“National Solutions To National Problems”: The Affordable Care Act Is Much More Than Politics
The law is a commonsense solution to our country’s broken healthcare system and is clearly constitutional. It eliminates insurance company abuses, makes coverage more affordable for seniors, families, and small businesses, and creates rules that stop insurers from denying care to the sick and jacking up premiums anytime they please.
The logic of the law is that we can make coverage more affordable and fair if everyone has insurance, including the young and healthy and those who don’t expect to get sick. That lowers costs by spreading the risk more broadly.
Our system is fundamentally out of balance. Many people don’t get the care they need, and others only get care at everyone else’s expense—and usually at an emergency room where services are far more expensive than at a doctor’s office. As a result, at least $43 billion in uncompensated care is provided every year, paid for by a $1,000 “hidden tax” in the premiums of every insured person in the country.
Today most people have insurance. Most of the 50 million uninsured want coverage but either can’t afford it or are excluded by insurers because of pre-existing conditions. When the law is fully implemented, families unable to afford coverage will get tax credits to put it within reach. The truth is that the individual responsibility provision, also known as the mandate, will affect only the 2 percent of Americans who have access to affordable coverage but refuse it. That’s what this fight is about: the 2 percent who reject rules that will allow the rest of us to get better, more affordable coverage.
The Supreme Court has consistently ruled that the Constitution gives Congress the ability to develop national solutions to national problems. If the court were to bow to political pressures to strike down the law, it would essentially put regulation of healthcare, which accounts for nearly 18 percent of our economy, beyond the reach of Congress. That is plainly absurd.
The case against the health law is an extension of a transparently partisan political mission to tear down this milestone law as a way to turn President Obama out of office in November. What the partisans selfishly refuse to acknowledge is that there is so much more than politics at stake.
By: Ethan Rome, U. S. News and World Report, March 26, 2012
“Mitt’s Legacy”: Health Reform Worked In Massachusetts
On February 8 the Center for American Progress hosted an event featuring Massachusetts Attorney General Martha Coakley, where she discussed the success of the Massachusetts health care reform law signed by former Gov. Mitt Romney (R) in 2006.
Attorney General Coakley discussed the framework of the law and explained how it’s played an essential role in providing unparalleled access to health care coverage for Massachusetts residents. She and CAP President Neera Tanden also discussed why the Affordable Care Act’s adoption of the Massachusetts framework fits comfortably within the United States’ constitutional authority.
In her introductory remarks, Tanden said that “the Massachusetts law, though sometimes maligned in our national debates, is actually an incredible success story, and has really demonstrated to the country how effective health care reform can be, and the Affordable Care Act can be.”
She mentioned the new CAP report “The Case for the Individual Mandate in Health Care Reform,” and said that Massachusetts’s embracing of the individual mandate in addition to its nondiscrimination over preexisting conditions has allowed its health care reform to flourish.
Flourish so much, Tanden said, that “98.1 percent of the state’s residents were insured at the end of 2010, compared to 87.5 in 2006, when the health care law started. Almost every child in the state is insured, and premiums in the individual market dropped 40 percent as the Massachusetts law was fully implemented.”
In her speech, Attorney General Coakley described the Massachusetts health care law, saying that “in some, but not all particulars, the Massachusetts Act of 2006 was really the prototype for what has become the Federal Patient Protection and Affordable Care Act.” Like the Affordable Care Act, Massachusetts’ reform includes a state-operated health insurance exchange, subsidies for low- and moderate-income individuals, and a mandate that all individuals who can afford health insurance purchase coverage, or an individual mandate.
Coakley said, “The law has resulted in the highest health care access rates in the nation, it has improved both access to and affordability of health care for hundreds of thousands of residents, while maintaining a high level of quality, and I think that’s important.
“We don’t talk about quality so much, but it’s part of what we are concerned about. Access, cost, quality: Ensuring two is relatively easy, if you want to do all three, not so much. And this has been, and is still, our challenge and our goal, and as a work in progress, I think the facts demonstrate that rather than our experiment proving a risk to the rest of the country, Massachusetts as a test laboratory has a lot to offer.”
