“Watch What You Pray For, You May Get It”: Republicans Have Boxed Themselves In A Corner On Obamacare
There’s an adage that perfectly captures the Republicans’ conundrum on Obamacare: Watch what you pray for; you may get it. Having spent the past five years viciously battling the Affordable Care Act, GOP leaders are worried that the U.S. Supreme Court may grant them a victory.
If the high court rules in favor of conservatives who have challenged the health care law — essentially gutting it — millions of Americans will lose the subsidies that allow them to purchase health insurance.
They’ll no longer be able to afford to see a doctor. They won’t be able to pay for knee replacements or chemotherapy treatments. They won’t have the money for drugs for hypertension and diabetes.
And they’ll be furious — just in time for the 2016 presidential election. Now that so many people have reaped the benefits of access to medical care, they want to keep enjoying them. They will be fighting mad if their health insurance is suddenly taken away.
That’s because the Affordable Care Act is doing exactly what it was designed to do. Consider a report from the highly respected RAND Corp. — a nonpartisan research group — which issued its latest judgment on the Affordable Care Act in May.
Its study found that nearly 17 million people now have health insurance because of Obamacare. In addition, families may keep adult children on their policies until age 26. There are no longer “lifetime caps” that limit the amount of money insurers will spend on the chronically ill. Patients are no longer turned down for health insurance because they are already sick.
“The Affordable Care Act has greatly expanded health insurance coverage, but it has caused little change in the way most previously covered Americans are getting health insurance coverage,” said Katherine Carman, who, according to a RAND press release, was the study’s lead author. In other words, the law didn’t wreak havoc on those who already had health insurance, as its critics had predicted.
It has slowly dawned on some Republican leaders that the law has provided tangible benefits to millions of Americans, and that they are likely to be blamed if those benefits are jerked away. But they have locked themselves into a very small room and lost the key. They can’t seem to find a way out.
President Obama noted the GOP’s intransigence in a speech to the Catholic Health Association a few days ago. “Once you see millions of people having health care, once you see that all the bad things that were predicted didn’t happen, you’d think that it’d be time to move on. It seems so cynical to want to take coverage away from millions of people,” he said.
But leading GOP officials have taught their aging base, many of whom are Medicare recipients, that the passage of Obamacare was tantamount to a communist takeover. Republican politicians have insisted for years that the Affordable Care Act would corrupt the health care system, ruin the economy and pave the way for a dictatorship. Now, they’d have a hard time persuading those voters, especially the Tea Partiers, it was all just extreme partisan rhetoric.
This latest high court challenge, King v. Burwell, is itself a symbol of Republicans’ determination to strip health care away from millions of Americans. (It’s also a sign of the partisanship that has overtaken the nation’s highest court, which should never have accepted the case.) It’s a frivolous suit that turns on the interpretation of four words in the statute — even though it’s perfectly clear what Congress meant.
If the court agrees with the challenger, chaos will ensue. The GOP will have to take responsibility for finding coverage for millions of people, although its fractious caucus is unlikely to agree on a fix.
Given the stakes, there are undoubtedly those among GOP elders who want the U.S. Supreme Court to maintain the status quo, even if they won’t say so publicly. After all, as Obama put it, “This isn’t … just about the Affordable Care Act. … This is now part of the fabric of how we care for one another. This is health care in America.”
Let’s hope at least five justices concur.
By: Cynthia Tucker, Pulitzer Prize Winner for Commentary in 2007; Featured Post, The National Memo, June 13, 2015
“GOP Bad Faith Legal Mischief”: Democrats Have Every Reason To Save Republicans From An Obamacare “Bloodletting”
Sometime this month, possibly as early as Monday morning, the Supreme Court will issue its ruling in King v. Burwell. If the Court ignores both the text and purpose of the Affordable Care Act, and rules for the challengers, millions of the law’s beneficiaries in 34 states will quickly lose their insurance subsidies and be forced off their health plans. The ensuing chaos would be the consequence not just of the ruling itself, but also of the Republican Party’s expected unwillingness to pass a one-sentence bill clarifying that Obamacare subsidies are available in every state, whether or not each state established its own health insurance exchange.
When King, and similar cases, were first conceived, they quickly became vessels of hope for conservatives, who recognized how difficult and punishing it would be to hobble or eliminate Obamacare through the legislative process. What many of them have come to recognize in the subsequent years is that farming out the job to the judiciary can’t spare them from the subsequent political cost: As decision day approaches, more and more of these conservatives are acknowledging candidly—and typically anonymously—that they will suffer badly if the Supreme Court does the very thing they’ve asked the Supreme Court to do.
