“The Long, Long Battle For Health Care Reform”: The Single Defining Goal Of American Progressivism For More Than A Century
So in this week of epochal Supreme Court opinions, even health policy wonks would not claim that King v. Burwell can match Obergefell v. Hodges in terms of its historical significance. There’s a reason the latter is stimulating spontaneous outbreaks of happiness among people who aren’t political and don’t follow constitutional law.
But at Vox today, Dylan Matthews reminds us that of the incredibly long hard path this country has followed to reach even the Affordable Care Act’s first timorous steps towards universal health coverage. Those conservatives who talk as though no one has ever seriously considered such a socialist abomination until now really are betraying their ignorance about history:
National health insurance has been the single defining goal of American progressivism for more than a century. There have been other struggles, of course: for equality for women, African-Americans, and LGBT people; for environmental protection; against militarism in Southeast Asia and the Middle East. But ever since its inclusion in Teddy Roosevelt’s 1912 Bull Moose platform, a federally guaranteed right to health coverage has been the one economic and social policy demand that loomed over all others. It was the big gap between our welfare state and those of our peers in Europe, Canada, Australia, New Zealand, and Japan.
And for more than a century, efforts to achieve national health insurance failed. Roosevelt’s third-party run came up short. His Progressive allies, despite support from the American Medical Association, failed to pass a bill in the 1910s. FDR declined to include health insurance in the Social Security Act, fearing it would sink the whole program, and the Wagner Act, his second attempt, ended in failure too. Harry Truman included a single-payer plan open to all Americans in his Fair Deal set of proposals, but it went nowhere. LBJ got Medicare and Medicaid done after JFK utterly failed, but both programs targeted limited groups.
Richard Nixon proposed a universal health-care plan remarkably similar to Obamacare that was killed when then-Sen. Ted Kennedy (D-MA) walked away from a deal to pass it, in what Kennedy would later call his greatest regret as a senator. Jimmy Carter endorsed single-payer on the campaign trail, but despite having a Democratic supermajority in Congress did nothing to pass it. And the failure of Bill Clinton’s health-care plan is the stuff of legend.
Yes, Obamacare haters may dismiss the experience of virtually every other wealthy country by intoning “American exceptionalism”, as though we have some long-cherished right to die young that’s as essential to the national character as unlimited possession of guns. But this has been a constant issue in our own country, too, and it’s a token of how far our political system has drifted to the right that redeeming the vision of Teddy Roosevelt and Harry Truman and Richard Nixon strikes so many people as a horrifying lurch into socialism.
By: Ed Kilgore, Contributing Writer, Political Animal Blog, June 26, 2015
“GOP Failure Theater”: How Conservatives Convinced Themselves That Another ObamaCare Loss Is Just Prelude To Greater Victory
There’s a ritual carried out by losing candidates on election night, in which they come before their supporters gathered in a hotel ballroom, look out at all the long faces and tired eyes, and say, “This has been a noble crusade. And though we may have lost today, the battle for the things we believe in goes on. I’ll be there fighting for that vision, and I hope you’ll be there with me.” Everyone applauds, and then they all go home.
Now that the Supreme Court has ruled against what was simultaneously the most absurd and the most threatening challenge to the Affordable Care Act, conservatives are enacting something similar to that election night ritual. In private, many are expressing relief, since there was widespread worry that if the King v. Burwell lawsuit had succeeded, they would have been responsible for at least six million Americans losing insurance subsidies, and quite appropriately gotten the blame for it. But what are they saying publicly?
The politicians are finding virtue in consistency; their line is that this changes nothing.
“Today’s ruling won’t change ObamaCare’s multitude of broken promises,” said Mitch McConnell.
“ObamaCare is fundamentally broken,” said John Boehner. “Today’s ruling doesn’t change that fact.”
“Today’s ruling makes it clear that if we want to fix our broken healthcare system, then we will need to elect a Republican president,” said RNC chair Reince Priebus, who also made the fascinating observation that a Hillary Clinton presidency would be terrible for America.
Naturally, conservatives are disgusted with Chief Justice Roberts, whom they regard as an unreliable ally, unlike Justices Scalia, Thomas, and Alito. Quin Hillyer of the National Review summed up their feelings: “He is a disgrace. That is all.” But as far as conservative commentators are concerned, the perfidy extends beyond the Supreme Court to the cowards and quislings in Congress. And so, in a particularly optimistic strain of thought, they’re arguing that the decision is really an excellent outcome.
