“Obamacare Opponents Still Await The Apocalypse”: Opponents Are As Wrong About Obamacare As Reagan Was About Medicare
A while back, progressive activists and politicians pushed for legislation to provide health insurance for a cohort of Americans who could not easily pay for their doctors’ visits and medications. Predictably, that effort was met with fierce resistance from conservatives, who didn’t seem concerned about those less-fortunate citizens who couldn’t afford medical care.
Conservatives denounced the plan as “socialized medicine” or a “communist takeover” of the American health care system. One notable conservative was especially alarmist, declaring that if the proposal passed Congress, “… you and I are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.”
No, that hysterical tirade didn’t come in response to the Affordable Care Act. Those words were spoken in 1961 by Ronald Reagan, who was crisscrossing the country to campaign against the adoption of Medicare. Yes, Medicare, which Congress passed in 1965 and is widely considered a resounding success.
Fast-forward a few decades. The same alarms were sounded more recently, as progressive activists and politicians pushed for legislation to provide inexpensive health insurance for those who couldn’t afford it. Actually, the denunciations of the Patient Protection and Affordable Care Act, usually called “Obamacare,” may have been even more hysterical.
As the law neared passage, I watched angry crowds gather near the White House — many holding vicious, racially charged signs lambasting the president — to chant about “socialism” and “communism.” Strangely, the most vehement criticisms came from Americans 65 and older, the very cohort that benefits from Medicare.
President Obama signed the Affordable Care Act in March 2010, so it has been the law of the land for five years. Given that, it’s possible to make a reasoned assessment of its strengths and weaknesses.
First off, let’s note that there has been no “socialist takeover” of American medicine. Obamacare uses private health insurance providers; the law merely sets requirements for health insurance plans and issues subsidies to patients who cannot afford to purchase policies.
As you might expect, the number of Americans with health insurance — and, therefore, with access to preventive medical care — has increased in the last five years. Before the law went into effect, there were 48 million uninsured Americans. Now, with 16 million people having signed up for Obamacare, that number has been cut by a third.
Furthermore, health insurance companies are no longer allowed to deny coverage to patients who are already sick or to set a “lifetime cap” on the amount of money a company will pay for medical care. Adult children, who might be in college or working at low-paying jobs without benefits, can stay on their parents’ policies until they are 26.
The Affordable Care Act may also have decreased the rate at which health care costs were escalating. Five years ago, medical care costs were skyrocketing, well beyond the rate of general inflation. Now, those costs are still going up — but at the lowest rate in 50 years. While economists aren’t certain that Obamacare’s cost-containment measures are responsible, many of them give the law credit.
To be sure, the Affordable Care Act has been no panacea. There are still 32 million Americans without health insurance. And, despite the president’s early pledge that people already insured could retain their policies, a tiny but vocal group lost their insurance because Obamacare deemed those policies inadequate. Many in that group ended up paying more for insurance, hardly a happy outcome.
But the worst failings of the Affordable Care Act are beyond its supporters’ control. Because of persistent, irrational Republican opposition, more than 20 states have refused to expand Medicaid — even though the feds would pay the lion’s share of costs. That means that millions of working-class Americans are not getting the health care they need. Furthermore, Obamacare’s unrelenting antagonists have mounted yet another challenge to the law before the U.S. Supreme Court.
It’s hard to fathom. The Affordable Care Act has failed to produce the apocalypse (remember “death panels”?) its fiercest critics predicted; instead, it has given millions of people access to decent health care. Its opponents are as wrong about Obamacare as Ronald Reagan was about Medicare.
By: Cynthia Tucker, Pulitzer Prize for Commentary in 2007; The National Memo, March 28, 2015
“Give Me Lipitor Or Give Me Death”: Last Call; Ted Cruz Signs Up For Obamacare
A day after announcing his White House bid – which included beating on the Affordable Care Act, his favorite punching bag – Sen. Ted Cruz, R-Texas, says he’s signing up for Obamacare.
Yes, you read that correctly: The man whose signature applause line is a promise to “repeal each and every word of Obamacare,” went on Healthcare.gov and got himself some benefits. Hypocrisy? Sure, but not in the way you might think.
Cruz had been covered through his wife’s employer, Goldman Sachs. If some insurance plans are Cadillacs, hers was a chauffeured, solid-gold Fleetwood, reportedly worth some $20,000 a year — around half of Texas’ median income. Heidi Cruz is taking a year or so of unpaid leave to help him on his campaign, though, so her health care coverage evaporates along with her likely very substantial paycheck.
Now, the senator – or maybe an aide, or an intern or campaign volunteer or someone – will schlep to the computer, log on to Healthcare.gov and hunch down over the keyboard to do the Obamacare two-step to get coverage for the upcoming year.
Cruz says he had to get health coverage Obamacare, and he’s right: Sen. Chuck Grassley, R-Iowa, inserted an ACA amendment that requires all members of Congress to sign up through the federal exchange. That means Cruz has to if he wants health insurance, although, unlike a lot of Obamacare enrollees, his $174,000 annual Senate salary covers the premiums.
“Well, it is written in the law that members will be on the exchanges without subsidies just like millions of Americans so that’s – I think the same rules should apply to all of us,” Cruz told the Des Moines Register. “Members of Congress should not be exempt.”
Cruz has come up with his own Obamacare alternative, a plan which shifts a lot of control to the states — including ones like Texas, that opted out of Obamacare and all that federal money that went with it. If it were available, he probably would have signed up for Cruzcare instead.