“The most likely option is that Congress is unable to pass a fix,” an anonymous Republican Hill staffer told Joel Gehrke of the conservative National Review—a magazine that has beseeched the Court to void the subsidies. “Either Republicans won’t be able to settle on a fix or the president will veto whatever we do come up with. At that point, it will be up to the governors to pass their own laws deeming the national exchange a state exchange. That is the path of least resistance.”
Gehrke looks at the cross-pressures Republicans would face after a ruling for King and wonders whether they “could be in for a bloodletting.” Though they can’t admit it publicly, the promise of a bloodletting—compounded by the fact that every vulnerable Republican senator in cycle next year represents an affected state—is precisely why so many Republicans privately hope the Court will uphold the subsidies.
If the conventional wisdom which took shape after oral arguments—and to which I subscribe—is correct, the government will win, and this painful exercise in bad faith legal mischief will come to nothing. But if the challengers win, and a bloodletting ensues, Democrats won’t be able to stand back while Republicans absorb the political damage. Bloodletting or no, Obamacare will be crippled in most states. It could easily remain crippled indefinitely. Its fate will turn on the question of whether the political consequences for Republicans resemble the consequences of a government shutdown or collision with the debt limit. But either way Democrats will have to play an active role in bringing about a resolution.
The best-case scenario for Democrats is a public outcry so severe and sustained that Republicans cave, and agree to restore the subsidies with a clean fix.
Republicans have tacitly acknowledged that they won’t be able to sit on their hands while state insurance markets collapse. They have introduced legislation in both the House and Senate that would restore subsidies, but only for existing beneficiaries, and only on conditions Democrats could never accept, like the repeal of the ACA’s individual mandate.
You can interpret these offers in two ways. The first, as Greg Sargent of The Washington Post has noted, is that these bills are designed to be vetoed, allowing Republicans to blame an uncompromising Obama for perpetuating the crisis. But they could also serve as bases for a compromise, or surrender. If the public responds to a ruling for King the way they’ve responded to other GOP-instigated crises, Republicans would have to scale back their demands and eventually agree to reinstate the subsidies, perhaps for a modest price.
Two different forces will push in that direction. Even if sprinkled liberally with poison pills, and even if its proximate purpose is to invite a veto, Republican-sponsored legislation to partially reinstate ACA subsidies probably can’t pass. Democrats aren’t going to vote for an ersatz fix and neither will many rank-and-file conservative members of Congress. “As soon as the messaging is out there saying, ‘Look, a half-a-sentence fix saves millions of people from either losing their coverage or having massive spikes,’ we as a party won’t be able to sustain that pressure very long — certainly not through the August recess,” another Republican aide tells Gehrke.
But that doesn’t mean Democrats will win a standoff outright. Though their case for a clean fix will be compelling, they will also be highly motivated to reinstate the subsidies immediately, even if it means Republicans get to pocket unreciprocated concessions. Those can’t include structural damage to the core of the law, but could include eliminating things like the medical device tax and the employer mandate.
Real danger arises if, per Gehrke’s other source, an adverse King ruling registers somewhere below a government shutdown on the political Richter scale, inflicting damage on the GOP but not enough to make them seek a solution in earnest. Against the backdrop of a paralyzed Congress, Obamacare would begin to unravel in dozens of states, and would continue to do so until at least 2017. A ruling for the challengers would boomerang violently on Republicans, but Democrats have every reason in the world to want them spared from it.
By: Brian Beutler, Senior Editor, The New Republic, June 8, 2015
“Some GOPers Want To Play Chicken”: Getting An Obamacare Repeal Bill On Obama’s Desk; For What?
There’s an interesting Rachel Bade/Jennifer Haberkorn piece up at Politico about all the trouble congressional Republicans have encountered in trying to use the budget reconciliation process to pass a simple veto-proof “root and branch” repeal of the Affordable Care Act. Seems the Senate parliamentarian is telling them they’d have to limit themselves to items with an immediate budgetary impact in any reconciliation bill. But any “partial” repeal–much less a replacement–legislation would raise policy questions on which Republicans disagree, and might also involve deficit-boosting consequences for which offsets would have to be found. So some GOPers want to play chicken:
Some conservatives and staff in both chambers, like House Freedom Caucus Chairman Jim Jordan (R-Ohio), are urging the chambers to do a straight one- or two-sentence repeal of everything. They argue that the parliamentarian has to look only at the words in front of her during reconciliation and should not be able to force lawmakers to break out the provisions on their own.
