“An Alternate History”: The 3 Stages Of ObamaCare Trutherism
As we approach the March 4 oral arguments for King v. Burwell, the Supreme Court case that may decide the fate of ObamaCare, it’s worth delving further into a legal argument that approaches 9/11 truther levels of insanity.
As I observed in a recent piece for The Week, there are two ways that the argument can proceed in its attempt to establish that the Affordable Care Act does not authorize health insurance subsidies on federally established state exchanges. The first is to say that no matter what lawmakers intended to accomplish, they mangled the letter of the law to say that the subsidies will not flow to such exchanges. Whoops.
The other argument, fully embraced by the law’s opponents at the Supreme Court, is that legislators intended to deny subsidies to the states — even though that would go against everything they set out to accomplish.
These are both terrible arguments; one would deny millions of people health insurance over the equivalent of a typo, while the other flies in the face of common sense and the historical record. But they permit opponents of the ACA to switch from one to the other as a means of evading devastating objections to any individual argument.
A classic example of a pundit engaging in this dance is Ramesh Ponnuru, who tries to split the difference between the two variants. His column in Bloomberg is a useful distillation of the three stages of Affordable Care Act trutherism.
Ponnuru starts out by suggesting that the letter of the law is clear — “nowhere does the law authorize subsidies for plans purchased on those federally run exchanges.” But you can arrive at this conclusion only by using terrible, unworkable methods of statutory construction. You don’t have to take my word for it — the brief submitted by major legal scholars, including Ronald Reagan’s solicitor general and one of the country’s foremost experts in statutory construction, explains this in clear detail.
When you focus on the statute as a whole, rather than on the isolated phrase that appears to confine subsidies to the exchanges established by state governments, it is clear that exchanges established by the federal government on the state’s behalf are “[e]xchange[s] established by the State,” as the statute defines them. Indeed, the ACA is an excellent illustration of why phrases in statutes should be read in context. Doing so produces a coherent reading of the statute’s purpose, whereas the reading of the ACA’s opponents, represented by Jonathan Adler and Michael Cannon, produces numerous anomalies and puts the statute at war with itself.
There’s a reason why Adler and Cannon haven’t been content to rest on the typo argument. It sounds superficially plausible in a seminar room, but in the broader world, people are going to wonder why literally none of the relevant federal or state officials read the statute in accordance with its allegedly clear and unambiguous meaning. (If the statute is not clear and ambiguous, under well-settled precedent the courts are supposed to defer to the judgment of the IRS, which will be responsible for administering the subsidies.)
As a sort of way station between the two arguments, then, Ponnuru proceeds to an argument we can label, “Looks like those clowns in Congress did it again. What a bunch of clowns.” In other words, various members of Congress had different intentions, many weren’t really paying careful attention — who can say what Congress was really trying to do? As Ponnuru writes, lawmakers are “generally not detail-oriented people.”
There is a grain of truth to this argument — Congress is a “they,” not an “it,” as social scientists say, and we should be careful in making broad generalizations. Nonetheless, everybody makes reasonable judgments about what Congress is trying to accomplish, not least because it would otherwise be impossible to practice law or interpret history. We can understand why the Wilmot Proviso, for example, broke down on sectional rather than partisan lines without claiming to know the precise subjective intentions of each and every member of Congress.
And in this case, the idea that we can’t reasonably infer what Congress was trying to do is absurd. The amicus brief written by Nicholas Bagley, Thomas Merrill, Gillian Metzger, and Abbe Gluck is particularly strong on this point. Federal backstops are not some mysterious new innovation of the ACA — they’re a bog standard part of cooperative federalism. They’re inserted in statutes when Congress wants to ensure that benefits of programs administered primarily by states will flow to citizens even if the states decline to participate.
Congress did not intend for the federal backstop to fail, and it was universally understood that the insurance exchanges could not work without tax credits and the individual mandate. There’s only a mystery here if you hate the ACA so much that you’ve become willfully blind to what it’s trying to accomplish and how it relates to previous statutes in the New Deal/Great Society tradition.
As such, it makes sense that the ACA’s opponents would develop an alternate history that can actually reconcile their reading of the statute with an explanation of Congress’ intentions. The Supreme Court is much less likely to strip insurance from millions of people based on what the architects of the suit initially identified as a “glitch,” than if it convinces itself that it’s upholding the will of Congress.
