In a debate with opponent Mark Pryor last night, Republican Senate candidate Tom Cotton, who’s very much the poster boy for the GOP future if the party refuses to moderate or diversify, showed again he’s not as smart as he thinks he is. ThinkProgress’ Alice Ollstein has the story:
Tom Cotton, the Republican candidate for Arkansas’ U.S. Senate seat, has repeatedly denounced the Affordable Care Act as a failure and vowed to help repeal it if elected. But in his second and final debate Tuesday night against Democratic incumbent Mark Pryor, he went further, claiming the high-risk insurance pools that many states ran before Obamacare’s passage were better for people with pre-existing conditions than the current exchanges.
“Many people were happy with their coverage under the high-risk pool, before it was eliminated,” Cotton said. “They should have been allowed to keep that choice.”
Pryor shot back, saying his personal experience proved otherwise. “I am a cancer survivor,” he said. “I have been in the high-risk pool. I have lived there. It is no place for any Arkansan to be. If we go back to the high-risk pool, it’s like throwing sick people to the wolves.”
Many of the high risk pools Cotton praised were known for their sky-high costs, exclusion of many applicants, and strict limits on what care is covered. In Arkansas, out of pocket costs for patients in such pools could be as high as $20,000 and those with pre-existing conditions had an average 6 month waiting period for care.
Now to be fair, it’s not 100% clear whether Cotton was referring (as was Pryor) to the high-risk pools that existed in Arkansas and many other (though not all) states prior to the enactment of the Affordable Care Act, or to the new high-risk polls set up by Obamacare itself. But either way, the costs are much higher and the coverage much less extensive than under policies available via the exchanges. Maybe there’s somebody out there who did better under an unusually generous high-risk poll than under, say, an Obamacare Bronze Plan. But I’d say the burden’s on Cotton to explain what the hell he’s talking about. Certainly as a cancer survivor Pryor is in a superior position to know what it’s like to depend on high-risk pools, and Republicans everywhere have gotten away far too much with blithely talking about such pools as an “answer” without acknowledging the problem of crappy insurance at unaffordable rates.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, October 15, 2014
Like many eleventh-hour strategies, the right’s final offensive against the Affordable Care Act has a last-gasp quality to it. Where better-laid plans to defeat the ACA in Congress and via Constitutional challenge were fraught with ideological purpose, the challengers in Halbig v. Burwell are engaged in something much smaller. Their argument is merely that if you read a poorly drafted section of the statute out of context, it appears that the law doesn’t contemplate subsidies in states that availed themselves of the federal government’s backstop, Healthcare.gov. Millions of people would lose their health insurance in service of teaching Congress a lesson about the importance of legislative draftsmanship.
That’s not a very becoming political argument, though, so the Halbig supporters have stapled a grandiose claim to their core challenge. Because many of the people who would lose their insurance would also qualify for an exemption from the law’s insurance coverage mandate, they frame it as a principled campaign for liberty.
But many is not all. It’s probably not even most. As University of Michigan law professor Nicholas Bagley noted on Tuesday, a conservative victory in Halbig would eliminate subsidies for everyone, but the hardship exemption would only apply to a subset. Many, many people—those above about 180 percent of the federal poverty level—would still be required to purchase insurance. It would just become more expensive for them. The exemption—the escape hatch to freedom—would only be available to those whose coverage costs more than eight percent of income: the poor, and near-poor. These are the people whose liberty conservatives claim to be fighting for—the people who were only able to purchase insurance because the subsidies made it affordable. The people who, as Bagley writes, would “be free to decline coverage that, without tax credits, they can’t afford anyhow.”
This kind of post hoc appeal to liberty long predates the Affordable Care Act, but it has become particularly salient in the fight against Obamacare as enrollment has grown and weakened traditional tools of opposition. When the Supreme Court made the Affordable Care Act’s Medicaid expansion optional back in 2012, it vouchsafed an old but typically losing conservative argument that using federal spending as an incentive to force state action can be unconstitutionally coercive—a freedom-crushing blow against states’ rights. But the freedom the Court upheld two years ago looks, in effect, an awful lot like the freedom the challengers in Halbig claim to be fighting for. In both cases there’s something conspicuous about the people to whom these strange conceptions of liberty apply.
As of early April, per this Kaiser Family Foundation map, 19 states remained fully unwilling to consider Medicaid expansion. In the weeks since, Wyoming and Tennessee joined Utah and Indiana among GOP-controlled states working toward expanding Medicaid. So the chips are slowly falling. But they are falling along fairly predictable racial and income lines.
