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The recent ruling by federal judge Roger Vinson against the Affordable Care Act (ACA) shocked no one, though he did manage to deliver a surprise.

Judge Vinson, a conservative judge appointed by President Reagan, fulfilled expectations by denying the constitutionality of the ACA’s individual health insurance mandate. The plaintiffs challenged the government’s ability to require everyone to buy health coverage and Vinson agreed in an opinion published last week.

The surprising part of his decision was the scope. Not only did he strike the insurance mandate, he rejected the entire bill.

This decision will have little tangible effect on the law since states are already developing infrastructure to support the ACA’s directives and the case likely won’t be settled until the Supreme Court enters a decision. Nevertheless, many see Judge Vinson’s ruling as a turning point in the health reform debate.

By chucking the whole bill Vinson validates the “repeal and replace” -ers. These critics of the bill want Congress to drop the ACA and replace it with other laws. They argue replacement legislation targeting specific changes to the health system would achieve reform without including an individual insurance mandate. If the Supreme Court follows Vinson’s precedent, they will achieve the “repeal” part of this plan. Unfortunately, the “replace” part will be harder.

Replacing the ACA means trying to rebuild health reform in a noxious political environment. Aspiring reformers would need to navigate a voting public that has lost patience after over two years of debate. They would also need to overcome other politicians’ reticence to address a divisive issue. Those present for the vitriol at previous regional town hall meetings will understand why few politicians look forward to renewed health reform discussions.

Because of this public and political distaste for health reform, replacement legislation is a non-starter.

With replacement legislation untenable in the current political environment, repealing the ACA per Judge Vinson’s decision would effectively table health reform. This would be a blow to the President and a sad end to the most recent chapter in the debate. While imperfect, the legislation is a step toward a better health system. Repeal would erase this progress and leave America with little hope for change.

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