“Can’t Stop, Won’t Stop”: GOP Will Never Stop Coming For Obamacare
Obamacare turned 5 on Monday, a birthday achieved despite sustained and repeated efforts to smother the law in its cradle.
The law has taken some hits, including a 2012 Supreme Court decision that buckled the knees of the bill’s backers but seemed to make the Affordable Care Act the settled law of the land.
Now the Supreme Court has again taken up another challenge to the law.
King v. Burwell hinges on whether or not four words buried deep in the text of the law contain the seeds of Obamacare’s destruction by eliminating tax subsidies for people living in states that declined to set up their own insurance exchanges.
But even if they lose again at the court, conservatives say that they will continue to try to undo the law through the courts.
Michael Cannon, a health-policy expert at the Cato Institute, said the most promising challenge to the ACA comes from the state of Maine, which, after the Roberts court ruled in 2012 that the federal government was limited in how much it could compel states to expand Medicaid, sued to roll back its existing Medicaid coverage.
Last year, a federal appeals court ruled against the state, but Gov. Paul LePage has appealed to the Supreme Court, even as Maine’s attorney general has refused to represent the state in its challenge of the law.
Other remaining challenges include Sissel v. U.S. Department of Health and Human Services, which argues the ACA is unconstitutional because it violated the Constitution’s origination clause that states spending bills must originate in the House, not the Senate.
“They are both kind of long shots,” acknowledged Cannon, noting that “the Supreme Court has never struck anything down on origination grounds” and that the House likely lacks standing in its lawsuit against the administration.
If the administration loses King v. Burwell, most health-policy experts predict that it will create a “death spiral” as low-income beneficiaries lose their subsidies in states that did not set up their own exchanges, and insurers are forced to raise rates. But conservatives say they will not delay in kneeing the law into the grave by filing lawsuits in states that set up their own exchanges.
Because many states rushed to do so, conservatives say they expect that governors and their health departments may have violated their state constitutions, and so even residents of those states that believed they were immune from the Burwell decision could face a loss of subsidies as well.
If the Supreme Court decides in favor of the government in King, conservative legal scholars said that what they decide to do in the future to tear down the law depends upon precisely the way in which the judgment is rendered. Halbig v. Burwell mirrors the King case in many respects, but other cases could still go forward, in particular one in Indiana in which several dozen school districts have argued that the employer mandate to provide health insurance puts too much of a burden on state and local governments.
Smaller challenges to the law, meanwhile, continue to mount. Little Sisters of the Poor sued to exempt themselves from the contraceptive mandate. If successful, the suit would allow more organizations to opt out than the Hobby Lobby decision did.
Another challenge, brought by the Goldwater Institute of Arizona, takes aim at the Independent Payment Advisory Board, which was designed to permit the Executive Branch to limit Medicare payments. Even some of the law’s liberal supporters, like former Vermont Gov. Howard Dean, have said that the board should be eliminated or rethought.
Meanwhile, conservative legal scholars say they continue to pore over the text of the law in the hopes that they will find some other legal weaknesses that were not readily apparent. The King case, after all, hinges on four words in the text that were discovered by a legal scholar months after the law was passed.
“This law is so complicated that even those who have read it don’t understand the depths of it,” said John R. Graham, a senior fellow at the conservative National Center for Policy Analysis. “Every time we look at it, we find something else to take to a judge.”
And such lawsuits, he added, help galvanize opposition to the bill years after it has passed.
“They keep the energy up, keep Obamacare on the front pages, keep hope alive.”
Which is necessary, because many conservatives still hope that the law will collapse under its own weight.
“They have really reached the limit of sign-ups. Enrollment is flattening as people see more and more how expensive the coverage is, how high the deductibles are, all the hoops they have to jump through, and they realize it is just not very attractive insurance,” said Grace-Marie Turner of the Galen Institute. She said that many states would be able to opt out of some of the law’s provisions in 2017, and find their own alternatives.
“There is going to be huge momentum going forward to make changes to this law,” Turner said. “I could go on forever about how damaging this law has been to people’s lives. It has to be changed.”