That’s because it has saved the right from another round of what blogger Allahpundit calls “GOP failure theater,” in which Republicans in Congress “make a pretense of putting up a fight in hopes that conservative voters will be impressed and to obtain some sort of mostly meaningless concession to wave at them when the inevitable, and predestined, cave finally happens.”
Similarly, Ben Domenech argues that the decision is a good thing for conservatives, because now Republican candidates will have to come up with really good health care plans to enact when they take back the White House: “Thus, I think the ruling today probably increases the likelihood of repealing ObamaCare in 2017 by a not insignificant margin.” On a similar note, Bill Kristol tweeted, “Repeal of ObamaCare and replacement with limited-government alternative in 2017 will be one of modern conservatism’s finest hours.”
That presumes that the Republican nominee will win, of course. But it also presumes that he would have the ability and willingness to repeal the ACA upon taking office.
There’s no question that the Republican presidential candidates will continue to express their eagerness to do so, at least until we get to the general election. Though none of them has anything resembling a fully-formed plan for the “replace” part of “repeal and replace” that Republicans have been advocating for years, they still have to pay lip service to the idea that the consensus conservative health care plan is coming any day now. When you’ve spent the last five years arguing that this law is a poison-tipped dagger plunging into liberty’s heart, you can’t just say, “Eh, looks like we’ll live with it,” no matter what the practical reality might be.
The practical reality is that whatever public opinion may be about this large abstraction called “ObamaCare,” the law is delivering particular benefits of which Americans are quite fond and that they don’t want to lose. Taking away those subsidies through a lawsuit would have been a political disaster for Republicans, and that would have affected only a portion of the public. What if Republicans were to take away subsidies from people in all 50 states, and toss millions more off Medicaid, and make it so that now insurance companies can deny you coverage because of a pre-existing condition again? That’s what repealing the ACA would mean. Republicans may not be able to admit it, as they promise that their phantom alternative plan would take care of all that, but they know that just undoing the ACA would be a disaster.
They can’t acknowledge that fact, because they have a constituency that has been fed heaping plates of apocalyptic rhetoric on this issue ever since the ACA became law. Those Republican base voters need to be told that, though they’ve suffered a loss, the fight is not over. As Ted Kennedy said 35 years ago in what may be the prototypical example of that losing candidate’s speech to his dismayed supporters, “the work goes on, the cause endures, the hope still lives, and the dream shall never die.”
By: Paul Waldman, Senior Writer, The American Prospect; Contributing Writer, The Week, June 25, 2015
“Antonin Scalia’s ‘Interpretive Jiggery-Pokery'”: With Increasing Frequency, Scalia’s Reputation Continues To Deteriorate
Two years ago tomorrow, the U.S. Supreme Court struck down the Defense of Marriage Act, much to Justice Antonin Scalia’s chagrin. Adding to his greatest-hits list, the far-right jurist called the majority’s rationale “legalistic argle-bargle.”
Today, as my msnbc colleague Irin Carmon reported, Scalia was once again in rare form today in his King v. Burwell dissent.
Justices Antonin Scalia, Clarence Thomas and Samuel Alito dissented. Writing on their behalf, Scalia accused the majority of acting in bad faith just to save the law. “So it rewrites the law to make tax credits available everywhere. We should start calling this law SCOTUScare,” Scalia wrote in the dissent. He said Roberts’ reasoning was an act of “interpretive jiggery-pokery.”
No, seriously. Scalia actually used the phrase “interpretive jiggery-pokery.” It’s on page 8. Two pages later, he published the phrase “pure applesauce” as a complete sentence.
The justice has been embarrassing himself with increasing frequency, but Scalia’s reputation continues to deteriorate further.
The broader point, however, is less about the justice’s strange word choice and more about his increasingly twisted approach to the law.
The dissent in King is literally hard to believe. On page 17 of the majority opinion, Chief Justice John Roberts even mocks the dissenters for making the opposite conclusion that they drew three years ago:
“It is implausible that Congress meant the Act to operate in this manner. See National Federation of Independent Business v. Sebelius, 567 U. S. ___, ___ (2012) (SCALIA, KENNEDY, THOMAS, and ALITO, JJ., dissenting) (slip op., at 60) (“Without the federal subsidies … the exchanges would not operate as Congress intended and may not operate at all.”).