She said, “We’ve seen significant improvements in the care of our residents. From 2006 to 2010, adults from all income groups, but in particular lower-income adults, experienced a significant decline in reported unmet health care needs due to cost. … we also have seen significant overall economic benefits for our state as a result of this.”
In terms of costs, she said, “[w]e’ve seen a sharp decline in the amount of spending on the so-called ‘free care,’ [when an uninsured person visits an ER, for example, and costs get passed on to the insured in higher rates] about $300 million, and that’s 33 percent less than we spent in 2006.” And nongroup or individual insurance premiums cost 40 percent less.
Attorney General Coakley also discussed why she believes the Supreme Court will not overturn the individual mandate. Massachusetts, she said, is giving a very positive endorsement for the mandate, and it is “a constitutional act by Congress.” It would be quite surprising if the Supreme Court overturned “the 70 years of precedent that have been set” by case law establishing what Congress has constitutional authority to regulate, including commerce such as health care.
After her speech, Attorney General Coakley spoke with Tanden about health reform. In response to an audience question about the constitutionality of the mandate, Tanden said that “when you say that people have coverage when they go to the emergency room, that immediately means that they’ll be cost-shifting, and the individual mandate is just a way in which people have the same responsibility for their own health care so they’re not shifting costs anymore.”
As Attorney General Coakley asserted, Massachusetts is an essential—and the only U.S. example—of the importance of the individual mandate in ensuring affordable access to health care for all.
By: Center for American Progress, February 27, 2012
An “Ideological” Faith: Ron Paul’s Appealing To Mormons
He’s the only Mormon in the presidential race, but that doesn’t mean Mitt Romney is the only candidate Mormons support. Another favorite White House hopeful? Ron Paul, whose demand that Washington strictly adhere to the Constitution has some members of the Church of Jesus Christ of Latter-day Saints singing his praise.
“You cannot grow up in the church and not hear of and be taught that the Constitution is an inspired document,” says Connor Boyack, a Mormon who heads the Utah Tenth Amendment Center. “And when it comes to who best supports and defends the Constitution, Ron Paul is that guy.”
In Paul’s hunt for convention delegates, the Mormon vote will be key in early caucus states such as Nevada, where 25 percent of GOP caucus-goers in 2008 were LDS members. Exit polls from 2008 show nine of 10 Mormon voters cast ballots for Romney, but the Texas congressman is seeing a surge in support there and elsewhere.
While the Salt Lake City-based church does not officially endorse any candidate for president, members like Boyack have been preaching the gospel of Ron Paul. Boyack explains that Romney might be a brother in faith, but Paul’s commitment to upholding the tenets of the Constitution make him a more ideological choice for Mormons. A controversial and sometimes persecuted group, Mormons have historically looked to the Constitution as a safeguard to preserve their religious freedom. The Constitution is even mentioned in the church’s Doctrine and Covenants, described as revelations to the church’s founder, Joseph Smith. Brigham Young University religion professor Richard Bennett says the devotion to the Constitution came after an 1833 attack on a Mormon church in Missouri. Bennett says God told Smith to use the Constitution to fight the persecution of his church.
Paul’s team has been quick to highlight the Mormon support, setting up a special “Latter Day Saints for Ron Paul” Facebook page (“liked” by over 1,300 fans). It’s one of a number dedicated to pro-Paul coalitions, including evangelicals, Protestants, and Catholics, as well as truckers, gamers, and accountants. The candidate is also featured in a five-minute Web ad, recycled from the 2008 campaign, titled, “Ron Paul preserves, protects, defends LDS Constitution view.”
Paul spokesman Gary Howard says, “Members of the LDS church make up one of those important coalitions, all of which are great assets in this campaign. Dr. Paul’s message resonates with everyone who believes in the principles he espouses: limited government, personal and economic liberty.”
By; Lauren Fox, U. S. News and World Report, January 30, 2012
Plaintiffs Challenging Affordable Care Act In The Supreme Court Admit That The Law Is Constitutional
One of the oddest arguments made by the plaintiffs now challenging the Affordable Care Act before the Supreme Court is a claim that, if just one small part of the law is declared unconstitutional, the whole law must fall with it. The overwhelming majority of judges who have heard ACA cases rejected the ridiculous claim that any part of the law is unconstitutional. And, of the handful of judges to strike part of the law down, only one — the guy who included an explicit shout-out to the Tea Partyin his opinion — accepted the legally indefensible position that the whole law must fall.