One aide working on the matter suggested they may try this and see if it works — but others are doubtful.
I guess I’m unclear as to why this is worth the trouble. Getting legislation repealing Obamacare onto Obama’s desk, long the obsessive goal of congressional Republicans, will not accomplish a thing other than confirming that Obama doesn’t want to kill his signature domestic policy achievement and Republicans do. I think most voters out there for whom opposition to Obamacare is a “bullet vote” have probably already figured out they should vote Republican in 2016. So the whole exercise appears to be one of those “energize the base” things whose value I am always questioning.
I do think that if SCOTUS kills Obamacare subsidies in states using federal exchanges there will be some value in Republicans getting a bogus “fix” onto the president’s desk in order to blame him for the subsequent chaos. In that contingency they could almost certainly structure a bill that would meet the conditions for reconciliation, and could probably tamp down any internal opposition by ensuring dissenters there’s zero chance any of it will become law. But on “root and branch repeal,” they might as well just promise they’ll git er done when President Bush or Walker or Rubio takes office.
By: Ed Kilgore, Contributing Writer, Political Animal Blog, The Washington Monthly, June 1, 2015
“The Political Consequences?: Will Republicans Suffer Politically If The Supreme Court Strikes Down ObamaCare? Don’t Count On It
Next month, the Supreme Court might rule in King v. Burwell that the Affordable Care Act does not make subsidies available on insurance exchanges established by the federal government. In a rational world, this argument would be laughed out of court, as even former Republican politicians and congressional staffers have suggested. But that’s not the world we live in.
So it’s worth considering the political fallout if the Supreme Court’s Republican nominees throw the U.S.’s health care market into chaos. The short answer is that, with some notable exceptions, Republicans could very well get away with it.
The policy consequences of such a ruling are much clearer: It would be a disaster. Without subsidies, the vast majority of people would not be able to afford insurance, and therefore would not be subject to the mandate to carry insurance. As a result, younger and healthier people would drop out of the insurance market, creating an actuarial death spiral in which more and more expensive policies are offered to fewer and fewer customers — until the exchanges collapse. Millions of people stand to lose their insurance as a result.
This, of course, is why Congress did make subsidies available on the federally established exchanges. It certainly didn’t go to the trouble of creating a federal backstop that was designed to fail. And until a few libertarian fanatics willfully misread the law as a Hail Mary in their legal war on the ACA, nobody on either side of the aisle involved in the bill thought otherwise.
Should Republicans be careful what they wish for? Possibly. “Fear of change has been the right’s most powerful weapon in the health-care wars since they began under Harry Truman,” writes New York‘s Jonathan Chait. “Seeing their weapon turned against them is a frightening sensation, one they are likely to experience many times again.” The GOP “might be better off if the court just left the law as is,” agrees The Washington Post‘s Greg Sargent. Even The Wall Street Journal editorial page is worried.
The idea that destroying ObamaCare would be politically counterproductive is superficially plausible. Any such decision would be a 5-4 opinion with only Republican-nominated judges in the majority, over at least one lengthy dissent. The Republican-controlled Congress could restore the subsidies by passing a one-paragraph bill, as President Obama will surely emphasize repeatedly.
Congress could try to pass the buck to Obama by passing a “fix” loaded with poison pills that the president would have to veto, but I agree with Chait and Sargent that the Republican conference is too dysfunctional to pull this off. And when Congress fails to act, overwhelmingly Republican-controlled statehouses could solve the problem by establishing their own exchanges — could, but in most cases won’t.
So a Republican Supreme Court takes health insurance away from millions of people, and Republican-controlled governments fail to take simple steps to solve the problem. That has to be a political disaster for the GOP, right?
Not necessarily. “If the Obama Administration loses in the Supreme Court,” argues New Yorker legal analyst Jeffrey Toobin, “the political pain will fall almost exclusively on the president and his party.” And counterintuitive as it might seem, political science favors Toobin.
The problem is that a separation-of-powers system dilutes accountability, and voters generally lack the information that will allow them to sort out the blame for a given disaster. Presidents generally get both more credit and more blame for what happens under their watch than is justified by their power.
This is reflected in the fact that the ACA — a statute that required immense congressional skill on the part of Democrats to pass — is commonly known as ObamaCare. To voters who aren’t Democratic partisans, Republican assertions that Obama is at fault for any bad outcomes that arise from ObamaCare will carry a lot of weight. The media, which tends to give credence to even hare-brained Republican notions out of a misguided effort to remain balanced, is unlikely to make it much clearer.
