It’s health reform’s birthday. Should we celebrate?

The Affordable Care Act turns two today. That makes this a good time to take stock.

Who should be celebrating?

A lot of people. Like the more than 3-1/2 million seniors who pay less for prescription drugs under Medicare. ACA is gradually shrinking the infamous “doughnut hole” that denies coverage at certain spending levels.

And the more than 32-1/2 million people who have received free preventive services.

And the 2-1/2 million young adults who have gained coverage through their parents’ plans.

And don’t forget more than 100 million people whose health insurance had been limited by lifetime caps on coverage. They are now covered for as much health care as they need. Because many of them will never reach the cap, they may not even realize their insurance has improved.

And the major expansion of health insurance is yet to come. It will occur in 2014, when insurers are required to cover everyone, regardless of health status and Medicaid expands dramatically.

Of course, all is not entirely rosy. Only about 48,879 people with pre-existing medical conditions, far fewer than expected, have taken advantage of coverage under new high-risk insurance plans. And the plan to create affordable long-term care coverage, known as the CLASS Act, has been put on hold because financial projections showed it to be impractical.

On the other hand, a lot of people see little cause to celebrate in ACA. Recent polls show the public remains almost evenly divided.

As a result, the biggest immediate test for the law is not in its effect on health care access but in the actions of politicians and lawyers. Politicians are having their say as Republicans try to chip away at the law, so far with limited success.

Lawyers will have their say next week when the Supreme Court hears arguments on ACA’s constitutionality. That case could turn out to be more important than the law itself.

The case is really two separate constitutional challenges rolled into one. The first asks whether Congress can require everyone to have health insurance under its power to regulate interstate commerce. The second asks whether Congress can require states to expand the number and kinds of people covered under their Medicaid programs.

Most experts are betting that the court will issue a narrow ruling. That means its decisions on the two key issues, whatever they turn out to be, will focus on ACA, and the broader implications will be limited.

But the court could go in a different direction. It could issue a sweeping ruling that restricts the power of Congress to regulate interstate commerce and attach strings to spending programs. That could affect a wide range of existing laws from Medicare to environmental protection to highway construction. If the court follows this route, ACA will have changed much more than just health care.

Beyond the legal drama and political passions, let’s not forget what ACA itself is really about. Millions of Americans now enjoy better access to health care than they did two years ago. And millions more will have even better access in two years.

Whatever the Supreme Court rules, we should keep that accomplishment in mind.

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