Ponnuru doesn’t go quite so far as to say that he’s “100 percent certain” about what the ACA’s drafters were setting out to accomplish, but he does argue that the Adler/Cannon interpretation makes sense. Denying subsidies on federally established exchanges, Ponnuru asserts, is “not at all absurd in principle.” After all, states that don’t comply with the requirements of Medicaid don’t get the money — why shouldn’t we think that the same principle of coercion is at work in the exchanges?
But the contrast with the ACA’s Medicaid expansion destroys Ponnuru’s argument rather than fortifying it. The Medicaid expansion shows how Congress proceeds when it’s actually trying to coerce states. To state the obvious, if you’re making a threat, you don’t keep the consequences of failing to comply a secret. On the flip side, legislators were well aware that some states would not or could not establish their own exchanges, and this is why they wanted to establish a backstop.
The weakness of all these arguments explains why apologists for the latest legal war on the ACA like to alternate between them. If a critic points out that you should take the context of the entire statute into account, just say that Congress was consciously trying to coerce the states, not create a federal backstop. When people point out that this is nonsense, return to asserting that Congress messed up the language. Repeat as necessary.
Hopefully, at least five justices will see through this game of legal three-card monte.
By: Scott Lemieux, The Week, February 20, 2015
“Who Are These People”: ‘I Don’t Like The Idea Of Throwing People Off Their Health Insurance’
When it comes to the insanity surrounding the King v. Burwell case, we already have a pretty good sense of most of the relevant angles. We know who supports the ridiculous case and why, what happens if Republican justices go along with this dangerous nonsense, how many families will suffer and where, etc.
We don’t, however, know much about the specific plaintiffs themselves.
Remember, when challenging a federal law, it’s not enough for someone to get a lawyer, go to court, and demand the law be struck down. In the American system, plaintiffs need standing – litigants have to demonstrate that a law harms them in some direct way.
And so, in the painfully absurd King v. Burwell case, anti-healthcare lawyers went out and found four people willing to sue because they’re eligible under the Affordable Care Act for insurance subsidies. They’ve been largely overlooked, but given the possibility that this case will end access to medical care for millions of families, it seems like a good time to ask, “Who are these people who want to destroy the American health care system?”
Stephanie Mencimer reports today on all four of the plaintiffs, and it’s quite a collection of folks. For example, David King of King v. Burwell notoriety, “brought up Benghazi” when asked about the anti-healthcare lawsuit. Rose Luck believes President Obama may be the “anti-Christ” and was elected by “his Muslim people.” But a Virginia woman Brenda Levy stood out as especially significant.
What was more surprising, though, was that she said she didn’t recall exactly how she had been selected as a plaintiff in the case to begin with. “I don’t know how I got on this case. I haven’t done a single thing legally. I’m gonna have to ask them how they found me,” she told me. She thought lawyers involved with the case may have contacted her at some point and she had decided to “help ‘em out.” […]
When I asked her if she realized that her lawsuit could potentially wipe out health coverage for millions, she looked befuddled. “I don’t want things to be more difficult for people,” she said. “I don’t like the idea of throwing people off their health insurance.”
Her case, whether Levy realizes it or not, exists to throw people off their health insurance.
She added that she intends to go to D.C. for the Supreme Court’s oral arguments “It’s an adventure,” Levy said. “Like going to Paris!”
Complicating matters further, three of the four plaintiffs are finding their standing suddenly facing new scrutiny. The Wall Street Journal reported late Friday that King “appears to qualify for veterans’ medical coverage, raising questions about his ability to challenge the law.”
The plaintiffs have persuaded courts to hear their case on the grounds that the subsidies allegedly harm them by subjecting them to the law’s requirement to carry insurance or pay a penalty. Without the subsidies, insurance would be too expensive for them, they contend, thus making them exempt from having to pay the fine for lacking insurance.
But Mr. King could avoid paying that fine or any insurance premiums because, according to him and his attorneys, he served in the Army in Vietnam. That qualifies him for medical coverage with no premiums through the Department of Veterans Affairs, benefits and legal experts say. In an interview at his home here, Mr. King said he had been to a VA medical center and had a VA identification card, which typically serves as proof of VA-care enrollment.
Legal experts say the fact that Mr. King could avoid paying the penalty for lacking insurance by enrolling in VA coverage undermines his legal right to bring the case, known as “standing.” The wife of a second plaintiff has described her husband on social media as being a Vietnam veteran. The government previously questioned the standing of a third plaintiff on the grounds that her income may exempt her from paying the penalty for lacking insurance, but a lower court didn’t address the issue.