In their attempt to see the entire Affordable Care Act fall, however, several of the plaintiffs challenging the law committed what should be a fatal blunder — they effectively admit that their entire constitutional challenge to the law is garbage.
The primary attack on the ACA targets its provision requiring most Americans to either carry health insurance or pay slightly more income taxes — the so-called “individual mandate.” This insurance coverage provision exists because without it, the law’s other provisions ensuring that people with preexisting conditions can obtain insurance cannot be implemented. 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, massively driving up costs for the rest of the plan’s consumers.
This problem doesn’t just make the insurance coverage requirement good policy, it also makes it constitutional. The Constitution doesn’t just give Congress sweeping authority to regulate the national economy, it also authorizes it “[t]o make all laws which shall be necessary and proper for carrying into execution” regulations of interstate commerce. As conservative Justice Antonin Scalia explains, this means that, “where Congress has the authority to enact a regulation of interstate commerce, it possesses every power needed to make that regulation effective.”
So, with this background in mind, consider the following passage from the private plaintiffs’ brief arguing that the entire law must fall if the insurance coverage rule goes down:
The mandate was intended to be a direct subsidy to insurance companies, as compensation for requiring them (in the guaranteed-issue provision) to insure against “risks” that have already come to pass and forbidding them (in the community-rating provision) from using actuarially sound insurance premiums. The mandate thus works to counteract the powerful inflationary impacts of these other provisions, which would otherwise make premiums in the individual insurance market prohibitively expensive, thereby frustrating Congress’ goal of affordable health insurance. And Congress further viewed the mandate as necessary to prevent “adverse selection” to “game” the new insurance rules, which proponents warned would spark a “death spiral” in insurance.
The guaranteed-issue and community-rating requirements thus cannot operate without the mandate in the manner intended by Congress. Rather, “their associated force—not one or the other but both combined—was deemed by Congress to be necessary to achieve the end sought.” To strike the mandate alone would impermissibly eliminate a central quid pro quo of the Act. If the mandate falls, the guaranteed-issue and community-rating regulations must therefore fall with it, as the Government itself has conceded.
So the plaintiffs admit that, without the insurance coverage requirement, premiums will become “prohibitively expensive” and that the ACA’s provisions protecting people with preexisting conditions or who otherwise are highly likely to need health care (what are known as “guaranteed-issue” and “community-rating” laws in the jargon of health policy) “cannot operate without the mandate in the manner intended by Congress.” This is a flat out admission that the Scalia Rule applies in this case. Guaranteed issue and community rating are regulations of interstate commerce, and thus Congress has “every power needed” to make them effective — including the power to enact the insurance coverage requirement.
I discuss this rather breathtaking admission at greater length in an amicus brief I filed Friday on behalf of several health provider organizations, which also includes some more details about why the plaintiffs’ attempt to take out the entire ACA has no basis in law. Ultimately, however, there is no need whatsoever for the justices to consider how much of the law stands or falls without the coverage requirement. The private plaintiffs already gave away the farm when they admitted that their entire legal challenge rests on a crumbling foundation.
By: Ian Millhiser, Think Progress, January 30, 2012
Newt Gingrich And His “Rock, Paper, Scissors” Constitution
The closer Newt Gingrich gets to the Republican nomination for president, the more unhinged become his attacks on the independence of the federal judiciary. In early October, when Gingrich was nowhere in the polls, he ginned up a patently unconstitutionalargument for subpoenaing judges to come before Congress to justify and explain what Gingrich considers their “radical” decisions. “The spectacle would be like a dog walking on its hind legs,” said Bruce Fein, the respected conservative attorney and former Reagan official, when asked about Gingrich’s plan. “You are surprised not that it is done ineptly, but that it is attempted at all.”
