In terms of the real lives of many people, it’s good news that a few of the improvements enacted in the Patient Protection and Affordable Care Act of 2010 will be maintained by private health insurers no matter what the Supreme Court does later this month. It’s particularly helpful that UnitedHealthcare, Humana and Aetna are promising to continue covering key preventive care measures without copayments.

But the really big reforms just ain’t happening without something very like ACA, as Jonathan Cohn reminds us:

[T]he really big changes in health care are the ones that come in 2014. That’s when the law makes it possible for anybody, at any age, to get insurance regardless of pre-existing conditions. That’s when the law makes it possible for people making up to four times the poverty line, or about $90,000 a year for a family of four, to get subsidies if they buy coverage on their own. That’s when the law makes it possible for anybody making less than 133 percent of the poverty line, or around $30,000 a year for a family of four, to enroll in Medicaid. That’s when the law establishes a minimum set of benefits that all plans must eventually cover.

These changes will mean financial security and access to health care, not just for the 25 to 30 million people slated to get coverage but for many others with inadequate coverage. But these changes will only happen if the law stays in place, because insurers can’t provide them on their own.

Politically, of course, the private insurer actions mean that an invalidation of ACA by the Supreme Court would create less of an immediate shock, less of a backlash, and less pressure on Republicans to tell us what they would do (their plans range from “nada” to “market-based reforms” that would make the status quo ante look like paradise) if they gain control of Congress and the White House this November. We’d drift into 2013 with many Americans really having little or no idea what had been taken away from them, and what sort of health care dystopia they may soon face.

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Ed Kilgore

Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.