“Hello Public Option”: The Public’s Inch-Deep Hate Affair With The Individual Mandate
Maybe the individual mandate is doomed, as an agitated-slash-celebratory Twitterverse seemed convinced after conservative Supreme Court justices posed challenging questions about it (shocking!) on the second day of arguments on the Affordable Care Act. If the justices vote later this year to kill it, with the possibility that the whole law will collapse as a result, Republicans would be vindicated in their fight against “big government.” But in practical terms, would the country really know what it has lost?
From a political standpoint, the mandate invented by the GOP of yore (“yore” being a dozen years ago) has been manna for today’s GOP. Polling shows the requirement to buy insurance or pay a fine — meant to discourage freeloaders — has become highly unpopular. Strangely, the dreaded mandate is not particularly unpopular in Massachusetts, the only state that charges penalties for not buying coverage.
Disapproval of the individual mandate nationally, meanwhile, seems to be a mile wide but not all that deep. There’s evidence that many people don’t understand what it is, why it is, and how it would affect them, and that their answers change depending on word choice and word sequence.
They like it better – about even with disapprovers in a Pew poll — if the last thing they hear is about subsidies to help lower-income people buy insurance. They like it somewhat when it’s explained that without it, people would just buy insurance when they got sick (driving up costs for everyone) or alternatively, insurance companies could not be required to cover people with existing medical problems (because without a mandate, there wouldn’t be enough healthy people in the pool). They like it best – 61 percent approval in a Kaiser Family Foundation poll — when they’re told it won’t apply to most people because they have insurance through work.
That spike to 61 percent, nearly twice as high as the 33 percent who support the mandate when asked a simple up-or-down question, is telling. It suggests many Americans aren’t comrades-in-arms with conservatives waging an ideological battle – they’re just people nervous about change and relieved to hear it won’t affect them.
Attitudes toward the overall health law are just as complicated as those toward the mandate. A new CNN/ORC International poll, like most polls, finds that the law is unpopular – favored by 43 percent, opposed by 50 percent. Breaking down the numbers further, CNN found 43 percent favor it, 37 percent oppose the law because it’s too liberal, and 10 percent oppose it because it’s not liberal enough. Hello public option!
You have to wonder if that 10 percent – which has gone as high as 14 percent in earlier CNN polls – keeps doggedly voicing opposition to the law in hopes the Supreme Court will strike it down and force Congress to regroup. At some point, as 50 million uninsured rises to 60 million and 70 million and higher, as more states approach the astonishing Texas rate of 26 percent uninsured, Congress may decide it has to do something. And, barred from effectively regulating the private market, there will be no options except the public option – Medicare for all.
That should be a safe course. After all, the policy already exists. But in the current climate it’s not hard to envision a conservative challenge to Medicare, and who knows what the Supreme Court might do?
By: Jill Lawrence, The National Journal, March 27, 2012
Justice Kennedy’s “Nuanced View”: A Bad Beginning And A Better Ending
The Constitution’s words enabling Congress to “regulate commerce…among the several states” gives the United States broad authority over economic matters — although non-economic regulation is far more suspect. Early in today’s argument, however, several of the justices appeared poised to impose an entirely novel limit on Congress’ authority — suggesting that laws which require, in Justice Kennedy’s words, an “affirmative duty to act to go into commerce” is somehow constitutionally suspect. So there were no shortages of pointed questions about the Affordable Care Act’s requirement that everyone either carry health insurance or pay slightly more income taxes.
There are two reasons why this requirement is necessary. The first is that, because the law prohibits insurers from denying coverage to patients with preexisting conditions, it must also ensure that healthy people enter the insurance market before they become sick. If patients can wait until they get sick to buy insurance, they will drain all the money out of an insurance plan that they have not previously paid into, leaving nothing left for the rest of the plan’s consumers. The second reason relates to a problem with our health system that long predates the Affordable Care Act. Because emergency rooms must provide at least some degree of care free of charge to people who cannot afford it, these costs wind up being transferred to persons with insurance — driving up annual premiums as much as $1,100 on the average patient.
Initially, the Court’s conservatives appeared highly credulous of the plaintiffs’ false claim that upholding the health reform would necessarily enable the federal government to do absolutely anything. Solicitor General Don Verrilli addressed this question by explaining that the health care market is unique in that it is the only market that everyone inevitably participates in — we all get sick at some point — and that, because of health care’s sudden and unexpected costs, people typically pay their health bills through insurance. Thus, he explained, because everyone is already caught up in the health care market, the Affordable Care Act does not impose any kind of “duty…to go into commerce” — it merely tells people who are already in the health care market to make sure they pay for their health costs through insurance.