Now, leading most polls, but evidently still needing his own radical pitch, Gingrich has doubled down on his crackpottery. On Sunday morning, he told Bob Schieffer of CBS News’ Face The Nation that the Capitol police, or federal marshals, could and should come and arrest those judges if they refuse to respond in person to a subpoena seeking to publicly shame them for making unpopular decisions. He also delivered this shuddering version of the Constitution, an unfamiliar Rock-Paper-Scissors version, in which the promise of separation of powers is akin to a playground game:
Here’s the key — it’s always two out of three. If the president and the congress say the court is wrong, in the end the court would lose. If the congress and the court say the president is wrong, in the end the president would lose. And if the president and the court agreed, the congress loses. The founding fathers designed the constitution very specifically in a Montesquieu spirit of the laws to have a balance of power not to have a dictatorship by any one of the three branches.
Poof, just like that, the leading candidate’s “key” to nowhere. What Gingrich really is saying, under the guise of blasting “elitist” judges, is that the Bill of Rights would no longer be used to protect individual rights because the judges who help ensure those (often unpopular) rights can be outvoted by the White House and the Congress. In President Gingrich’s world, evidently, the Supreme Court would not have the final say on the law. The majority, as represented by the popularly elected branches, would have the ultimate vote. Not in every case, Gingrich says, just in some. Does that reassure you the way he meant it to?
Here’s the Face The Nation video from this morning in which Gingrich says “… there’s no reason the American people need to tolerate a federal judge who who is that out of sync with an entire culture….” http://www.cbsnews.com/video/watch/?id=7392048n
There are two possibilities for this level of jeremiad. Either Gingrich actually believes this nonsense, in which case he would be a constitutionally dangerous president, or he doesn’t, in which case he’s committing constitutional heresy just to win a few primary votes. Either way, it is conduct unbecoming a president. Close your eyes for a second and imagine if a Democratic candidate for the White House suggested that the judiciary be neutered by the White House and Congress; if a “liberal” running for president suggested that individual liberties and minority rights would hereafter be defined by Washington. Wouldn’t Gingrich be first in line with his pitchfork and torch?
You don’t need to be a lawyer, politician or scholar to hear the contradictions in Gingrich’s latest argument. He’s against “elitist” judges but not against the lobbyist-infused Washington insiders who would overrule them. He rails on the 9th Circuit for its Pledge of Allegiance ruling as though it were the law of the land (it is not, as your school-age child is likely to tell you). Similarly, he picks on a federal trial in judge in Texas whose school prayer ruling was almost immediately overturned on appeal. Small beer, indeed, for the monumental remedies Gingrich seeks; it’s like destroying the whole house to get rid of a few nagging flies.
“I think part of the advantage I have is that I’m not a lawyer,’ Gingrich told Schieffer. “And so as a historian, I look at the context of the judiciary and the constitution in terms of American history.” The fact that Gingrich is not a lawyer helps explain why he sounds so ignorant about the law. The fact that he is an historian helps explain why he’s hanging much of his theory on some hoary precedent involving Thomas Jefferson, the slave owner, who eliminated 18 of 35 judges back in his day. Never mind the constitutional precedent and practice of the intervening 200 years, Gingrich’s argument goes, it happened once so it should happen again.
I cited Judge Johnson above not just because his quote is a timely reminder to demagogues like Gingrich that they are often responsible for the very “activism” they decry. Judge Johnson, as a federal trial judge in Alabama from 1955-1979, essentially devoted his entire judicial life to helping to ensure that black citizens would gain the basic civil rights that governors and state legislators and the Congress and the White House would not give them. Imagine how many times Judge Johnson would have been called onto the carpet on Capitol Hill under a Gingrich Administration. On which side of that history would you want to be?
The last word goes to Fein, the proud Reaganite. On Sunday afternoon, he called Gingrich’s ideas “more pernicious to liberty than President Franklin Roosevelt’s ill-conceived and rebuked court-packing plan.” More colloquially, Fein told me in October when Gingrich first went off the rails on this issue: “This is crazy. It would bring us back to the pre-Magna Carta days… The idea that these legislators, who haven’t read the Constitution or their own statutes, are going to lecture federal judges about the law is ridiculous. It’s juvenile. It’s high school stuff.” Indeed—and thus perfect for a bumper-sticker: Your Constitution: Rock, Paper, Scissors, Newt.
By: Andrew Cohen, The Atlantic, December 18, 2011
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