By: David Freedlander, The Daily Beast, March 25, 2015
“Give Me Lipitor Or Give Me Death”: Last Call; Ted Cruz Signs Up For Obamacare
A day after announcing his White House bid – which included beating on the Affordable Care Act, his favorite punching bag – Sen. Ted Cruz, R-Texas, says he’s signing up for Obamacare.
Yes, you read that correctly: The man whose signature applause line is a promise to “repeal each and every word of Obamacare,” went on Healthcare.gov and got himself some benefits. Hypocrisy? Sure, but not in the way you might think.
Cruz had been covered through his wife’s employer, Goldman Sachs. If some insurance plans are Cadillacs, hers was a chauffeured, solid-gold Fleetwood, reportedly worth some $20,000 a year — around half of Texas’ median income. Heidi Cruz is taking a year or so of unpaid leave to help him on his campaign, though, so her health care coverage evaporates along with her likely very substantial paycheck.
Now, the senator – or maybe an aide, or an intern or campaign volunteer or someone – will schlep to the computer, log on to Healthcare.gov and hunch down over the keyboard to do the Obamacare two-step to get coverage for the upcoming year.
Cruz says he had to get health coverage Obamacare, and he’s right: Sen. Chuck Grassley, R-Iowa, inserted an ACA amendment that requires all members of Congress to sign up through the federal exchange. That means Cruz has to if he wants health insurance, although, unlike a lot of Obamacare enrollees, his $174,000 annual Senate salary covers the premiums.
“Well, it is written in the law that members will be on the exchanges without subsidies just like millions of Americans so that’s – I think the same rules should apply to all of us,” Cruz told the Des Moines Register. “Members of Congress should not be exempt.”
Cruz has come up with his own Obamacare alternative, a plan which shifts a lot of control to the states — including ones like Texas, that opted out of Obamacare and all that federal money that went with it. If it were available, he probably would have signed up for Cruzcare instead.
Cruz: 2, Hypocrisy: Undecided. Still, let’s take a closer look.
If Cruz wanted to stand on no-Obamacare, no-way principle, however, perhaps he could opt out of government-sponsored health care entirely, just like the 6.3 million Texans who don’t have health insurance — in part because his state, and his party, decided to block it. That includes 1.2 million children just like Cruz’s two little girls who can’t get health care if they get sick.
That’s made Texas the state with the highest number of uninsured people, nearly twice the national average.
Further, if you squint, the changes the Cruz family are undergoing — loss of a job or a dramatic life change that reduces income — are the top reasons people lose health insurance, and among the reasons Obamacare exists in the first place. And if a parent or spouse gets sick without insurance, it can lead to some serious financial hardship.
It’s perhaps safe to say Cruz understands that intuitively, even if he probably would never say so explicitly. Which is probably why he signed up, and where the hypocrisy comes in.
Even though it exposes him to a modicum of ridicule, allegations of hypocrisy and getting the stink-eye from some of his die-hard supporters, Ted’s Excellent Obamacare Adventure speaks more loudly than his “repeal every word of Obamacare” applause line. When it came down to brass tacks and he lost his wife’s coverage, he opted-in.
He may be a fierce Obamacare critic, and he may agree with the decision to deny affordable health insurance to more than 6 million Texans who, one imagines, he assumes would rather have liberty than Lipitor. But when it becomes a personal matter involving his own family, his conservative ideals don’t necessarily apply.
By: Joseph P. Williams, Washington Whispers, U. S. News and World Report, march 24, 2015
“It’s Better To Let Your Constituents Lose Their Coverage”: Paul Ryan To States; Help Us Sabotage Health Care
On the fifth anniversary of the Affordable Care Act becoming law, there’s value in reflecting on the systemic advances, which we did earlier. But it’s also a good time to look ahead and consider where the policy fight is headed.
Congressional Republicans, for example, who’ve already voted literally several dozen times to repeal the law, released budget plans last week that would – you guessed it – uproot the American health care system, replacing it with an alternative that Republicans can neither explain nor identify.