Levy, the one who doesn’t want to throw people off their health insurance despite her role as a plaintiff in this case, will qualify for Medicare this June – which would remove her from the ACA coverage system anyway.
These fresh details reinforce the impression that the entire King v. Burwell case seems like a transparent scam, and as the WSJ added, the standing issues “could create skepticism about the strength of the challengers’ case and highlight the difficulty of finding plaintiffs to show the health law’s subsidies harm Americans.”
By: Steve Benen, The Maddow Blog, February 9, 2015
“An Unexploded Ordnance”: Why Republicans Secretly Hope The Supreme Court Will Save Obamacare
Because a Supreme Court decision for plaintiffs in King v. Burwell would impose extreme hardship on Affordable Care Act beneficiaries in 34 states and leave President Obama’s signature achievement in a frightening state of limbo, the law’s supporters are united in opposition to such a ruling.
And for the same reason, most analyses of the consequences of an adverse King decision have centered around the practical nightmare the ruling would create: How would states react? Congress? Insurance companies and providers? Obama himself? Will the pressure to fix the problem grow severe enough to force Republicans into surrender or to cut a reasonable deal?
These are important questions. But individually and combined, they hint at a premise that the aftermath of an adverse King ruling will exclusively effect, and be driven by, existing stakeholders. They neglect that the case itself, which will be decided in late June, is an unexploded ordnance lying in the middle of the 2016 presidential campaign field. An adverse King ruling wouldn’t just introduce familiar, crisis-driven legislative politics. It would likely become the defining issue of the Republican primary and general election. It would leave Republicans strategically and substantively divided over how to contain the fallout. And it would transform Obamacare as an issue from a modest liability for the Democratic candidate, into a factor that unifies the entire party against Republicans and the Supreme Court.
Because movement conservatives have signed on enthusiastically to the arguments of the King case, they convey the impression that the right is poised and eager for the Court to do their bidding. But activists and elected officials have different imperatives, and if you immerse yourself in the Republican Party’s posture toward this case—its public attestations, blind quotes, and conspicuous silences—a much more nuanced picture emerges. If the Court grants Republicans a “victory,” many actual Republicans won’t consider it a victory at all, and the competing concerns of anti-Obamacare zealots, industry-friendly pols, swing state incumbents, governors, and presidential candidates will break out into the open.
Democrats would obviously rather win than lose this case, and Republicans vice versa. But the truth is, as one anonymous GOP congressional health care aide conveyed to TPM’s Sahil Kapur, “In fact: King wins, they [the Obama administration and Democrats] hold a lot of high cards. And we hold what?”
That’s just one anonymous aide. But a lot of Republicans are privately “joking” that they’d be happier losing this case than winning.
Some Republican insurance commissioners take a dim view of the King case publicly. Others have communicated their squeamishness by keeping their heads down.
States on both side of the issue have filed briefs with the Supreme Court. But only six red states—Oklahoma, Alabama, Georgia, Nebraska, South Carolina, and West Virginia—joined a brief on behalf of the petitioners. Conspicuously missing are deeply conservative states like Texas, with large beneficiary pools, or any swing states under GOP control. Republican senators from many of those states—including Wisconsin, Ohio, and Florida—are in cycle in 2016.
By contrast, the following states have signed on to a brief supporting the government: Virginia, Kentucky, Massachusetts, Pennsylvania, California, Connecticut, Delaware, Hawaii, Illinois, Iowa, Maine, Maryland, Mississippi, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Oregon, Rhode Island, Vermont, Washington, and the District of Columbia. Many of these are healthcare.gov states, and thus have a direct stake in the outcome.
The outcry for a fix will be broad, sustained, and lockstep, but it will meet wildly different audiences. Everyone in the GOP primary field will face extensive pressure to treat an adverse decision as an opportunity to get rid of the law altogether, but some of them will be governors or former governors who won’t be as amenable to using constituent suffering to leverage an unrealistic political goal. Republican Senate candidates from the above-mentioned Wisconsin, Ohio, and Florida, but also from Pennsylvania, New Hampshire, Illinois and elsewhere, will quickly see their political fortunes become entwined with the cause of fixing Obamacare.
