“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
“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
“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
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