In vowing this morning to do what the Supreme Court didn’t—repeal Obamacare—Mitt Romney trotted out all his arguments against the newly constitutionally sanctioned health care law. Among them were these two points: First, that Obamacare would cause 20 million Americans to lose their health insurance, and second, that it would be a job-killer to boot.
Problem is, these two arguments directly contradict each other.
The 20 million Americans who presumably would lose their health insurance would do so because their employers would decide to cease offering it, letting their employees fend for themselves on the health-insurance exchanges. Why would these employers opt to do that? The only conceivable reason is that it would be cheaper for them to do that. And if it was cheaper for them to do that, they’d then have more money to hire more employees, creating rather than killing jobs.
You can argue, with serial implausibility, that Obamacare will cause millions to lose their health insurance or that it’s a job-killer. You can’t argue both.
With today’s ruling, the fate of Obama’s health-care reform will be up to the voters in November’s election. For voters who hate Obama and all he stands for, that’s one more reason to go to the polls—but those voters are probably going to the polls in any event. If Romney decides to ride this issue, it’s not clear he’ll gain any more votes than he already has locked up. He may motivate some Republicans who don’t particularly care for him but will vote out of their hatred of Obama to care for him somewhat more. (Polling shows that a higher percentage of pro-Obama voters support the president because they like him than pro-Romney voters like Romney.) But I doubt that raising his positives among voters who are already determined to vote for him anyway matters.
Republicans will doubtless exploit the court’s upholding the mandate under the Congress’s power to tax rather than under the Constitution’s commerce clause. There’s that t-word again! It’s unlikely that more than a couple percent of the American people, those with incomes adequate enough to decline to buy insurance, will ever be subject to that tax, but you can count on Republicans to depict it as a mass confiscation worthy of Lenin. Obama and the Democrats need to be able to counter this with real numbers—in Massachusetts, the one state that has already adopted a similar law, just 1 percent of taxpayers are subject to the penalty—even as they focus on the benefits most Americans will derive from the law, which was the tack the president took in his statement this morning.
By: Harold Meyerson, The American Prospect, June 28, 2012
For supporters of the Affordable Care Act, it was hard to hear—over the cheering—anything besides the fact that the Supreme Court today kept the law almost entirely intact. But the Court did make a slight change to a crucial part of the ACA: Medicaid expansion. Under the law, by 2014, states are supposed to extend their Medicaid programs to cover people under 65 with incomes up to 133 percent of the federal poverty line. An analysis from the Center on Budget and Policy Priorities shows that means 17 million more people would have access to health care over the next 10 years. Before today, it looked like states didn’t have much choice in the matter. If they didn’t make the necessary expansion, they would lose all federal Medicaid dollars. In their brief, states argued that wasn’t much of a choice—federal Medicaid grants simply constitute too much money to lose. Back in February, Timothy Jost had a very helpful explanation of the states’ argument on this point in Health Affairs. As he wrote:
A state that refuses to expand its Medicaid program will under the ACA lose all Medicaid funding. Medicaid is the single largest source of federal funding to the states, accounting for 40 percent of all federal money dispersed to the states. States do not really have a choice to walk away from federal Medicaid funding, they argue. The states do not, therefore, really have a choice to refuse to participate in the Medicaid expansions. This coercion, the states contend, is unconstitutional.
According to SCOTUS Blog, the Supreme Court basically agreed: The feds can’t cut all Medicaid funding for states that refuse to expand. Now, states that choose not to extend benefits will forgo the money they would have received for doing so—but they won’t lose the money they’re already getting for current Medicaid services. But while states can now avoid the extension more easily, there’s still no practical reason to go down that path. “It’s still an incredibly good deal for the states,” says Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities. Already the federal government pays, on average, 57 percent of Medicaid costs. But the ACA gives states much higher levels of funding when it comes to extending benefits. As a CBPP report in March noted, the feds will pay a whopping 93 percent of the costs of expansion over the next nine years:
Specifically, the federal government will assume 100 percent of the Medicaid costs of covering newly eligible individuals for the first three years that the expansion is in effect (2014-2016). Federal support will then phase down slightly over the following several years, and by 2020 (and for all subsequent years), the federal government will pay 90 percent of the costs of covering these individuals. According to CBO, between 2014 and 2022, the federal government will pay $931 billion of the cost of the Medicaid expansion, while states will pay roughly $73 billion, or 7 percent.