As chaos grows, it will be tempting for these Republicans to claim that they and the broader right bear no culpability. Obama and Obamacare did this to them. But that message won’t wash outside of precincts where antipathy to the president already runs extremely deep. Elsewhere it’ll be drowned out by a simple but forceful argument, promulgated by people with much larger megaphones—and by the fact that everything was basically OK until five Republican-appointed Supreme Court justices intervened. Unlike Republicans, the team of organizers, lawyers, and political operatives who have banded together to save the ACA have adopted a strategy that precludes them from discussing their political contingency planning. But it stands to reason that Obama and Clinton would both lay the damage at the feet of those justices, and the party on whose behalf they had acted. The ruling would create a hydra of loyal but politically disengaged Obama supporters, consumer groups, health care providers, and other actors, none of whom will be satisfied with Republican excuse-making and inaction.
That returns us to the related question of whether Republicans would respond to the pressure by betraying the conservative base. Would they fix the law? Or perhaps patch it temporarily? Generally speaking, Republicans only break faith in this way when persisting would invite unsurvivable political damage. The various debt limit and government shutdown fights of the Obama years are the most similar precedents. But there are others. In recent years, Republicans proved they were willing to allow extended unemployment benefits to lapse, and the payroll tax holiday to expire. By contrast, they also revealed that they preferred to allow taxes on top earners to increase rather than explain to the broader public why they allowed taxes to increase up and down the income ladder.
In Arkansas, a now-retired Democrat expanded the state’s Medicaid program dramatically. The GOP-controlled legislature has since balked at multiple opportunities to rescind the expansion—even as its majority grew and a Republican moved into the governor’s mansion this year.
Which is the long way of saying that gaming this out is tough. But the question will be whether a ruling for King plaintiffs puts Republicans on their heels briefly, or whether it dominates campaign politics through November 2016.
By: Brian Beutler, The New Republic, February 9, 2015
“A Rickety Scaffold Of Fictional History”: The Sham Lawsuit That Could Eviscerate Obamacare
Republicans in the House voted on Wednesday to repeal the Affordable Care Act—for the fifty-six time. After four years these show votes have become a tedious joke. But Wednesday’s action had bleaker implications, as it was cast in the shadow of a lawsuit that could undermine the healthcare law in fatal ways.
In a few weeks the Supreme Court will hear oral arguments in King v. Burwell, which contends that the text of the ACA allows the IRS to give subsidies only to people who purchase insurance through exchanges set up by their state, and not to those who rely on the federally run marketplace. If the plaintiffs prevail, some 7 million people in the thirty-four states that have declined to set up their own exchanges would lose the tax credits that subsidize their insurance. Coverage would likely become unaffordable for many of them; without enough people in the marketplace, the law could collapse into a “death spiral.” In human terms, a group of hospitals wrote in a brief supporting the government, a ruling in favor of the plaintiffs “would be a disaster for millions of lower- and middle-income Americans…. The ranks of the uninsured will swell again, with all that portends in the way of untreated illness and overwhelming debt.”
To build their case, the plaintiffs have erected a rickety scaffold of fictional history around a single phrase in the 906-page law. The section of the law in question concerns the calculation of subsidies available to people “enrolled in through an exchange established by the State.” The plaintiffs argue that lacking an explicit reference to subsidies available to people enrolled in the federal exchanges, the text indicates that subsidies are only available in states operating their own. Furthermore, the plaintiffs argue, this was not sloppy writing but instead “reflects a specific choice by Congress” to design the subsidies as a carrot to entice states to establish their exchanges and punish them if they failed to do so.
The lack of structural integrity in the plaintiff’s case has become increasingly obvious in the past week, thanks to a sheaf of briefs filed states, lawmakers, and the healthcare industry. In sum, there’s about zero evidence for the challengers’ version of history, and what proof they do muster is shoddy. For example, one brief cites former Nebraska Senator Ben Nelson, who played a defining role in designing the exchanges. According to the plaintiffs, Nelson thought it was “insufficient to merely allow states the option to establish Exchanges,” hence the need for a stick. But Nelson himself stated recently that he “always believed that tax credits should be available in all fifty states regardless of who built the exchange, and the final law also reflects that belief as well.”