As if that weren’t quite enough, the GOP budget plans would likely double the uninsured rate, while eliminating $1 trillion in tax revenue that pays for the ACA. Because the Republican budget blueprint relies on bizarre gimmicks and fraudulent arithmetic, the plan offers no explanation for how it would cover the $1 trillion loss and no details about how Congress would help the millions of families that would lose access to affordable medical care after Republicans take their benefits away.
The GOP budget also makes no effort to address the possibility that Republican justices on the Supreme Court may soon scrap subsidies to consumers in two-thirds of the country in the ridiculous King v. Burwell case. House Ways & Means Committee Chairman Paul Ryan (R-Wis.), however, is on the case – he doesn’t have a policy solution, but Ryan has a plan to persuade state policymakers to help congressional Republicans’ broader game plan.
Rep. Paul Ryan urged state lawmakers to resist setting up state insurance exchanges if the Supreme Court rules that key parts of the Affordable Care Act can only continue if they do so.
“Oh God, no… The last thing anybody in my opinion would want to do, even if you are not a conservative, is consign your state to this law,” the Wisconsin Republican told state legislators Thursday during a conference call organized by the Foundation for Government Accountability, a conservative think-tank.
Ryan reportedly went on to say, “If people blink and if people say, ‘This political pressure is too great, I’m just going to sign up for a state-based exchange and put my constituents in Obamacare,’ then this opportunity will slip through your fingers.”
The right-wing Wisconsinite is known for some pretty extreme postures, but this is a brazen move, even for Paul Ryan.
If the Republican justices gut the Affordable Care Act, it’s likely Americans would see a bifurcated system: consumers in states run by Democrats would continue to receive subsidies to afford quality medical coverage, while millions of consumers in Republican-run states would go without. Or put another way, if your state created its own exchange marketplace, very little will change. If your state has referred consumers to healthcare.gov to enroll, you and your neighbors may be in big trouble.
If the high court’s ruling sides with the right, it’s quite likely that some Republican-led states would scramble to create their own exchange in order to help their citizens. Indeed, leading GOP officials in states like Michigan and Ohio have already indicated an intention to do exactly that in order to prevent their constituents from suffering.
That’s what Paul Ryan is responding to – he’s effectively telling these state officials, “No, wait, it’s better to let your constituents lose their coverage. Helping families keep their coverage is what the White House wants, so don’t do it.”
And what about the “opportunity” Ryan mentioned on Friday? As the congressman sees it, if the Supreme Court sides with Republicans, and if states agree to let their citizens go without, then they’ll be able to take advantage of the new GOP alternative to the Affordable Care Act. What’s in it? Paul Ryan doesn’t know. What will it cost? Paul Ryan doesn’t know. How many people will it cover? Paul Ryan doesn’t know. When can we see it? Paul Ryan doesn’t know.
Why in the world would state officials listen to such ridiculous advice, putting their own constituents in jeopardy? Paul Ryan doesn’t know – and neither does anyone else.
By: Steve Benen, The Maddow Blog, March 23, 2015
“Completely Erroneous Impressions”: The Race Between Slander And Reality On Obamacare
Speaking of million pixel images, Sarah Kliff has an important piece at Vox today about perceptions of Obamacare five years in, and the big takeaway is how little has changed, in no small part because people with no direct experience of the new system have internalized the (mostly negative) propaganda they’ve heard. That is particularly true with respect to completely erroneous impressions of the net cost of Obamacare:
Forty-two percent of Americans think Obamacare has gotten more expensive over the past five years. Only 5 percent of poll respondents hit on the right answer: budget estimates for the Affordable Care Act have consistently fallen since it became a law.
Make no mistake: Obamacare spends a lot of money on its tax credits and Medicaid expansion. It recoups some, but not all, of that new spending with hundreds of billions of dollars in Medicare cuts, which reduce federal health spending. The bulk of the remainder is made up with tax increases. But back when the law was passing, Republicans argued up, down, and sideways that the Congressional Budget Office was sharply underestimating the amount of money Obamacare spends.
