edward Kennedy (D-Mass.) during Obama’s healthcare push, noted that big pieces of healthcare legislation have only passed when one party controlled the House, the Senate and the White House.

Republicans aren’t especially focused on expanding coverage — their priority is lowering costs. And even if Democrats roar back to power relatively soon, the specter of “ObamaCare” would loom large if the Supreme Court throws out the law.

“Healthcare comes in cycles,” Pollack said, noting that almost 20 years passed between the Clinton and Obama proposals.

Some Democrats said a loss at the Supreme Court wouldn’t scare the party away from pursuing healthcare reform.

“This isn’t so much a dream as a necessity,” Rep. Peter Welch Peter Francis WelchShakespeare Theatre Company goes virtual for 'Will on the Hill...or Won't They?' Vermont Rep. Peter Welch easily wins primary Vermont has a chance to show how bipartisanship can tackle systemic racism MORE (D-Vt.) said. “The healthcare system we have is broken, so if, worst case, the Supreme Court strikes it down, we’re back to a bad situation that pre-existed the passage of healthcare. What’s driving healthcare now is the unsustainability of the system that we have. We would have to address it.”

Democrats didn’t completely abandon healthcare in the wake of the 1992 failure. They took an incremental approach, passing laws to tighten privacy standards and creating the Children’s Health Insurance Program.

If the Supreme Court throws out Obama’s healthcare law, bite-sized proposals to build on its popular elements might be Democrats’ best chance to make at least some progress. Rep. James Clyburn (D-S.C.) has said Congress will have to return to the issue several times.

“What folks call the Civil Rights Act are four distinct acts done over eight years. That’s what I think we’re going to have to do with healthcare,” Clyburn said in April on MSNBC’s “Morning Joe.”

But some doubt universal coverage can be achieved that way.

“We’re talking about an incremental process, unfortunately, as opposed to a comprehensive process, which is really what we need,” Grijalva said.

He also said Republicans and other opponents of the Affordable Care Act would be adamant about standing in Obama’s way on anything.

“They’ll be emboldened to resist any effort, whether it’s incremental or not,” he said.