It’s no small detail. Three years ago, when the Affordable Care Act’s constitutionality was challenged, Scalia, Clarence Thomas, and Sam Alito read the law in such a way as to see all eligible consumers receiving subsidies, regardless of state or federal exchanges. In today’s dissent, these three had to read the law in the polar opposite way.
And therein lies the point: it seems as if the dissenting justices were so eager to rule against “Obamacare” that they were willing to ignore legislative history, legislative intent, context, and their own beliefs from three years ago.
I’m also reminded of this Linda Greenhouse piece from February.
Statutory interpretation is something the Supreme Court does all the time, week in and week out, term after term. And while the justices have irreconcilable differences over how to interpret the Constitution, they actually all agree on how to interpret statutory text. […]
Every justice subscribes to the notion that statutory language has to be understood in context. Justice Scalia said it from the bench just last month, during an argument about the proper interpretation of the federal Fair Housing Act. “When we look at a provision of law, we look at the entire provision of law, including later amendments,” Justice Scalia said. “We try to make sense of the law as a whole.” … Across the ideological spectrum, the court’s opinions are filled with comments like Justice Scalia’s.
Today, Scalia threw all of that out the window, saying what matters isn’t the entire provision of law, but how he could take half a sentence out of context to undermine a law he doesn’t like.
“Words no longer have meaning,” Scalia whined today. In reality, words are still fine. What lacks meaning are Scalia’s unhinged complaints.
By: Steve Benen, The Madow Blog, June 25, 2015
“Hooray For Obamacare”: The Great Conservative Nightmare Has Come True, And It’s A Beautiful Thing
Was I on the edge of my seat, waiting for the Supreme Court decision on Obamacare subsidies? No — I was pacing the room, too nervous to sit, worried that the court would use one sloppily worded sentence to deprive millions of health insurance, condemn tens of thousands to financial ruin, and send thousands to premature death.
It didn’t. And that means that the big distractions — the teething problems of the website, the objectively ludicrous but nonetheless menacing attempts at legal sabotage — are behind us, and we can focus on the reality of health reform. The Affordable Care Act is now in its second year of full operation; how’s it doing?
The answer is, better than even many supporters realize.
Start with the act’s most basic purpose, to cover the previously uninsured. Opponents of the law insisted that it would actually reduce coverage; in reality, around 15 million Americans have gained insurance.
But isn’t that a very partial success, with millions still uncovered? Well, many of those still uninsured are in that position because their state governments have refused to let the federal government enroll them in Medicaid.
Beyond that, you need to realize that the law was never intended or expected to cover everyone. Undocumented immigrants aren’t eligible, and any system that doesn’t enroll people automatically will see some of the population fall through the cracks. Massachusetts has had guaranteed health coverage for almost a decade, but 5 percent of its nonelderly adult population remains uninsured.
Suppose we use 5 percent uninsured as a benchmark. How much progress have we made toward getting there? In states that have implemented the act in full and expanded Medicaid, data from the Urban Institute show the uninsured falling from more than 16 percent to just 7.5 percent — that is, in year two we’re already around 80 percent of the way there. Most of the way with the A.C.A.!
But how good is that coverage? Cheaper plans under the law do have relatively large deductibles and impose significant out-of-pocket costs. Still, the plans are vastly better than no coverage at all, or the bare-bones plans that the act made illegal. The newly insured have seen a sharp drop in health-related financial distress, and report a high degree of satisfaction with their coverage.
What about costs? In 2013 there were dire warnings about a looming “rate shock”; instead, premiums came in well below expectations. In 2014 the usual suspects declared that huge premium increases were looming for 2015; the actual rise was just 2 percent. There was another flurry of scare stories about rate hikes earlier this year, but as more information comes in it looks as if premium increases for 2016 will be bigger than for this year but still modest by historical standards — which means that premiums remain much lower than expected.
And there has also been a sharp slowdown in the growth of overall health spending, which is probably due in part to the cost-control measures, largely aimed at Medicare, that were also an important part of health reform.
What about economic side effects? One of the many, many Republican votes against Obamacare involved passing something called the Repealing the Job-Killing Health Care Law Act, and opponents have consistently warned that helping Americans afford health care would lead to economic doom. But there’s no job-killing in the data: The U.S. economy has added more than 240,000 jobs a month on average since Obamacare went into effect, its biggest gains since the 1990s.
