Above, watch the full conversation on the Affordable Care Act.
One day after the Supreme Court's ruling upholding the Affordable Care Act, an Aspen Ideas Festival Spotlight Health panel of former politicians and administration officials agreed that a lot more work lies ahead -- in terms of further implementation, improving health care quality and especially the politics.
The good news, said former U.S. Health and Human Services Secretary Kathleen Sebelius, is that the 6-3 ruling was definitive, with no deferred decisions. "This was the strongest possible decision they could have made," she said. "They said, 'This is what the law says.'"
But while the battle over Obamacare has been won in the courts, "the battlefield is now going to be the political arena," said former Sen. Bill Frist (R-TN), who throughout the discussion reminded the audience that more people still disapprove of the law than approve of it. Yet the Supreme Court victory means that the Affordable Care Act has grown up and is here to stay, he said, that it now "has reached the stature of Medicare or Medicaid."
The panelists agreed with former Sen. Tom Daschle's (D-SD) prediction that congressional Republicans "are going to be under pressure to schedule one more repeal vote, because it's good politically for their base."
Daschle said that in the longer term, that strategy is not going to work, because Americans want to see Congress working together. Pointing to some bipartisan efforts in the health care arena recently, Daschle added, "once you get beyond this emotional debate of Obamacare, it's amazing how many things out there have the potential for reasonable dialogue and consensus."
Recently retired Rep. Henry Waxman (D-CA) noted that Republicans "dodged a bullet" with the Supreme Court decision, because in red states, they would have had to contend with all their constituents who stood to lose or pay more for health insurance if the decision had gone the other way.
Not surprisingly, the Democrats on the panel doled more praise on the Affordable Care Act, while Frist, the lone Republican, argued that it would result in higher costs and other challenges, even though it has "good substance in it."
Calling it "miserably passed and messily written," Frist said the opportunity to fix or modify anything in the bill was taken away because of the partisan way it was passed.
"If it was passed in a partisan way, it's going to get increasingly more partisan, because we're electing more and more people that say, 'It's not my bill,'" he said. "We haven't been able to fix the bad things in it, because we haven't been able to work together."
Sebelius and Nancy-Ann DeParle, another Obama administration official involved in developing the Affordable Care Act, argued that while political divisions have been detrimental, the law has succeeded in bringing down health care costs and is beginning to improve quality of care.
"We have had the lowest health cost inflation in 50 years; we're finally in the ballpark of trending GDP with health inflation," said Sebelius, who added that what people don't like about Obamacare is Obama.
Daschle suggested that while the concept of Obamacare may still be unpopular, people generally admit that they like its specific components.
And Waxman reiterated that it's necessary to look beyond the propaganda:
"One of the objectives of the ACA was to reduce the number of uninsured; that's happened dramatically. We were told by Republican leaders in the House that more people would lose their health insurance. Not true. That more people would lose their jobs. Not true. That it would break the budget. Not true. At some point people will evaluate what's happened with this law, and by any measure, it's been a great success."
Waxman also noted that unlike Medicare and Medicaid, "The ACA intended to change the practice of medicine in this country. So we are putting in place an effort for government to give the right incentives, which are going to come from the private sector, with the right balance. All these things are happening right now. We're living in a very exiting time."
Still, there's plenty of work to do on the nitty gritty level. DeParle noted that unlike other legislation, there was no opportunity to work on specifics and fix things that were understood to be bad after the bill was passed, because of its partisan nature.
The cost of prescription drugs and the need for more states to pick up the Medicare option were identified as just two of the issues that still need to be resolved. And while the administration can work on such details without Congress's involvement, Sebelius pointed out that congressional Republicans are already starting to flag areas they're going to fight.
In terms of future areas of focus, Daschle said that while access -- getting people insured -- has gotten the bulk of the attention, "we still have mess out there with quality." Frist suggested that with 20 million people still uninsured in the United States, the access issue remains pertinent.
"We've got to have more enrolled to make this work," he said, adding that, "If government and the private sector work together, we can get this solved."
Yet Frist also said that of all the factors that impact good health, the Affordable Care Act -- and government involvement in general -- is a relatively minor one.
"If you want to have an impact on health, what we all need to do is go back to our homes, see what our counties are doing in terms of health, and challenge local community leaders to come together to say, for example, we want to go from being 15th in the state to No. 1 in the state," said Frist. "We're not going to address it all with the ACA or better doctors or hospitals."
Catherine Lutz is a contributor to the Aspen Idea blog.