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“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

 

 

 

May 29, 2015 Posted by | Affordable Care Act, Health Exchanges, King v Burwell | , , , , , , | 1 Comment

“The Right’s Collective Amnesia And Fantasia”: Former Republican Senator Admits The Obamacare Court Challenge Is Built On Lies

For months, when the Affordable Care Act was still swimming upstream through the legislative process, President Barack Obama and Senate Democrats courted Senator Olympia Snowe, a Republican from Maine, thinking she would respond rationally to enticements and provide Democrats bipartisan cover to reform the U.S. health insurance system.

Their efforts ultimately failed. Snowe, like every other Senate Republican, voted against the health reform bill in 2009 and 2010, and then joined Republicans in their various efforts to undermine or repeal the law, until she retired in 2013.

But now it looks like all the time Democrats wasted on negotiating with Snowe, and allowing her to help shape the legislation, has paid off. Snowe has, to my knowledge, become the first contemporaneous Republican senator, current or former, to acknowledge that a Supreme Court challenge meant to cripple Obamacare is built on a tissue of lies. If the Court sides with Obamacare opponents, her comments will become incredibly relevant to the ensuing political shitstorm.

“I don’t ever recall any distinction between federal and state exchanges in terms of the availability of subsidies,” Snowe admitted, according to New York Times health reporter Robert Pear.

“It was never part of our conversations at any point,” said Ms. Snowe, who voted against the final version of the Senate bill. “Why would we have wanted to deny people subsidies? It was not their fault if their state did not set up an exchange.” The four words, she said, were perhaps “inadvertent language,” adding, “I don’t know how else to explain it.”

There are two intersecting argumentative threads that one must untangle to really understand King v. Burwell. The first, specialized one addresses the question of what the text of the Obamacare statute means. Does it, in all its interlocking, cross-referenced parts, provide authorization for the IRS to issue subsidies to all exchanges? Or does it prohibit those subsidies in the three dozen states that have availed themselves of federal fallback exchanges, through Healthcare.gov? Only the most cribbed reading of the law—literally less than a sentence of the whole text—suggests the latter.

The second thread is, if anything, even more straightforward: What were the framers of the Affordable Care Act trying to do? Were they trying to stitch together a harmonious system across all state borders, with subsidies available everywhere? Or were they trying to coerce states into setting up their own exchanges by threatening to withhold subsidies from their citizens, and impose chaos on their insurance marketplaces? There is no evidence to suggest that the goal of the Affordable Care Act was the latter.

These threads invariably become entwined for two reasons. First, if Congress was trying to create an incentive for states to set up their own exchanges, then its failure to provide those states clear notice of the threat in the law raises serious constitutional concerns. But also, judges have consciences and intellectual standards, too, and may in some cases allow their understanding of the political history of the Affordable Care Act to influence the way they think about what the text of the law actually conveys. This explains why conservatives have been engaged in a year-long campaign to revise the history, and assert that the framers of the ACA knew all along that threatening the states would leave the law vulnerable to ruin, but did it anyway.

Pear’s article largely elides the textual question—if anything, it proceeds from the assumption that Obamacare opponents have a better legal case than they really do. But at the same time, it is devastating to the spin that Republicans are putting on the ACA’s history to bolster the plaintiffs in King.

Here, for instance, is Snowe’s erstwhile colleague, Senator Orrin Hatch, who served with Snowe on the committee that drafted Obamacare, claiming that the law’s drafters, not its enemies, are falsifying the historical record to influence judges.

“The Democrats were arguing that the only way to get the states to sign up is to put the pressure on them by making them have to do a state exchange, so it’s kind of disingenuous for them to come in now and say they didn’t mean that,” Hatch told reporter Todd Zwillich in this DecodeDC feature. “I’m not the only one that knows that. Their attitude was, you’ll never get all the states to sign up if you don’t force them. Yeah, I don’t think there’s any doubt in the Democrats’ minds they wanted to do that because they were afraid the states wouldn’t form their own exchanges. Now they’re trying to say they didn’t say that, but they did.”

With respect to King, almost every Republican member of Congress is, like Hatch, caught in the grip of the right’s collective amnesia and fantasia. The spectacle of it is breathtaking to sentient observers of the health reform process, but ultimately meaningless if the Supreme Court does the right thing in June, and rules for the government. If it doesn’t, the textual argument will effectively be over. But, for the purposes of reading such a bad decision into its proper context, addressing the ensuing chaos, and clarifying for the record for the public, the historical argument will take on even greater significance—which makes Snowe’s contribution extremely valuable.

 

By: Brian Beutler, Senior Editor, The New Republic, may 27, 2015

May 28, 2015 Posted by | Affordable Care Act, Health Exchanges, Olympia Snowe | , , , , , , | 1 Comment

“GOP Irrational Hostility”: A Mean-Spirited Interpretation Would Deny Millions Health Care Coverage

Millions of Americans only recently rescued from worry and hardship by acquiring health insurance now face losing it because Obamacare’s foes won’t end their obsessive opposition.