While Verrilli was still at the podium, the Court’s conservatives did not seem to buy this claim. A ray of hope emerged at the end of the oral argument, however, when Justice Kennedy expressed a somewhat nuanced view:
[T]he government tells us that’s because the insurance market is unique. And in the next case, it’ll say the next market is unique. But I think it is true that if most questions in life are matters of degree, in the insurance and health care world, both markets — stipulate two markets — the young person who is uninsured is uniquely proximately very close to affecting the rates of insurance and the costs of providing medical care in a way that is not true in other industries. That’s my concern in the case.
There’s a lot going on in this statement. On the one hand, Kennedy is clearly skeptical that, if the Court says this market is unique, the government won’t simply argue that the next market is also unique in the next case. On the other hand, Kennedy also appears sympathetic to the second reason why the mandate is essential — that the problem of uninsurance leads to billions in health care costs being transferred to other health care consumers. A young person who forgoes health insurance is “uniquely proximately very close” to affecting the health care costs of others, and that may be enough to get Kennedy’s vote to uphold the law.
The big loser in all of this debate, however, is the Constitution itself. The Constitution says nothing about unique markets. Or about the need to impose artificial Congress authority to regulate the nation’s economy. It simply says that Congress can “regulate commerce.” The idea that a law which regulates 1/6 of the nation’s economy is not regulating commerce is, frankly, absurd. Nor was there ever any risk that a decision upholding health reform would lead to all things being permissible. There are many things that are not commercial — federal murder laws, assault laws, child neglect laws or sexual morality laws, for example. A law regulating our entire national health care market, however, is clearly and obviously constitutional.
Justice Kennedy may inevitably vote to uphold the law — he may even bring Chief Justice Roberts along with him — but, whatever the Court does this term, it appears increasingly likely that we live under the constitution of Anthony Kennedy, and that we no longer live under the Constitution of the United States.
By: Ian Millhiser, Think Progress, March 27, 2012
“In Text And History”: Founding Fathers Would Approve Of National Healthcare Policy
Our Constitution’s text and history demonstrate that the national healthcare crisis—in which tens of millions of Americans lack access to quality, affordable care—is the sort of national problem that the framers of our founding charter wanted the federal government to have the power to solve.
Our Constitution was drafted in 1787 “in Order to form a more perfect Union”—both more perfect than the British tyranny against which the Founding generation had revolted and more perfect than the flawed Articles of Confederation under which Americans had lived for a decade since declaring independence. George Washington and the other delegates to the Constitutional Convention shared a conviction that the Constitution must establish a national government of substantial power, in contrast to the extremely weak central government of the Articles, which was so dysfunctional that Washington thought it nearly cost us victory in the Revolutionary War. (George Washington was also apparently fine with government mandates—he signed into law the 1792 Militia Act, which required young men to outfit themselves with a musket, knapsack, and, in some cases, a serviceable horse.)
Under our enduring Constitution, Congress has the express constitutional authority to regulate interstate commerce—the healthcare industry comprises nearly 20 percent of our nation’s economy—and tax and spend for the general welfare, as well as the broad power to pass laws that help execute these specific grants of authority.
Given the Constitution’s grant of significant authority to the federal government to act in the interests of the country as a whole, it is no surprise that a majority of the lower court judges who have ruled on the healthcare law have upheld it, including prominent conservative judges. Reagan-appointee Judge Laurence Silberman on the D.C. federal appeals court explained that the attacks on the law have no support “in either the text of the Constitution or Supreme Court precedent.” Another conservative appeals court judge, Jeffrey S. Sutton—who clerked for Supreme Court Justice Antonin Scalia—explained that whether you think the law is good policy or not, it clearly passes constitutional muster.
If the Supreme Court Justices are faithful to the Constitution’s text and history, principles of federalism, and precedent—including decisions authored or joined by some of the current conservative Justices—the Court should conclude the healthcare law is constitutional.
