“Deadly Consequences”: Public Health Experts Have Estimated How Many Americans Will Die If The Supreme Court Repeals Obamacare
When conservative American Enterprise Institute scholar Michael Strain published an article last week titled, “End Obamacare, and people could die. That’s okay.” he made two critical errors: He embedded a genuinely extreme view into a banal one, and then demanded absolution for both without defending the former.
Strain’s larger point is so uncontroversial, it barely needs reprising: Obamacare was not the final word in U.S. health policy, and if Republicans want to replace the Affordable Care Act with a different, less redistributive set of reforms, they should be able to try, without necessarily catching hell for preferring a system that tolerates marginally more avoidable deaths than Obamacare does (especially if they ply fiscal savings into different programs that alleviate poverty, or improve general welfare).
This is an unobjectionable point. Had Strain argued that the Republican presidential nominee should make an Obamacare alternative the centerpiece of his 2016 platform, nobody would have called it immoral. But the premise of his article is that conservatives (including himself, presumably) will be pleased if the Supreme Court intervenes to gut Obamacare, because it would provide Republicans the missing leverage they’ll need to impose a replacement through the political branches.
First comes god from the machine, and only then comes an Obamacare replacement.
If such a dramatic predicate carried no consequences, Strain’s cost-benefit argument would stand on its own. But when you account for the damage the Supreme Court would incur in order to provide Republicans their missing leverage, it collapses completely.
In a brief to the Supreme Court, dozens of public health scholars, along with the American Public Health Association, detail the harm the Court would create by ruling for the challengers in King vs. Burwell. Most of their analysis is rooted in the basic point that stripping insurance away from eight million people would dramatically impede their access to the health system. But they also flesh out the corollary argument that an adverse ruling would have deadly consequences, and ballpark the number of avoidable deaths such a ruling would cause.
“Researchers found that, in the first four years of the [health care reform] law in Massachusetts, for every 830 adults gaining insurance coverage there was one fewer death per year,” the brief reads. “Using the national estimate that 8.2 million people can be expected to lose health insurance in the absence of subsidies on the federal marketplace, this ratio equates to over 9,800 additional Americans dying each year. Although the specific policy context and population impacts of any policy cannot be directly extrapolated from one setting to another, the general magnitude and power of these findings from the Massachusetts study demonstrate that even when approached cautiously, these earlier findings carry enormous public health implications for withdrawing subsidies and coverage from millions of Americans.”
The Massachusetts story wouldn’t unfold precisely in reverse everywhere the subsidies disappeared, but the experience there suggests the Supreme Court ruling would have measurable mortality implications. These costs (read: deaths) couldn’t be paired against the benefits of increased spending on anti-poverty programs. These are the costs conservatives are eager to inflict on others simply to gain the leverage they need to advance an alternative that the status quo forecloses.
Responding to critics in a followup article, Strain brushes this all aside by stipulating that Republicans would never allow all this suffering. “I think it’s very likely that the congressional GOP would enact some sort of replacement if the Supreme Court strikes down Obamacare,” he writes. “They would very likely take measures to address the needs of those who lost their subsidies as a result of the Court’s action.”
To back up his suspicions, he cites a suspiciously limited set of news reports, quoting Republicans who claim to be working on such a plan—or, at least “talking about how to build consensus on a replacement.”
He does not quote from this Wall Street Journal article titled, “Republicans to Block Legislative Fix to Health-Care Law,” or this article by TPM’s Sahil Kapur titled, “Republicans Are At A Loss On What To Do If SCOTUS Nixes Obamacare Subsidies.”
For those who haven’t been keeping score all along, Republicans have spent the past several years cyclically promising and then failing to deliver an Obamacare alternative. They didn’t have an alternative prepared in 2012 when conservatives asked the Court to declare Obamacare unconstitutional. They didn’t have an alternative prepared later in the year, when Mitt Romney was their presidential candidate. They didn’t have an alternative prepared when they shut down the government as part of an ill-fated effort to defund Obamacare. They didn’t run on an Obamacare alternative in 2014. And they don’t have an Obamacare alternative prepared this week, though they’re scheduled to pass another repeal bill on Tuesday.
The story’s a little different today in that the subsidies really could disappear by fiat, harming millions of people, under GOP control of Congress. Republicans genuinely haven’t encountered a motivating force this strong in the five years since Obamacare became law. If in defiance of such a remarkable pattern, Republicans manage between now and June to come up with a workable plan or a stopgap—one that President Obama will sign—they will have filled the hole in Strain’s argument. Five months might seem like a long time in politics, but remember: It took Democrats more than twice that to pass Obamacare, and almost 10 times as long thereafter to implement it.