Finally, what about claims that health reform would cause the budget deficit to explode? In reality, the deficit has continued to decline, and the Congressional Budget Office recently reaffirmed its conclusion that repealing Obamacare would increase, not reduce, the deficit.
Put all these things together, and what you have is a portrait of policy triumph — a law that, despite everything its opponents have done to undermine it, is achieving its goals, costing less than expected, and making the lives of millions of Americans better and more secure.
Now, you might wonder why a law that works so well and does so much good is the object of so much political venom — venom that is, by the way, on full display in Justice Antonin Scalia’s dissenting opinion, with its rants against “interpretive jiggery-pokery.” But what conservatives have always feared about health reform is the possibility that it might succeed, and in so doing remind voters that sometimes government action can improve ordinary Americans’ lives.
That’s why the right went all out to destroy the Clinton health plan in 1993, and tried to do the same to the Affordable Care Act. But Obamacare has survived, it’s here, and it’s working. The great conservative nightmare has come true. And it’s a beautiful thing.
By: Paul Krugman, Op-Ed Columnist, The New York Times, June 25, 2015
“In A Terrible Predicament”: A Victory For Obamacare’s Challengers Will Be A Disaster For Republican Candidates
Once the conservative legal strategy that gave rise to King v. Burwell got off the ground, Republicans in Congress probably had no choice but to become cheerleaders for, or active participants in, the ensuing litigation.
The imminence of the decision in the Obamacare challenge, expected from the Supreme Court sometime this month, is exposing the terrible predicament the entire strategy created for the party.
The problems Republicans will encounter if they win King—eliminating billions of dollars worth of insurance subsidies—are fairly clear and have been detailed at length. But it is also quite conceivable that the whole effort will boomerang on the GOP even if the government wins in King, and the federal subsidies survive for those states using federally facilitated exchanges. A number of persuasive legal arguments point to a victory for the government. But one of the most likely paths begins with the Court concluding that the Affordable Care Act statute is ambiguous—that both parties’ readings of the law are plausible—and that deference should go to the government.
As Chief Justice John Roberts suggested with his one and only question at oral arguments, this would leave the door ajar for a future presidential administration to reinterpret the statute, and discontinue the subsidies.
It’s difficult to fathom that any Republican president would turn off the subsidies quite as abruptly as the challengers want the Court to do. But if the government wins in this way—on what’s known as the second step of the Chevron deference standard—it will create a new conservative litmus test for Republican presidential candidates. If elected, will you shut down the subsidies? I suspect most of the candidates will yield to pressure from the right and promise to do precisely that. Most immediately, this promise becomes a general election liability for the Republican primary winner. If that person becomes president, it will turn into an administrative and political nightmare, forcing states and the U.S. Congress to grapple with a completely elective policy fiasco.
King, as Josh Marshall noted recently, “is a wholly-owned subsidiary of the Republican Party.”
That the case was conceived by conservatives and endorsed by Republicans has created an extensive paper trail tying the GOP to the consequences of a decision for the challengers. It has also forced Republicans to playact as if they can and will fix the problems that flow from an adverse King ruling. Initially the idea was to foam the runway for conservative justices eager to void the subsidies; it has become an accession to the reality that the public will hold Republicans to account for the ensuing chaos.
Among the pitfalls of the extended charade is that Republican presidential candidates will reject and condemn proposals to clean up a King mess if they even resemble constructive solutions.
“Things can’t be turned on a dime,” Senate Majority Whip John Cornyn told Politico. “People can run for president, but we’ve actually got to solve a problem.” Cornyn may have been thinking of his fellow Texan Ted Cruz, who wants to use King as a pretext to repeal all of Obamacare. But his discomfort with Cruz’ absolutism carries a whiff of inconsistency: Cornyn signed on to Republican briefs, first urging the justices to hear King and then asking them to void the subsidies. In January he eagerly anticipated that the Court would “render a body blow to Obamacare from which I don’t think it will ever recover.”
The promise of the King challenge has apparently faded since then. Republicans in Congress are quite likely incapable of solving the problem Cornyn was talking about in a way that pleases conservatives, and will be little better equipped if a Republican president discontinues the subsidies on his own. Six months ago, Republicans claimed excitedly that the path to repealing Obamacare outright ran through a victory in King. Now it seems that the best political outcome for Republicans would be to lose the case as conclusively and embarrassingly as possible.
By: Brian Beutler, Senior Editor, The New Republic, June 17, 2015
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