Not long after the U.S. Supreme Court upheld the Affordable Care Act on Thursday, the members of Hawaii’s congressional delegation — all Democrats — were in unison in welcoming the surprise decision.

For her part, U.S. Rep. Mazie Hirono, the Senate candidate, noted that the act had already helped people in Hawaii.

“An estimated 6,000 young adults in Hawaii now have access to health insurance,” she said in a statement. “Nearly 25,000 people on Medicare have saved over $14.5 million in prescription drug costs. More than 200,000 people helped control long-term health costs by gaining preventative health service coverage.”

Said U.S. Rep. Colleen Hanabusa, who is running for re-election, “Today’s decision is not about politics; it is about the well-being of ordinary people.”

Actually, the high court’s ruling has a great deal to do with politics — both the decision and the outcome.

It is both an “an enormous victory” for Obama, whose presidency was on the line with the ruling, and a “stinging disappointment” for Republicans.

But the ruling is also a “rallying cry,” as The Hill put it, for the GOP “to win an electoral mandate to repeal it.”

The presumptive Republican nominee for president, Mitt Romney, has repeatedly promised that his first act as president will be to end Obamacare. The health care debate will be at center stage in the presidential contest as well as the races for Congress.

That could pose challenges for Republicans Linda Lingle and Charles Djou, the Hawaii GOP candidates for the U.S. Senate and the 1st Congressional District, respectively.

Lingle, the former governor, will face either Hirono or Democrat Ed Case in the general election, while Djou, the former congressman, will face Hanabusa. Hirono and Hanabusa in particular strongly support the Affordable Care Act.

The contests are also taking place in a state that embraces its 1974 Prepaid Health Care Act, which has resulted in about 90 percent of residents being covered by health insurance. Hawaii is also a state with one of the proportionately largest and fastest-growing senior populations — a population that cares tremendously about health care.

You can bet AARP Hawaii will be reminding voters on where the congressional candidates stand on health care and preserving Medicare and Social Security.

If it wasn’t already at the top of the list, health care is now firmly a key political issue in Hawaii’s congressional races.

Where Lingle and Djou Stand

Civil Beat asked the campaigns of Lingle and Djou for comment on the Supreme Court ruling, and on how it might affect their respective races. Their statements came several hours after those of Hawaii Democrats.

Not surprisingly, both candidates tied the ruling to the issue of how to pay for health care, which plays to their reputations for fiscal accountability.

Here’s what Djou had to say:

Today’s ruling was a disappointment to working families and small businesses who have been looking for relief from the heavy hand of the federal government. While I believe we need real health insurance reform, this bureaucrat-focused, DC-centered approach based on bigger government is not what is right for Hawaii, or the nation. In addition to cutting Medicare, raising taxes and stifling economic growth with paralyzing uncertainty, the healthcare law does not address the real issue in health insurance: rising costs.

As a Congressman, I fought for Medicare and genuine reform that would increase access and lower costs and I will do so again. This process is far from over as the debate moves from the Supreme Court to Congress as to how the law should be further refined. I will be a commonsense, moderate voice for the people of Hawaii and ensure that the federal government stops making promises it cannot keep by spending money it doesn’t have.

Lingle, more nuanced, said this:

I have always believed that all Americans should have access to quality, affordable health care, and if elected as the next U.S. Senator for Hawaii I will make health care a priority in the next Congress.

This is not the end, but the beginning of what can and should be a healthy, productive and successful revamping of medical care access for the people of Hawaii and the nation. As Chief Justice Roberts noted in his majority opinion, “Members of this Court are vested with the authority to interpret the law; we possess neither the expertise nor the prerogative to make policy judgments. Those decisions are entrusted to our Nation’s elected leaders.”

Beginning in January, the next Congress must address what the PPACA ignored, including important health care policy issues like the skyrocketing health care costs for the majority of Americans and small businesses, the quality of health care Americans receive, and the limited access to care for those in rural and remote areas. At the same time, questionable policy judgments in the PPACA such as the decision to create unelected Independent Review Boards, the punitive tax on medical device manufacturers, and the elimination of Medicare Advantage programs deserve meaningful bipartisan discussion.

We need to seriously consider these issues if we are to truly meet the health care needs of our country, without pushing it further into debt.

Djou’s campaign has been relatively quiet thus far, and he has had little to say about health care.

On the issues section of his website, Djou said the solutions to health care costs are tort reform, the sale of inter-state health insurance, allowing for individual tax deduction of health insurance and making the health insurance market a more “normal” individual choice.

Lingle has more to say on health care, devoting a separate link to it on her campaign website and another for Commitments to Seniors.

When it comes to health, Lingle stresses individual responsibility (“I personally try to eat right, don’t smoke (I stopped decades ago), swim frequently, and pay regular visits to my doctor”), the 1974 Hawaii act (“My experience with this law has given me a solid grounding in the field of health insurance and the options to ensure access and affordability”) and Medicare (“My Medicare proposal includes simplifying the billing and coding system to ensure healthcare providers continue to participate in Medicare”).

Lingle’s issues page on health care also has a great deal more to say about the Affordable Care Act, which is also known as the Patient Protection and Affordable Care Act.

She calls the elimination of the Medicare Advantage programs for seniors in the act “shortsighted,” says the creation of health insurance exchanges by states “has not been well thought out,” has “serious reservations” about the federal government forcing states into a “one-size-fits-all program that is financially unsustainable” and believes Independent Payment Advisory Boards “will slow access to medical procedures, put people needing care on wait lists and set up a bureaucratic appeals process.”

Lingle has clearly given consideration to the matter of health care. Whether her views fit with most voters will be known later this year.

Already Campaign Fodder

Hawaii Democrats running for federal office quickly seized on the health care ruling.

In an email to supporters titled “Big things happened today,” the Hanabusa campaign wrote, “This election is about big things. The future of our middle class. Healthcare reform. The ability of students to afford college. The existence of Social Security and Medicare.”

The email asks for a donation before Saturday’s deadline for the latest campaign contribution report.

Case, meantime, said the health care ruling presented an opportunity to move beyond the “gladitorial circus” and make the law work.

“Repeal is not a practical reality, so it’s time to put the political histrionics aside and work to implement the law in the best possible fashion for all Americans,” he said in a statement. “On the national level, we also have unfinished business in assuring accessible, affordable and quality health care for all Americans. Preserving Medicare, controlling still-escalating costs and curbing excessive litigation are among the primary areas.”

Case added that he is concerned the law “does not address the growing crisis in provider availability and services, especially on the Neighbor Islands, driven largely by crushing Medicare paperwork and discriminatorily low Medicare reimbursements.”

Hirono, likely sensing the political capital to be made, made the most of the ruling.

“Unlike Ed Case or Republican Linda Lingle, I have stood firm in my support of this historic legislation,” she in a campaign statement. “It is telling that not one Republican Senator voted to pass the Affordable Care Act and the law’s repeal is one of the top priorities for both House and Senate Republican leadership. The people of Hawaii deserve to know if Linda Lingle would follow her national Republican leadership in voting to repeal the Affordable Care Act.”

Hirono’s camp provides background data to underscore the arguments about where Case and Lingle have stood.

Expect health care to be a key issue in the Hirono-Case primary.

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