Tennessee was a genuine surprise, in that it isn’t lily white, and has fairly high rates of poverty. But the GOP-controlled states that have expanded Medicaid, or are considering Medicaid expansion, are pretty white relative to GOP-controlled states where expansion is out of the question. Deep Southern states, where poverty is most concentrated and black population rates approach 30 percent, aren’t calling up the Department of Health and Human Services in Washington to negotiate a conservative Medicaid expansion compromise. To the contrary, that’s probably where resistance to the expansion runs strongest.
The story won’t be much different if conservatives get their way and ACA subsidies disappear in Healthcare.gov states. If you haven’t caught on by now, the conspicuous thing about the Medicaid freedmen and those who would be freed from the individual mandate is that they’re disproportionately black and poor. ACA rejectionism isn’t enhancing their liberty at all.
But there’s something conspicuous about the Obamacare opponents posing as tribunes for liberty, too. They’re nearly all affluent white people, who take their own health insurance for granted and probably wouldn’t consider themselves liberated if a court or legislature took aim at it for any reason. And though their rhetoric suggests otherwise, they’re waging the final Obamacare battles against poor people and minorities, not on their behalf.
By: Brian Beutler, The New Republic, September 4, 2014
The D.C. Circuit just agreed to hear the Halbig lawsuit. The short explanation of what this means is that it has closed off the easiest path to crippling Obamacare. Here’s the long explanation:
1. The Halbig lawsuit is the right’s most recent desperate effort to retroactively nullify the Affordable Care Act. The lawsuit is a wildly tendentious argument that, based on an extremely narrow reading of one ambiguous passage in the health-care law, people in states with federal-run insurance exchanges should be ineligible. Since the tax credits make insurance affordable for most consumers, the lawsuit would wreck the exchanges for some 6.5 million people, which is its entire point.
2. The Halbig suit has previously been laughed out of court, but in July, two out of three judges from the D.C. Circuit agreed with it. This ruling reflected the luck of the draw — the two judges were Republican appointees on a court consisting mostly of Democratic appointees.
3. This created a split, with some courts dismissing Halbig and another one embracing it. The split created an obvious window for the Supreme Court to take up the case — contrasting opinions between Federal Courts is a common reason for the Supreme Court to take up a case.
4. The split would close if the entire D.C. Circuit took up the case. In important cases with split decisions, the entire court usually weighs in. Conservatives desperately wanted to avoid this, for the reason stated above. They undertook a furious public campaign (see, for instance, here and here) to persuade the Court not to hear Halbig as a whole. Their rationale is that the Halbig lawsuit is not legally important enough to merit a full hearing. That argument is as ridiculous and transparently partisan as it sounds. Nicholas Bagley explains why here.
5. What happens next is that the entire D.C. Circuit will hear the case. Since the logic of the lawsuit is so ludicrous only a wildly partisan Republican jurist would ever accept it, it stands zero chance of success.
6. After that, Federal Courts will be unanimous in opposition to the Halbig lawsuit. The Supreme Court could still take up the case then, but it could just as easily decide not to hear it.
By: Jonathan Chait, Daily Intelligencer, New York Magazine, September 4, 2014
“Sorry, Obamacare Denialists, You’re Insane”: Don’t Want To Be Called Ridiculous And Nutty, Stop Saying Ridiculous, Nutty Things
Conservative writer Philip Klein, who seems very nice, complains that liberals are being far too mean about the latest conservative attempt to gut Obamacare. “Liberal critics of this legal theory have portrayed it as absurd, ridiculous, nutty, stupid, and even criminal,” he writes. “Recently, I’ve been likened to the health policy equivalent of a World Trade Center attack conspiracy theorist merely for sympathetically reporting the legal case of the challengers.”
Not exactly. Klein is conflating two different things here. First, there’s the Halbig lawsuit, which hinges upon a strained, somewhat-exotic reading of the law to argue that the Affordable Care Act fails to create tax credits for people who buy their insurance through a federal exchange. The basis of this lawsuit is that the most explicit reference in the law mentions only state exchanges, and therefore courts ought to ignore all the other, less explicit parts of the law implying the opposite.