By: Brian Beutler, The New Republic, February 2, 2015
“An Iron Determination”: Revisionist History On Obamacare Subsidies
As we drift toward a potentially disruptive Supreme Court decision on the subject of whether Congress in the the Affordable Care Act intended to withhold insurance purchasing subsidies from people in states that declined to set up their own exchanges, the large and ever-increasing evidence that nobody in the states making such decisions thought they were risking subsidies is becoming a potential factor in how the Supremes come down. At the Plum Line this morning, Greg Sargent collects a variety of statements from Republicans involved in state-level exchange decisions, and concludes with this compelling quote from University of Michigan law professor
Nicholas Bagley:
[T]he challengers say that Congress clearly threatened the states with the loss of tax credits if they didn’t set up their own exchanges. But the states read the ACA very carefully, and they didn’t see any threat.
It’s the worst kind of revisionist history to claim that the ACA put states on notice of the harsh consequences of failing to establish an exchange. The states had no idea that tax credits hung in the balance. And the Supreme Court has said time and again that statutes shouldn’t be read to impose unexpected burdens on the states. That basic principle — the idea that states must have clear notice of the consequences of their decisions — protects the rights of the states in our federal system. And it cuts hard in favor of the government.
That’s going to be an argument that only an iron determination to mess up implementation of the Affordable Care Act can overcome.
By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, January 27, 2015
“Titillating The Republican Base”: Under Pressure From The Right, Gowdy Renews Benghazi Shenanigans
The Benghazi Select Committee shed the bipartisan cloak it had worn in public, as Republican members used Tuesday’s hearing to bully Joel Rubin, deputy undersecretary of state for legislative affairs. For more than two hours they badgered their witness, apparently haven taken cues from Eric Cartman (a petulant child portrayed in the cartoon South Park) demanding the State Department respect their “authoritah.”
The Central Intelligence Agency’s Neil Higgins, director of the agency’s Office of Legislative Affairs, for the most part sat silently at the witness table, happy to allow his State Department counterpart take the brunt of the public flogging as successive Republican lawmakers berated Rubin.
The exchanges between Rubin and the Republican members of the committee were a sideshow to the real fight in the room. For months tensions have been brewing between the majority and minority staff.
Ranking Member Elijah Cummings, Democrat of Maryland, made this clear in a series of letters he wrote to Gowdy, two of which were made public on Tuesday morning. At the heart of the dispute are interviews the majority staff conducted without the knowledge or presence of Democratic staff.
Investigating the accusations reported by Sharyl Attkisson at The Daily Signal, a website owned and published by the Heritage Foundation, that Deputy Assistant Secretary Raymond Maxwell witnessed members of the department’s staff removing documents “that might put [State Department officials at the Bureau of Near East Affairs] in a bad light,” the committee interviewed a second witness whom Maxwell claimed would confirm these allegations.
Instead that witness contradicted the story, saying that they had never been a part of such an effort, according to the letter penned by Cummings to Gowdy on November 24. This came as a surprise to the committee’s minority staff, who, according to Cummings, had been told by the Republicans via e-mail that they “learned nothing else of note in our discussion, so we don’t plan to conduct any additional follow-up.” Far from nothing of note, debunking a major conservative allegation is a seemingly important detail.
From the perspective of Representative Trey Gowdy, the South Carolina Republican who chairs the select committee, the source of tension was the State Department’s inability to fully respond to the committee’s request for documents and the availability of witnesses, despite the 40,000 documents that State had already forked over. The wide-ranging request delivered on November 18 was for “two full years worth of emails from 11 State Department principals.”
Democrats were quick to point out that this first request for documents came a full six months after House Speaker John Boehner created the committee. They repeatedly noted at the hearing that the committee created to investigate the federal government’s failure to respond to Hurricane Katrina had started and completed its work in this time span.
In the eight months since the committee’s formation was first announced, Gowdy has yet to present a single question about the attacks that has not already been answered. For six months, the committee had not requested a single document. Now it was suddenly claiming that State’s failure to comply with the entire document request in two months was unacceptable. Republicans tried to smooth over this uncomfortable fact by citing subpoenas from other committees.
Yet as recently as mid-December, Gowdy seemed to indicate he was pleased with the performance of the State Department, in response to his committees request telling Fox News Host Greta Van Susteren:
“They are making an effort to be cooperative. The timing issue we may work on a little bit. But you know as lawyers look at documents it may lead them to make another request for production. So if the State Department were here they’d tell you: ‘Look quit asking us for more documents. We’ve given you what you wanted so far.’ But for us to be able to do the kind of job you expect and the people who watch your show expect we’re going to have to have access to the witnesses and the documents. But sometimes that means lawyers decide late in the game that I need this batch. So the State Department hasn’t been difficult to work with and I don’t expect that will change.”
Clearly Gowdy’s comments on Tuesday signaled a change in tune.