The latest threat to the Affordable Care Act is a Supreme Court case, due to be decided this spring, that will determine whether all Americans are eligible for the subsidies that make coverage affordable. The Court should allow working families all across the country to keep their life-saving subsidies.

The case turns on the kind of technicality that only a lawyer could love. The law says citizens are eligible for subsidies purchased through health-insurance exchanges established “by the State.”

Because of intense ideological hostility, 36 state governments betrayed their uninsured residents and refused to set up exchanges. In those cases, the law called for the federal government to set up exchanges for the states.

Obamacare’s implacable enemies are arguing that only Americans who were lucky enough to live in the 14 states that set up their own exchanges are eligible for subsidies, thereby excluding those who live in two-thirds of our country.

Since 85 percent of purchasers need subsidies to make insurance affordable — the subsidies cut monthly premiums on average from $346 to $82 — that nonsensical, mean-spirited interpretation would deny millions of working Americans decent health insurance.

That’s not what Congress intended when it passed the most sweeping reform of American health care in nearly 50 years. It didn’t mean to punish millions of citizens by denying them health insurance because of what state they live in. The architects of reform — the chairmen of the relevant committees — confirmed this obvious truth in a recent op-ed.

And it’s not only the five million Americans losing coverage who will suffer if the Supreme Court rules against national subsidies. The whole system will risk collapse as healthier enrollees succumb to the cost squeeze first and drop out, leaving sicker, more desperate, more expensive clients behind. Other components of the law — such as the one requiring large employers to offer coverage to their workers — could also be questioned in states that didn’t establish their own exchanges.

Trying to downplay the impact of a potential decision that would cut off millions of Americans from their health insurance, some Obamacare opponents claim states would quickly set up their own exchanges in response.

But there’s no sign that irrational hostility has weakened much to the law — even as millions of Americans experience its benefits, and besides, the vast majority of state legislatures will be out of session by the time the High Court rules in June, so no quick fix will be available.

Another answer would be to change the health-care law to remove any uncertainty about who’s eligible for subsidies, but of course the new GOP majority in Congress is too busy trying to repeal the law altogether to usefully amend it.

Indeed, the current legal attack on the Affordable Care Act is only part of an unrelenting five-year campaign of opposition, one that will presumably continue regardless of the Supreme Court’s decision in this case. There’s no clear historical precedent for so much time, effort and emotion being poured into resisting an improvement in the material well-being of fellow citizens.

Think how American health care could be improved if all that angry passion was redirected into fruitful cooperation! Not even its biggest supporters are content with the Affordable Care Act as it is. Health care is still too expensive, too many people are still left out, health outcomes are still disappointing.

But we can’t address those problems until fiery Obamacare opposition cools. The Supreme Court can help the process along by acknowledging that Congress intended for all Americans — not just those living in certain states — to have access to affordable health care.

 

By: William Rice, The National Memo, February 12, 2015

February 15, 2015 Posted by | Affordable Care Act, Health Exchanges, Republicans | , , , , , | Leave a comment

“What Happens If The Dog Catches The Car?”: GOP Faces Health Care Challenge It’s Totally Unprepared For

We don’t yet know what the Supreme Court will do in the King v. Burwell case, but we have a fairly good sense what will happen if the Supreme Court sides with Republicans. In effect, there will be chaos that could do considerable harm to insurers, families, state budgets, the federal budget, hospitals, and low-income children.

It sounds melodramatic, but the fact remains that if the GOP prevails, more Americans will literally go bankrupt and/or die as a result of this ruling.

With this in mind, I couldn’t help but find some sardonic humor in the House Republicans’ request for information from the Obama administration yesterday.

Senior House Republicans are demanding that the Obama administration reveal its contingency plans in the event that the Supreme Court scraps Obamacare subsidies in three dozen states. […]

“Specifically, we are examining the extent to which the Department of Health and Human Services (HHS), and other relevant agencies of the federal government, are preparing for the possible consequences of the Supreme Court’s decision in the case of King v. Burwell,” wrote the lawmakers.

The fact that the GOP lawmakers didn’t appreciate the irony was itself unfortunate, but the simple truth is that the underlying question – what happens if the Supreme Court takes this stupid case seriously and guts the American health care system? – is one Republicans should be answering, not asking.

If we had a normal, functioning political system, represented by two mainstream governing parties, the solution would be incredibly simple. If the Supreme Court said the language in the Affordable Care Act needed clarification, lawmakers would simply approve more specific language before Americans felt adverse consequences. The legislative fix would be quite brief and the whole process could be wrapped up in an afternoon.

No one, in this scenario, would actually suffer.

But in 2015, Americans don’t have the benefits of a normal, functioning political system, represented by two mainstream governing parties. On the contrary, we have a dysfunctional Congress led by a radicalized, post-policy party that has no use for governing, and which welcomes adverse consequences no matter how many Americans suffer.

And the question for them is what they intend to do if, like the dog that catches the car, Republican justices on the Supreme Court rule their way in the King v. Burwell case. Sahil Kapur had a terrific report on this overnight.