In fact, the CBO overestimated the cost of Obamacare — and by quite a lot. In April 2014, it marked down its Obamacare projection by more than $100 billion. Much of the revision comes down to the fact that health-care costs have grown very slowly during 2009, meaning it’s less expensive for the government to help millions of Americans purchase coverage. Just this month, CBO released new projections showing that Obamacare’s subsidies would cost 20 percent less over the next decade than initially expected.
The government is now spending less on health care than CBO had projected back in January 2010 — a projection that didn’t include any Affordable Care Act spending at all.
Another problem is that people attribute to the Affordable Care Act phenomena that would have occurred anyway, especially rising (though more slowly rising) premiums and disruption of individual insurance policies–and even the long, long trend away from fee-for-service medicine delivered by doctors of one’s own choice.
Assuming it is not crippled by the U.S. Supreme Court or repealed by a Republican Congress and president, Obamacare will slowly or surely chip away at the misconceptions. It is, sad to say, a sign of progress that (according to the Vox survey) that only 26% of self-identified Republicans believe in the “death panel” meme. The bigger question is how long it might take for Republican politicians to end their propaganda and treat Obamacare as part of the national landscape–as something to change, not kill–and whether that will precede their next turn in real power.
By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, March 23, 2015
“More Budget Gimmickry”: Republicans Vote To Hide Costs Of Repealing Obamacare In Budget
Republicans on the Senate Budget Committee voted Thursday to shield attempts to repeal the Affordable Care Act from objections that it would add to the government’s budget deficit.
The budget resolution for 2016 includes what are known as reconciliation instructions that tell several congressional committees to come up with ways to undo Obamacare. Such reconciliation measures only require 51 votes to pass in the Senate.
But the spending plan also includes language that allows lawmakers to raise what are known as budget points of order against any legislation that would add more than $5 billion to the deficit, and block it. According to the last estimate by the Congressional Budget Office, repealing Obamcare would add $210 billion to the deficit.
That would seem to make it likely that any Obamacare repeal effort would run afoul of a point of order, which takes 60 votes to surmount. So, later in the resolution, it exempts an attempt to repeal Obamacare from those points of order.
“What we have in this budget is a very interesting situation,” said Sen. Debbie Stabenow (D-Mich.), who offered an amendment to make the deficit rules apply to Obamacare repeal.
“We have a point of order in the budget for anything that adds to the deficit, but we have a section that specifically excludes the Affordable Care Act from that,” Stabenow said. “So think about it. This budget is conceding the fact that the Affordable Care Act has reduced the deficit, and repealing the law would increase the deficit.”
Stabenow also alluded a related problem the GOP budget ignores: At the same time that it instructs Congress to come up with a repeal, it continues to count all the revenue that the Affordable Care Act is expected to raise — and which the government wouldn’t collect if the law is dismantled.
“You can’t rig the rules on both sides,” Stabenow said. “That’s not fair. I would argue that’s really budget gimmickry. I think it’s important if you are going to eliminate the Affordable Care Act, you have to step up and assume the consequences of that.”
Budget Chairman Mike Enzi (R-Wyo.) did not dispute Stabenow’s claim, but seemed to think it was irrelevant, since even if a point of order applies to a repeal measure, it still could be overridden if 60 senators vote to do so. That’s the same filibuster-proof number it takes to pass controversial legislation.
And while using budget reconciliation instructions prevents filibusters — so something can pass with just 51 votes — many parts of the Affordable Care Act could not be legally included in such a measure. And even if they could, it would take a two-thirds majority to override a presidential veto that would be certain to follow.
“I think that probably any repeal is probably going to take at least 60 votes, and probably 67 votes,” Enzi said.
Still, Stabenow countered that her amendment was useful in making clear what was actually happening in the name of “honest budgeting.”
Republicans opposed Stabenow’s amendment on a party-line vote, 12 to 10, and passed the budget by the same tally.
The measure is expected to be on the Senate floor next week.
By: Michael McAuliff, The Blog, The Huffington Post, March 19 , 2015
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