It’s not hard to find conservative lawmakers, like Senate majority leader Mitch McConnell, who will argue now that “the language of the law says…subsidies are only available for states that set up state exchanges.” But the idea that subsidies might be withheld was never articulated by anyone during the congressional debate, nor in the months after the law’s passage—even when states began to signal they would not operate their own exchanges. Instead, the same Republicans who endorse the lawsuit now were passing laws and making statements that affirmed the idea that subsidies would be available in all states. Statements from legislators and state officials that back up the plaintiff’s version of legislative history were made only after the implications of that ambiguous phrase in the ACA began to circulate around right-wing thought shops like the American Enterprise Institute and the Cato Institute.
If Congress did intend to use the subsidies as an incentive for states to set up their own exchanges, the fact that many state officials were clueless about the possible loss of tax credits is perplexing. None of the states “had reason to believe that choosing a federally facilitated exchange would alter so fundamental a feature of the ACA as the availability of tax credits,” reads a brief filed last week by nearly two dozen attorneys general representing red and blue states alike. “Nothing in the ACA provided clear notice of that risk, and retroactively imposing such a new condition now would upend the bargain the states thought they had struck,” it continues. The Washington Post’s Greg Sargent spoke with a number of Republican state officials involved in the implementation of the ACA who confirmed that the possibility of losing subsidies was never part of discussions about whether or not to set up state exchanges.
The court could strike a blow against the ACA without fully accepting the strained version of history offered by the challengers. But as legal scholar Linda Greenhouse describes in The New York Times, doing so would require the justices to set aside their own principles and precedents. “The court has permitted itself to be recruited into the front lines of a partisan war. Not only the Affordable Care Act but the court itself is in peril as a result,” Greenhouse writes. “To reject the government’s defense of the law, the justices would have to suspend their own settled approach to statutory interpretation as well as their often-stated view of how Congress should act toward the states.”
It’s tempting to dismiss the lawsuit as a deeply silly partisan attack, akin to the House GOP’s repeated votes for repeal. Its basis may indeed be fluff. And yet it’s entirely possible that it will be this absurd case—not sabotage by Republicans at the state level; not lawsuits challenging the law on its constitutional merits—that dooms the signature achievement of the Obama years, at an immense human cost.
By: Zoe Carpenter, The Nation, February 5, 2015
“Judicial Activism”: What It Will Take For SCOTUS To Buy Conservative Arguments On ACA Subsidies
A lot of the points that the New York Times‘ legal correspondent Linda Greenhouse covers today in an overview of the stakes involved in King v. Burwell have been made in various places. But pulled together as they are, you can see exactly how radical an exercise in judicial activism it would take for SCOTUS to agree with the petitioners in this case.
First of all, there’s never been a SCOTUS decision validating anything like the principles of statutory interpretation the anti-ACA camp is demanding:
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. (They do disagree on such matters as the legitimacy of using legislative history, or on what weight to give a law’s ostensible purpose; I’m referring here to how they actually read a statute’s words.)
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.”
That militates against the sort of literalist meaning the petitioners are asking for. But worse yet from a conservative point of view, punishing the states for exercising an option ACA clearly provided for–allowing the federal government to create purchasing exchanges for them–would violate supposedly sacred principles of federalism.
A fascinating brief filed in support of the government by an unusual coalition of 23 red-state and blue-state attorneys general (some from states with their own exchanges and others from federal-exchange states) maintains that the challengers’ narrative would “violate basic principles of cooperative federalism by surprising the states with a dramatic hidden consequence of their exchange election.”
This brief, written in the Virginia attorney general’s office, continues: “Every state engaged in extensive deliberations to select the exchange best suited to its needs. None had reason to believe that choosing a federally facilitated exchange would alter so fundamental a feature of the A.C.A. as the availability of tax credits. Nothing in the A.C.A. provided clear notice of that risk, and retroactively imposing such a new condition now would upend the bargain the states thought they had struck.”
There are abundant Supreme Court precedents that require Congress to give states “clear notice” of the consequences of the choices a federal law invites them to make. Justice Samuel A. Alito Jr. invoked that principle in a 2006 case interpreting the Individuals With Disabilities Education Act, a case cited by the 23 attorneys general. The government’s own brief, filed by Solicitor General Donald B. Verrilli Jr., observes that “it would be astonishing if Congress had buried a critically important statewide bar to the subsidies under this landmark legislation” in technical sub-clauses.
Yes, “astonishing” is the right word to describe the implications of a SCOTUS action to blow up the Affordable Care Act. But not necessarily surprising.
By: Ed Kilgore, Contributing Writer, Political Animal, The Washington Monthly, February 6, 2015
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