This is the case conservatives made for several years — Congress hastily failed to write a clear law, so conservative legal activists can take advantage of the screwup to interpret what (they argue, tendentiously but not insanely) is its literal reading. As the right-wing Investor’s Business Daily, an early booster of this once-long-shot legal challenge, gleefully put it in 2011, “Oops! No Obamacare Tax Credit for You!” I’m sorry, the card says “Moops.” I find this argument highly, highly unpersuasive. It’s been laughed out of court by Democratic-appointed judges, and rejected by at least one Republican judge. I will say this for it — it is at least tenuously connected to reality.
But now conservatives are making a different argument. They’re no longer saying that the lawsuit is exploiting a drafting error. They’re claiming it interprets the law correctly, and that the law actually (or possibly) intended to deny tax credits to people in federal exchanges. They have gone from smugly saying the card says “Moops” to insisting that the people who invaded Spain in the eighth century were actually called “the Moops.”
And yes, that is completely insane. There is a massive trove of evidence here regarding the intent of the law’s drafters. Dylan Scott has the latest chunk today — a deep excavation of the role of the Congressional Budget Office, which was a kind of legislative super-body regarded as authoritative by Congress. The CBO, like everybody involved in the law’s passage, believed the federal exchanges were designed to give health insurance to people in states that did not build their own. They were not designed as a deliberately unworkable punishment.
Yes, some smart people, speaking extemporaneously, were sometimes confused about just how the law worked. (Conservatives have made a great deal about off-the-cuff comments made by Jonathan Cohn before the law was actually finalized.) That doesn’t change the fact that the federal exchanges were obviously designed to give people affordable insurance. It may be mean to point out that those who argue otherwise are completely, manifestly ahistorical, but that’s just reality. If you don’t want to be called ridiculous and nutty, stop saying ridiculous, nutty things.
By: Jonathan Chait, Daily Intelligencer, New York Magazine, August 1, 2014
Six federal judges ruled Tuesday on the legality of subsidies being provided for low-income subscribers under so-called Obamacare. The two with solid Republican credentials found the program illegal.
With all due respect to these members of the esteemed federal bench, I have to question whether they really went to law school – or, if they did, whether they ever tended a class in legislation. Because if they did, they should have been aware of two fundamental principles of legislative interpretation: (1) courts should defer to the obvious intent of the legislature; and (2) they should also defer to the interpretation of legislation provided by the administrative agency charged with its enforcement.
The statute provides for health exchanges in the states to run the program, and provides a back up for federal exchanges to administer them when the states decline to participate. The statute includes a provision that allows the Internal Revenue Service to provide tax subsidies to those enrolled in the “state” exchanges.
It is clear that Congress never expected 36 states (mostly those controlled by Republican governors or legislatures) to opt out. It should be equally clear that Congress never intended to deny subsidies to those citizens living in opt-out states.
But the two Republican judges sitting on the U.S. Court of Appeals for the District of Columbia, blindly adopted the bizarre argument of the law’s challengers that under a literal reading of the statute only state enrollees were entitled to the subsidies.
On the same day, another federal appeals court sitting in Virginia unanimously ruled the other way. In that decision, Judge Andre Davis ridiculed the argument adopted by the two majority judges in D.C. He wrote that “[plaintiffs want to] deny to millions of Americans desperately needed health insurance through a tortured, nonsensical construction of a federal statute whose manifest purpose… could not be more clear.” But that was precisely the “tortured, nonsensical” position taken by the D.C. duo to the dismay of their colleague, the senior judge on the D.C. Circuit, Harry Edwards.
Then comes the Chevron doctrine. Chevron is a long-standing doctrine established by the Supreme Court that it was the obligation of courts when interpreting statutes to give deference to the interpretation of the statute by the administrative agency entrusted by Congress with its implementation.
In this instance, it was the Internal Revenue Service which had primary responsibility for implementing the health care subsidies. But the D.C. majority ignored the IRS interpretation.
To be fair to the D.C. majority, there is another doctrine which they chose to follow. It is called “textualism,” and its primary exponent is Justice Anton Scalia, the legal guru of conservatism. And this principle seems to say implement the clear terms of the statute no matter how absurd – or “nonsensical” – the result. But as Scalia’s critics like to point out, he generally invokes that principle only when it brings about a result he is ideologically comfortable with.
Obviously, these cases will have to be reconciled by the United States Supreme Court. And, fortunately for the millions of persons entitled to health care subsidies in the 36 states with federal health exchanges, Scalia’s “textualism” does not have a lot of adherents, even among his conservative colleagues on the high court.
By: Frank Askin, Distinguished Professor of Law and Director of the Constitutional Litigation Clinic at Rutgers Law School-Newark; The Huffington Post Blog, July 30, 2014