By: Elizabeth Wydra, U. S. News and World Report, March 26, 2012
What If “The Bogeyman Disappears”: How High Court Ruling Could Backfire On GOP
At WaPo’s ‘The Fix,’ Aaron Blake has an interesting read, “On health care, Supreme Court loss could be electoral win.” Blake believes the GOP’s glee about the upcoming Supreme Court ruling on the ACA could backfire — in an unexpected way. Blake explains:
…Some Republicans are worried that their big challenge to Obama’s health care law could backfire come election time.Obama, of course, does not want to see his signature initiative overturned by the Supreme Court, which holds oral arguments on the bill next week and should render a decision by late June. And Republicans who have long railed against the bill would certainly be overjoyed to see the bill struck down.
But in an electoral milieu (yes, we just used that word) in which winning is often based more on voting against something rather than voting for it, losing at the Supreme Court may be the best thing that could happen to either side — and particularly Democrats.
“In a perverse way, Obama is helped if it is overturned, because then he can use it to rally his base,” said GOP pollster Glen Bolger. “If it is not overturned, then Republicans have a frying pan to bash over the Democrats’ head…”
That last point may be a bit of a stretch. It’s just as easy to imagine the GOP looking like whiners, grumbling about a pro-Republican court saying the law is sound. Plus it may be overstating the intensity of opposition to the mandate — many who don’t like it may be willing to at least give it a try, especially if the High Court says it’s OK.
In addition, don’t forget that polls indicate many who opposed the bill wanted a stronger role for government. Asked “What, if anything, do you think Congress should do with the health care law? Expand it. Leave it as is. Repeal it.” in a Pew Research poll conducted March 7-11, 53 percent said “expand it” (33 percent) or “leave it as it is” (20 percent), with just 38 percent supporting repeal.
Blake is on more solid ground, however, in arguing:
Republicans already hate the law, and if it gets struck down, there’s nothing to unite against. Obama may pay a price from his political capital for enacting a law that is eventually declared unconstitutional, but all of a sudden, the bogeyman disappears, and the GOP loses one of its top rallying cries.The Democratic base, meanwhile, would be incensed at the Supreme Court, which has generally tilted 5-to-4 in favor of conservatives on contentious issues, and could redouble its efforts to reelect Obama so that he could fill whatever Supreme Court vacancies may arise.
Blake argues less persuasively that Republicans will still put energy into repealing the law, even after the Supreme Court’s ruling. Seems to me that this would be a huge loser for the GOP. The public was tired of the legislative debate a long time ago. I would agree with Blake’s assessment, however, that Dems may “have more to gain than Republicans do” in terms of the election — even with an adverse ruling.
By: J. P. Green, The Democratic Strategist, March 23, 2012
“He’ll Do What He’s Told”: Conservatives Prepare to Boss Mitt Romney Around
Alexis Levinson of The Daily Caller has a short item up where she interviews some of the executive officers of FreedomWorks about a possible Mitt Romney presidency. They are remarkably sanguine about the possibility:
In a sit down with The Daily Caller, FreedomWorks Chief Operating Office and Treasurer Ryan Hecker, and Executive Director Russ Walker, explained that they were focused on their “Senate strategy” — getting strong conservatives into the Senate who can work with the House conservatives to drive an agenda, regardless of who is in office.
Most Americans assume that leadership in the country comes from the Presidency downwards. Freedomworks thinks it can come from the Congress and that Romney’s actual political opinions are irrelevant:
“The smaller-government movement has always looked for the man or the woman on the white horse to come in, take the presidency and move good policy. And the truth is, you can’t do it without a caucus within the Senate and the House that’s willing to move that same policy,” Walker said. “And our perspective is that if we build that caucus … that they will push good policy to the president regardless of who’s [in the White House].”
The most stunning part has to be when Freedomworks explains what they think will make Romney a historic president:
“My hope is that fifty years from now, someone is going to write a biography and it’s going to be known that Romney was one of the most conservative presidents in American history, and a conservative hero,” Hecker echoed. “And it’s going to be because a conservative Senate put bills in front of him that he signed.”
He joked that fifty years from now, Romney, who is currently being slammed for his political flip-flops, would have “a monument in D.C. or something because of his conservative bona fides.”
What would a monument to political obsequiousness look like?
This sentiment coming from Freedomworks may have first been expressed by Grover Norquist at CPAC. Clearly, the mood is spreading. Expect more conservative organizations and pundits to get the memo as it becomes obvious that Romney is going to be the nominee.
It will be a pretty interesting pitch: “Vote for Romney: He’ll Do What He’s Told.”
By: Noah Kristula-Green, The Daily Beast, March 22, 2012
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