Many Republicans would view it as a dream come true if the Supreme Court were to slash a centerpiece of Obamacare by the end of June. But that dream could fade into a nightmare as the spotlight turns to the Republican Congress to fix the mayhem that could ensue.

“It’s an opportunity that we’ve failed at for two decades. We’ve not been particularly close to being on the same page on this subject for two decades,” said a congressional Republican health policy aide who was granted anonymity to speak candidly. “So this idea – we’re ready to go? Actually no, we’re not.”

Republican leaders recognize the dilemma. In King v. Burwell, they roundly claim the court ought to invalidate insurance subsidies in some three-dozen states, and that Congress must be ready with a response once they do. But conversations with more than a dozen GOP lawmakers and aides indicate that the party is nowhere close to a solution. Outside health policy experts consulted by the Republicans are also at odds on how the party should respond.

Republicans could approve a simple legislative fix, but they don’t want to. Republicans could introduce their ACA alternative, but they don’t want to do that, either. They could encourage states to create their own exchange marketplaces, largely negating the crisis, but they don’t want to do that, either.

So what do GOP lawmakers want? They haven’t the foggiest idea.

Kapur talked to a GOP aide who works on health care policy on Capitol Hill who said, “Our guys feel like: King wins, game over, we win. No. In fact: King wins, they [the Obama administration and Democrats] hold a lot of high cards. And we hold what?”

Millions of families who would be screwed by Republican victory in this case will be eager to hear an answer to that question.

 

By: Steve Benen, The Madow Blog, January 29, 2015

January 30, 2015 Posted by | Affordable Care Act, Health Exchanges, Republicans | , , , , , , , | 2 Comments

“Playtime Is Over For Obamacare’s Foes”: And Still, Republicans Don’t Have A Serious Plan B

Friends of Obamacare, horrified that the Supreme Court has taken a case that could blow up the federal health insurance exchanges, should recalibrate their dread. While the health reforms were safely humming along, there was little political price for demanding their demise. Thanks to the Supreme Court, now there is.

Years of carpet-bombing assaults on Obamacare have left many Americans thinking that they don’t like the Affordable Care Act. But close down the federal exchanges covering 6 million people (so far) in 36 states and they may think otherwise. With a vengeance.

Here are the stakes in King v. Burwell: Should the justices strike down subsidies for coverage in the federal exchanges, only the very sick would hang in. That would be the end of the federal exchanges.

Donald Taylor, a health policy expert at Duke University, likens the Obamacare attackers to a dog chasing a car. “What’s the dog going to do if it catches the car?” he said to me.

Subsidies would be untouched in the 12 or 14 state-run exchanges (depends on how you define them), the majority of which are in blue states. Red-state politicians — oddly the biggest foes of a law that in effect transfers tax dollars from high-income liberal states to poor conservative ones — would have a mess on their hands.

“Some Southern states will be back up to 20 percent uninsured,” Taylor said, “and that doesn’t sound politically stable.”

The solution for Republicans would be a plan B. But they don’t have a serious plan B.

Republicans do have a proposal of sorts, composed early last year by three senators — Richard Burr of North Carolina, Orrin Hatch of Utah and now-retired Tom Coburn of Oklahoma. But it was written mainly as a political document with which to hit Obamacare over the head during the 2016 campaign — not as a ready-to-plug-in substitute.

Let’s look at the Republican plan that we aren’t supposed to examine too closely.

For starters, it would empower private insurers to play a bigger role in the relationship between you and your doctor — encouraging them to shrink the network of doctors and hospitals you may visit. So much for “choice.”

It also would cut government subsidies for many working stiffs who earn too much to claim poverty but too little to afford decent private coverage. And it would enable insurers to charge older people far more for their insurance. Obamacare lets them charge three times as much. The Republican plan would let them charge five times as much.

Gone would be the minimal coverage standards. That means the insurers could more easily deny payment for services that Obamacare considers basic. For all these gifts to private insurers, the industry actually prefers Obamacare because its subsidies create many more customers for their products.

The Republican replacement plan (as written so far) contains lots of other controversial elements pretty much ignored because few have taken it seriously. For example, it would tax employer-sponsored health benefits. (Obamacare’s “Cadillac tax” on luxurious coverage does some of that, for which it continues to take a beating.)

A group of conservative economists, led by Douglas Holtz-Eakin, has scored the Burr-Hatch-Coburn plan and claims that it would cut deficits by $1 trillion. These are reputable economists, Taylor says, but the text they were working with was “incredibly vague” on where the cap on the taxes would be put.

“The score is a number, and the text on which they did the score was ambiguous,” he said. “It shows just how hard this is.”

So now Obamacare won’t be the only piñata in town.

The Supreme Court will take up King v. Burwell in March. We do live in interesting times.

 

By: Froma Harrop, The National Memo, January 8, 2015

January 9, 2015 Posted by | Affordable Care Act, Health Exchanges, Republicans | , , , , , , | Leave a comment

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