It may also seem as if Republicans would take the rap for a decision written by a bare majority of Republican-nominated justices, but this overlooks how little the public knows about the Supreme Court. Only a little more than a quarter of the public can name the chief justice. The vast majority of voters will have no idea whether the decision was 5-4 or unanimous, let alone the partisan details of the split. Justice Ruth Bader Ginsburg might write her greatest dissent, but it’s hard to imagine it changing many minds, given that only a tiny minority reads Supreme Court opinions and almost all of them know what they think about the case beforehand.
So in general, I do think Toobin is right. Republicans in Congress and in deep red states can probably avoid any consequences. But there is one twist. Republicans are most vulnerable in states with federally established exchanges that are led by the GOP, but tend to swing to the Democrats in presidential elections. Voters in those states are more likely to blame Republicans for not establishing a state exchange.
As it happens, one such state is Wisconsin, whose governor is a frontrunner for the Republican nomination in 2016. The Republican primary electorate will prevent Scott Walker from signing a bill establishing a state exchange, but his refusal will make it harder for the GOP to duck the issue. In this instance, it might be harder for Republicans to deflect responsibility to Obama than it would be otherwise.
Ultimately, the political consequences of a Supreme Court ruling against the government are difficult to predict. But what we know for sure is that it would be best for the Supreme Court to uphold ObamaCare — so we don’t have to find out.
By: Scott Lemieux, The Week, May 27, 2015
“Shocking Sloppiness Won’t Doom The Health Reforms”: Republican Politicians Will Have A Lot Of Angry People On Their Hands
How many politicians, aides, lobbyists, lawyers, insurance moguls, professional groups, and interns — both the political and medical kind — agonized over the details in the Affordable Care Act? The number is big.
But despite thousands of hands in the kitchen, the final product included four words that cast doubt on a cornerstone of the reforms — subsidies for those buying coverage on federal health insurance exchanges. Unbelievable.
Diehard foes of the reforms have weaponized those words as a means to kill the law. They argue in the Supreme Court case King v. Burwell that specifically offering subsidies for plans bought on exchanges “established by the state” means no help for those going to federal exchanges.
Since the program started, low- and middle-income Americans have been receiving tax credits for coverage on both types of exchanges. Almost everyone assumes that’s how it’s supposed to be.Take away subsidies for federal exchanges and only the sickly will join it. The economic structure underpinning guaranteed coverage will collapse as premiums charged for plans on federal exchanges soar and the healthy stay away in droves.
The plaintiffs, though they come from the right, are doing their Republican colleagues no favors. You see, when the Affordable Care Act created federal exchanges in states that had not set up their own, leaders in Republican-controlled states could noisily defy President Obama while taking few political risks. They could refuse to set up state exchanges knowing that their constituents would enjoy subsidized coverage on the federal exchanges.
Lose those subsidies and Republican politicians are going to have a lot of angry people on their hands. Some 7.5 million Americans receive subsidies on federal exchanges.
Hypocrisy now crashes over the Republicans’ wall of opposition to the Affordable Care Act. Politicians are currently rewriting the story of their obstruction of a law that they dread could come apart.
An exasperating example is Olympia Snowe, a former senator from Maine who fancies herself a moderate Republican. During the battle for the bill’s passage, she strung Obama along for months, pretending that she might provide him at least one Republican vote. (Why Obama indulged these stalling tactics… perhaps his memoirs will tell.)
Anyway, Snowe recently commented that the little words at the heart of the Supreme Court case were unintended. “Why would we have wanted to deny people subsidies?” she said. “It was not their fault if their state did not set up an exchange.”
So why did she vote against the bill? She also railed against “Obamacare” as a “government-run health care system,” not that this was the case. Until Snowe left the Senate in 2013, she worked with her party to undercut the reforms.
But get this: At the time of the bill’s writing, Snowe proposed letting Americans buy cheaper drugs from Canada. It was OK, apparently, for a foreign government to help struggling Mainers obtain health care, but not OK for their own to do so.
One expects the health reforms to survive this latest assault. The best outcome would be the Supreme Court’s confirming that the words were a mistake and that yes, subsidies for the federal health exchange are legal.
If the court says no, politicians in states relying on federal exchanges could swing into action and set up some form of state exchange. And the Obama administration would probably make it easy for them.
The bipartisan takeaway here is the appalling state of American governance. We now hear from all sides that omission of subsidies for the federal exchanges was “sloppy,” “careless,” “inadvertent,” “a drafting error.” Actually, it was inexcusable.
But let’s move on.
By: Froma Harrop, Featured Post, The National Memo, May 28, 2015
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