That means, all in all, states will only see a 2.8 percent increase in what they would have spent on Medicaid if there was no health-care bill. The expansion is also in the interests of health-care providers. The ACA was meant to vastly decrease the amount of health care hospitals have to provide with little or no compensation. It was for that reason, Park says, that providers agreed to reductions in Medicaid and Medicare rates. But without the Medicaid expansion, working adults who are too poor to afford health care but not poor enough to qualify for Medicaid could still be left without coverage in some states. “Now there’s going to be a donut hole in the middle if the state doesn’t proceed,” says Park. That’s bad business for hospitals. There’s another factor that states will have to consider: the savings they will realize as populations begin to get healthier. According to the CBPP report, there will be 33 million fewer uninsured people by 2022. Uninsured people are expensive; they often rely on expensive emergency-room care, rather than getting preventative and early treatment which is ultimately cheaper and more effective. The Urban Institute reports that in 2008, $10.6 billion in state and local dollars went toward hospital care for the uninsured—20 percent of the total costs. The percentage is even higher when it comes to mental-health services. With the expansion, those costs will likely go down dramatically. States may have the option now to forgo the Medicaid expansion. But the results won’t be pretty.
By: Abby Rapoport, The American Prospect, June 28, 2012
The Supreme Court’s decision on the Affordable Care Act (ACA), particularly Justice John Roberts siding with the liberals, took most everyone by surprise this morning. But if you tune in to Fox News or surf around the conservative blogs, they seem to be taking it somewhat philosophically. They’re not happy, but there’s little rending of garments and gnashing of teeth. Mostly they’re saying, well, we’ll just have to win this in November (see here for a representative sample). There’s also a good deal of discussion of the fact that the Court declared that the requirement to carry health insurance is permissible under the government’s taxing power. After all, if there’s one thing Republicans know how to do, it’s complain about taxes. Mitch McConnell quickly took to the floor of the Senate to condemn the decision, and no doubt Mitt Romney will soon say something so vague that no one can determine what he actually thinks.
But here’s my guess: Republicans are going to drop health care very quickly. They took their shot with the only avenue they had to kill the ACA, and they came up short. The legal battle is over, and they know that once they start talking about repealing the whole thing, it makes it easier to talk about the benefits of the ACA that will be repealed, particularly since they have given up on even bothering to come up with a “replace” part of “repeal and replace.” Oh, they’ll still condemn the ACA when they’re on Fox, or when they’re talking to partisan audiences—just enough to reassure base conservatives that they’re still angry. But in short order, they’re going to move on to other topics now that the legal question has been settled.
That suits Mitt Romney just fine. You may remember that when the primary campaign started, many people said it would be impossible for him to become the Republican nominee, given that he had passed a health-care plan so closely resembling the ACA in Massachusetts, complete with an individual mandate. He managed to wriggle and writhe away from questions about it for the last two years. Those questions are no more comfortable than they ever were. As the leader of the GOP, he’ll set the agenda for the party. And there are few things he’d rather talk about less. We’ll pore over this decision for the next week, then the news media will move on, and Romney will breathe a sigh of relief.
By: Paul Waldman, Contributing Editor, The American Prospect, June 28, 2012
Majority Leader Mitch McConnell wasted no time getting to the floor of the Senate to argue
that today’s Supreme Court ruling clarifies that Obamacare is nothing more than a tax on the middle class which—according to McConnell—is precisely what the Administration and Congressional Democrats promised it was not.
Leader McConnell, and his fellow Republicans, should read the Majority ruling before they embarrasses themselves further.
In the opening paragraphs of Chief Justice Roberts’ opinion, he clarifies that the law specifically does not involve a tax. If it did, Roberts clarifies, the Court would have had no choice but to reject the case for lack of jurisdiction as a tax case cannot be brought until someone is actually forced to pay the tax. This is, as we know, not the case.
The fact that the Court found that the mandate was constitutional under the taxing authority granted Congress by the Constitution is an entirely different matter. This finding does not reduce the individual mandate to the status of a tax—it merely says that as the penalty for failing to purchase health insurance will fall to the Internal Revenue Service for collection was something Congress could provide for under it’s Constitutional authority.
While I grant you that this gets a bit into the weeds, the effort that is being made by the GOP to use the Court’s basis for decision as a weapon fails on its face and is completely disingenuous. There is a difference between the levying of a tax and the Court finding Constitutional authority for Congress under the taxing authority. But then, anything that is more complicated than your basic “See Spot Run” first grade reading primer has always been fair game and fodder for the GOP message machine which would prefer to base their arguments on misstatements than educating and enlightening its base.
By: Rick Ungar, Contributor, Forbes, June 28, 2012