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The politics of the Obamacare decision: Expect more shouting

THE Affordable Care Act has survived another encounter with the Supreme Court. Now 7.5m Americans who might otherwise have lost subsidised health insurance can keep it. This is a good thing. Trying to disentangle the effects of the law, better known as Obamacare, from all the other changes affecting health care is like trying to count raindrops. The implementation of the law has coincided with a slowing in health-care inflation and a drop in unemployment. This suggests that the two main charges against the law—namely that it is a job killer and it drives up costs—are shaky. Given that the ACA has been blamed for all sorts unwelcome changes to health-insurance plans that have little to do with it, it seems only fair to give it some credit when things go well.The absence of visible harm is not the only thing in the law’s favour: the number of Americans with no insurance has dropped to just under 12% since it passed. Intriguingly, given that the ACA is loathed by Republicans, one of its most noticeable effects seems to have been to rein in spending on Medicare, or federal insurance for retirees. Annual spending per Medicare beneficiary fell in real terms between 2011 and 2014.In political terms the decision in King v Burwell might look like it’s bad for the Republican party, but the reality is more complicated. In the run up to the decision, Senate Republicans had …

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