At some point this month, the Supreme Court will hand down its decision on the Affordable Care Act (ACA, or “ObamaCare”). It’s unclear what the court will decide, but if it strikes down part or all of the law, it will be good for anyone who cares about good health care policy. The question, especially for state politicians, will then be what policies should we enact to bring health care spending into line.

In preparation for this event, I’d like to lay some groundwork to prepare for the inevitable hysteria if the law is struck down. The main thing to remember is that this law is bad policy. And it’s bad policy whether it’s enacted at the federal level or the state level (which is likely what we’ll see in Maryland if the Supreme Court voids most or all of ACA).

The Washington Post’s Robert Samuelson has a good op-ed today about the various flaws of ACA, and it’s worth a read. He talks about a number of problems this law has. I’d like to focus on the specific health care problem he notes:

Uncontrolled health spending is the U.S. system’s main problem — and the ACA makes it worse. Spiraling health costs crowd out other government programs and squeeze wage increases by diverting compensation dollars into employer-paid insurance. Because insured people use more health services than the uninsured, the ACA (covering an estimated 30 million more) raises spending. As for the ACA’s cost-control provisions, even the government’s own actuaries don’t believe they will do much. By their latest projection, total health spending — government and private — rises from 17.9 percent of the economy (gross domestic product) in 2010 to 19.6 percent in 2021. In 1980, health care was 9 percent of GDP.

The variety of other problems with ACA might – might – be forgivable if ACA addressed the myriad problems in our health care system. It doesn’t. In fact, as Samuelson and others have noted, it makes these problems worse.

What then should be done to lower health care spending (or at least reduce its rate of growth)? Michael Cannon of the Cato Institute has some good suggestions from a free market perspective in this policy brief. In short, giving consumers control over their health care dollars and reducing government interference in the health care marketplace would go a long way towards controlling health care spending.

At a state level, Maryland policymakers could embrace these policy suggestions in the wake of whatever the Supreme Court decides about ACA. There is already a slight move in recent years to reduce some of the regulations about what health care services non-physicians can provide. This type of deregulation is a good first step and it should be followed with the dismantling of even more barriers that stop health care professionals from serving patients better. State policymakers could also allow Marylanders to purchase insurance across state lines and move towards allowing more consumer-centered health insurance products.

Given the makeup of our legislature, these moves are unlikely. But something needs to be done to control health care spending. The bad policy prescriptions in the ACA won’t help do this, and we’ll be better off if the Supreme Court invalidates them.