Conservatives have begun to turn on the chairman, calling him “ineffective.” Retired U.S. Navy Admiral James “Ace” Lyons spoke to the right-wing website WorldNetDaily, claiming that “the idea that government-agency stonewalling—continuing now for over two years—is the reason Gowdy’s committee can’t make progress is pure nonsense.”
Gowdy now seems intent on pleasing the right by taking his investigation down the same path that led Representative Darrell Issa of California, chairman of the Government Oversight Committee, and other Republicans astray. (Issa’s Benghazi investigations became something of a national joke.) To show his toughness in front of the conservative media, Gowdy took to abusing a deputy undersecretary of state. Then, at the end of the hearing, he acknowledged that Rubin was not responsible for his purported anger.
Just the kind of BDSM display that seems to titillate the Republican base.
By: Ari Rabin-Havt, The American Prospect, January 27, 2015
“Why Obama’s Budget Matters”: Differences Within The GOP That Could Be Finessed In The Past Will Have To Be Dealt With Openly
When President Obama releases his budget on Monday, the words “dead on arrival” will be widely incanted because they are part of a quasi-religious Beltway ritual.
This year, those words will be misleading.
No one expects Obama’s budget to be enacted as he proposes it. Republicans responded even to early outlines of his plan with a wall of opposition. But this time around is different because, paradoxically perhaps, the fact that Republicans control both the House and Senate makes Obama’s role more rather than less important.
For the last four years, the budget game was three-cornered. The president played alongside an often radically conservative Republican House and a Democratic Senate with views of its own. Now, Obama’s plan will be the main public alternative to whatever the Republicans decide to do.
Moreover, the Republicans are responsible for passing a budget through two houses, so differences within the GOP that could be finessed in the past will have to be dealt with openly.
The most obvious will be on whether to continue cuts in the defense budget prescribed under the so-called sequester enacted in 2011. GOP defense advocates want to raise Pentagon spending substantially, libertarians want to keep both domestic and military spending low, and many mainstream conservatives will try to cut domestic spending even more to accommodate defense increases. The third option will almost certainly be a non-starter, not only with the president — he has a veto and will insist that any cuts be balanced between the two sides of the ledger — but also with many in the GOP rank-and-file.
Obama has declined to offer premature concessions to the Republicans in his own proposal, which further clarifies the stakes. At the same time, he has made things trickier still for his opponents by putting many of his ideas in a form that Republicans have supported in the past. That’s true even of some of his tax proposals.
The president is aware that the most damaging alliance in Washington has been the one between establishment deficit hawks, who continue to think that long-term deficits are the premier economic issue before the country, and Republican conservatives, who have used the legitimate concerns of the deficit hawks to justify deep cuts in government programs without any offsetting increases in revenues.
The president will call this bluff by putting $1.8 trillion in long-term deficit reduction on the table. But most of it will come on the revenue side. His argument here is straightforward: The bulk of the deficit reduction in the deals reached since 2011 has come from cuts in discretionary spending — that is, almost everything except the big retirement programs — which is now at its lowest level as a share of GDP in decades.
The deficit hawks who aren’t part of the ideological assault on the public sector know that the basic functions of government have already been cut too much and that some new domestic spending, particularly for infrastructure, is essential. Obama calls the question: If additional revenues are unacceptable, how is deficit reduction supposed to be achieved? There can’t be any “grand bargains” until conservatives acknowledge upfront that tax increases of some kind need to be part of any long-term solution.
But the biggest challenge to Republicans may be whether they are willing to go along with Obama on ideas that are plainly in their wheelhouse. One small but significant hope: Rep. Paul Ryan (R-WI) and Sen. Patty Murray (D-WA) have been pushing the idea that we need more evidence-based policymaking, and Obama is joining their campaign. This sounds like a no-brainer, but much needs to be done to integrate concerns about what works and what doesn’t into our governing routines.
Republicans have been trying hard to tout their concern about income stagnation and an increasingly frozen class structure. Obama will be pushing for a new initiative, “The Upward Mobility Project,” to provide more flexibility to local officials in a set of government programs if they can show how their efforts will help people climb occupational and income ladders. Projects of this sort are exactly what we should be thinking about.
When budget fights become melodramas over whether the government will shut down or default, we lose track of what the exercise is supposed to be about. Obama’s opening bid ought to be the start of a back-to-basics debate — an argument that will extend into the 2016 campaign — over what we actually want government to do, and how we propose to pay for it.
By: E. J. Dionne, Jr., Opinion Writer, The Washington Post; The National Memo, February 2, 2015
“Church And State”: Mike Huckabee’s Christian Sharia Law
Mike Huckabee is known as a former governor, an author, a onetime Fox News host, and as a possible contender for the 2016 Republican presidential nomination. And now we have a new way to describe Huckabee: Christian Wahhabist.
