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Kristin Murphy, Deseret News
Tom Metcalf, MD and Utah Health Policy Project chair, speaks during a press conference held in reaction to the Supreme Court's decision to uphold the Affordable Care Act at the State Capitol Building Salt Lake City on Thursday, June 28, 2012.

It's official. Obamacare penalties are actually taxes, and now all three branches of the U.S. government have a stake in 2012 election outcomes, where the fate of the Affordable Care Act will ultimately be determined.

The Supreme Court decision upholding the law has been analyzed to death, but we can't help offering our thoughts on how health care reform will play out in Utah and presidential politics.

In his historic opinion, did Chief Justice John Roberts safeguard the Supreme Court as an institution, or (horrors of horrors) is he just another political hack in a black robe? Does it help or hurt Mitt Romney or Barack Obama?

Pignanelli: "Exercise freaks are the ones putting stress on the health care system." —Rush Limbaugh. To the University of Utah Law School: I want my money back! For three years I endured the pontifications from professors that the Supreme Court deliberated without external influence. The Chief Justice affirmed the Court is watching the nation's political dynamics. He underwent legalistic wrangling to uphold the ACA, because he did not want the blame of eliminating specific reforms enthusiastically supported by most Americans.

Health care reform reminds me of the holiday fruitcake passed around every December. Everyone concurs there are some healthy ingredients, but a majority distaste the entire loaf. The cook has to do a real PR effort within the party to get anyone to try it. Some insist that they will never look at a fruitcake again, but it shows up every season.

Roberts' decision instilled enthusiasm to the Obama campaign, while creating additional obstacles for Romney. Obama and Congress used Romney's Massachusetts recipe in developing ACA, a fact that prevents him from using Obamacare as a wedge issue. The Republican nominee almost broke his back flip-flopping this week over whether the penalty is a tax.

Webb: I'm not a slick-mouthed attorney who eats fruitcake, as Frank is, and I have no idea what motivated Roberts. But the best legal minds in the country are scratching their heads over Roberts' nuanced, muddled opinion braking federal power under the Commerce Clause, but then rewriting the health care law to turn a penalty into a tax, giving the federal government license for unlimited mischief and social engineering under its taxing authority. After digesting the opinion, conservative legal scholars generally find it a setback for limited government and balanced federalism, which is highly unfortunate.

Obama has avoided a big embarrassment, but Republicans are more energized than ever. Overturning Obamacare is now an immense campaign issue. The decision is a net minus for Obama.

In Utah, does the Supreme Court decision most help Democratic or Republican candidates?

Pignanelli: Local Republicans have already drawn battle lines over Obamacare, so they don't get much of a bump. Because the penalty is now a "tax," Democratic Rep. Jim Matheson has an open door to vote for a repeal of ACA — a position consistent with his long record against tax increases.

Webb: It's a major distraction for Democrats, especially congressional candidates. They all have to state, over and over again, their position on Obamacare and hope voters will forgive them if they support it or, if they oppose it, really believe that they will be disloyal to their president and vote to repeal it. It's tough for Democrats and gives Republicans a nice issue.

Utah initiated elements of an insurance exchange well before Obamacare passed in 2010. Although Utah's exchange has been recognized as a model in health care reform, some Republican officials are seriously considering stalling or junking the exchange. What is the future of the Utah exchange, given national and state politics?

Pignanelli: As a former general counsel — and now lobbyist — for Regence Blue Cross Blue Shield of Utah, I am trained to spot opportunities for health care reform. Insurance exchanges are clunky and expensive but will be increasingly larger features in the health care landscape — regardless of the 2012 elections. To prevent federal intrusion, Utah decision-makers should invigorate our famous exchange with true reforms that empower consumers (i.e., transparency, quality metrics, etc.) — with the eventual goal of privatizing. Utah could set the standard for the rest of the country of how to achieve greater access with lower cost.

Webb: It would be foolish to toss out Utah's insurance exchange just because Utah policymakers dislike Obamacare. Utah's exchange is entirely voluntary, consumer-oriented, market-driven and is a modest attempt to help small businesses and their employees find affordable health insurance.

It is vitally important to remember that repealing Obamacare doesn't solve the health care crisis, given the system's perverse incentives and escalating costs. Republicans who vilify Obamacare had better come up with substantive plans of their own or we'll see health care costs and programs, including Medicare and Medicaid, wreck our economy and destroy political careers. Remember that many, many Utah families are just one serious accident or illness away from financial disaster.

The Utah insurance exchange could be a part of the solution.

Republican LaVarr Webb is a political consultant and lobbyist. Previously he was policy deputy to Gov. Mike Leavitt and Deseret News managing editor. Email: lwebb@exoro.com. Democrat Frank Pignanelli is a Salt Lake attorney, lobbyist and political adviser. Pignanelli served 10 years in the Utah House of Representatives, six years as minority leader. His spouse, D'Arcy Dixon Pignanelli, is a state tax commissioner. Email: frankp@xmission.com.