For those unaware, Wahhabism is a sect of Islam, primarily practiced in Saudi Arabia, which follows a very conservative interpretation of the faith. Wahhabis demand that their religious principles be imposed as the law of their country. And Huckabee, in an interview that aired Sunday on CNN, made it clear that on certain social issues, he too believes that his religious beliefs should be the basis for the laws of the state.
But before we get to that issue, let me start with the reason Huckabee’s interview came to my attention. Huckabee stated that his continued opposition to same-sex marriage is based on the Bible, and that he can’t “evolve” on the issue “unless I get a new version of the scriptures.” He then added that it would be comparable to “asking a Muslim to serve up something that is offensive to him or to have dogs in his backyard.”
Being a Muslim who has offered many times before to be people’s “Muslim friend,” and to answer their questions the best I could about the faith, Huckabee’s dog comment immediately caused some friends to reach out on social media. “Are Muslims religiously prohibited from owning dogs?” they asked.
The simple answer: no. Nowhere in the Quran does such a prohibition appear. However, there are mentions of dogs in the Hadith, which are the sayings and teachings of the Prophet Muhammad. Many Muslims view the Hadith as second only to the Koran in terms of being authoritative. But it should be noted that not all Muslims follow the Hadith and there are questions about the veracity of some of its passages.
In any event, there are passages in the Hadith that suggest dogs are “unclean”—but scholars note that was meant literally because it referred to dogs in the desert some 1,400 years ago. Consequently, some Muslims avoid dogs. But other passages of the Hadith say that Muslims can own working dogs, such as for hunting, farming, etc. And yet another passage notes that the Prophet Muhammad stated that God had forgiven a prostitute of her sins after she offered water to a dog in need of drink on a hot summer day. So, clearly, dogs are described in different ways in Islamic texts.
Bottom line: Many Muslims I know, including my own family, own dogs as pets. There was even a “Good Muslims Love Dogs” day in Canada few years back to counter bigots who urged people to taunt Muslims with dogs.
And regarding Huckabee’s remark that Muslims should not be required to serve food they find objectionable, my father was a cook and prepared pork for people daily. This was not a problem. In fact, there would only be a problem if the pork jumped off the plate and jammed itself into his mouth.
So Huckabee was wrong, but it’s not a big deal because he was clearly not trying to demonize Muslims as dog haters. But what is a big deal is his ludicrous argument that Muslims being asked to serve pork is the same as his desire to impose laws that bar gay Americans from getting married because it violates his religious beliefs.
Marriage, as our courts have found many times in the past, is a “fundamental right.” And there’s absolutely no comparison between that important right and the serving or not serving of pork.
Huckabee then gave us another baffling comment during his CNN interview. While complaining about courts striking laws that banned gay marriage, he stated, that “we don’t change laws because some people in a black robe just decide” an issue.
Well, actually, that’s exactly what we do. Our nation’s Founding Fathers set up our system of government so that we have a separation of powers and the judicial branch would interpret the law. And if a law were found to be unconstitutional by the courts, it would be struck down. This is all pretty basic stuff.
Still not done, Huckabee then defended the prohibition on gay marriage in certain states by noting that sometimes 70 or 80 “percent of the state’s population have affirmed natural law marriage.” Translation: If a majority of people support discrimination, then the court should defer to the will of the people.
Well, in 1967, when the U.S. Supreme Court struck down state laws that made it a crime to enter into an interracial marriage in the seminal case of Loving v. Virginia, 73 percent of Americans supported such laws. In fact, it wasn’t until the mid-1990s that a majority of Americans finally approved of interracial marriage. So, if we followed Huckabee’s logic to its end point, then interracial married couples, like President Obama’s parents, should have been criminally prosecuted through the 1990s.
To be honest, Huckabee’s Wahhabist tendencies are nothing new. When he last ran for president in 2008, he argued that we “should amend the Constitution so it’s in God’s standards.”
What would be the reaction if a Muslim candidate for president (or even dog catcher for that matter) argued that we should amend our Constitution to agree with the Quran? The right wing in this country would explode. It would be all the Breitbart.coms of the world would talk about. But many of those same right-wing people who fabricate the claim that Muslims in America want to impose Islamic law have no problem when a Christian politician tells us point blank he wants to impose what is, in essence, Christian Sharia law.
The good news: Our First Amendment prohibits the establishment of any religion in our country, be it Christianity or Islam or anything else. That doesn’t mean people like Huckabee—just like Wahhabists in Saudi Arabia—won’t continue to advocate for their religious beliefs to be the law of the land. But in the United States at least, our laws must be based on public policy considerations and the Constitution, not passages of religious text.
And thank God for that.
By: Dean Obeidallah, The Daily Beast, February 1, 2015
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