Cruz: 2, Hypocrisy: Undecided. Still, let’s take a closer look.
If Cruz wanted to stand on no-Obamacare, no-way principle, however, perhaps he could opt out of government-sponsored health care entirely, just like the 6.3 million Texans who don’t have health insurance — in part because his state, and his party, decided to block it. That includes 1.2 million children just like Cruz’s two little girls who can’t get health care if they get sick.
That’s made Texas the state with the highest number of uninsured people, nearly twice the national average.
Further, if you squint, the changes the Cruz family are undergoing — loss of a job or a dramatic life change that reduces income — are the top reasons people lose health insurance, and among the reasons Obamacare exists in the first place. And if a parent or spouse gets sick without insurance, it can lead to some serious financial hardship.
It’s perhaps safe to say Cruz understands that intuitively, even if he probably would never say so explicitly. Which is probably why he signed up, and where the hypocrisy comes in.
Even though it exposes him to a modicum of ridicule, allegations of hypocrisy and getting the stink-eye from some of his die-hard supporters, Ted’s Excellent Obamacare Adventure speaks more loudly than his “repeal every word of Obamacare” applause line. When it came down to brass tacks and he lost his wife’s coverage, he opted-in.
He may be a fierce Obamacare critic, and he may agree with the decision to deny affordable health insurance to more than 6 million Texans who, one imagines, he assumes would rather have liberty than Lipitor. But when it becomes a personal matter involving his own family, his conservative ideals don’t necessarily apply.
By: Joseph P. Williams, Washington Whispers, U. S. News and World Report, march 24, 2015
“Be Very Afraid Of ‘King v. Burwell'”: It’s Whether Or Not The United States Has Essentially Become A Banana Republic
There was a society of men among us, bred up from their youth in the art of proving, by words multiplied for the purpose, that white is black, and black is white, according as they are paid. To this society all the rest of the people are slaves.
–Jonathan Swift, Gulliver’s Travels, 1726
The real question before the Supreme Court in the ballyhooed case of King v. Burwell isn’t merely the continuance of the mandated health insurance subsidies of “Obamacare.” It’s whether or not the United States has essentially become a banana republic — an oligarchy whose legal institutions exist to provide ceremonial cover for backroom political power plays.
Almost regardless of what you think of the Affordable Care Act, legalistic chicanery of the kind on display shouldn’t be rewarded. That King v. Burwell has reached the high court is bad enough. Should the Roberts Court hand down a 5-4 decision based upon a tendentious misreading of the statute, several things will happen: An estimated 8.2 million Americans will lose health insurance coverage, the U.S. health care system will be thrown into economic chaos, and a few thousand citizens will no doubt die.
To a certain kind of person styling himself “conservative,” this would be perfectly all right. In an op-ed titled “End Obamacare, and People Could Die. That’s Okay,” one Michael R. Strain argues that higher death rates are “an acceptable price to pay for certain goals,” including “less government coercion and more individual liberty.”
Acceptable to Strain and his colleagues at the American Enterprise Institute, that is, a plutocrat-funded Washington think tank whose resident “scholars” are handsomely paid to mimic the values of 19th-century Russian aristocrats.
Along with the human casualties, the U.S. Supreme Court’s prestige as a fair arbiter would also be irrevocably damaged. As New York Times legal correspondent Linda Greenhouse argues, “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.”
And that would damage what’s left of American democracy.
During his 2005 confirmation hearings, Chief Justice Roberts likened himself to an umpire. His job would be to call balls and strikes, not to reinvent the rules of baseball. It was a very shrewd formulation, as most Americans prefer a non-partisan judiciary. “It is a very serious threat to the independence and integrity of the courts to politicize them,” Roberts has said repeatedly.
With the signal exception of Citizens United, a 5-4 decision invalidating campaign finance laws and pushing the nation in the direction of plutocracy, some observers do credit the Chief Justice with making an effort to move the Court away from overt partisanship. Almost two-thirds of recent Supreme Court rulings have been unanimous.
However, Roberts’ deciding vote legitimizing Obamacare’s insurance mandate infuriated many Republicans. They see in King v. Burwell an opportunity for the Chief Justice to redeem himself. All he needs to do is persuade a majority of the Justices, presumably including himself, that because the Affordable Care Act speaks of subsidies being available through a health insurance “exchange established by a state,” it means only, exactly, and literally that.
If your state—say, New York—set up and ran its own marketplace, then you’re eligible for Obamacare.
If not, you’re not.
No more health insurance subsidies for residents of Texas, Oklahoma and 32 other states that let the feds set up exchanges for them.
Never mind that the law specifically requires the U.S. Department of Health and Human Services to “establish and operate such exchange[s] within the states.” Never mind that nobody anywhere understood the Affordable Care Act to have such a restrictive meaning when it was being debated, enacted and put into operation. Such an interpretation certainly never came up during the difficult period when the HealthCare.gov website labored to get up to speed.
Never mind too that time-worn Supreme Court precedents direct judges interpreting laws to consider not isolated snippets of language, but “the specific context in which that language is used, and the broader context of the statute as a whole.” (The wording is from a 1997 opinion by Justice Clarence Thomas.)
For that matter, if anybody in Congress on either side thought the law meant what the plaintiff’s lawyers in King v. Burwell claim, why have we been having the political battle of the century about it? Why vote 56 times to repeal a law that only applies in 16 of the 50 states?
It’s an odd form of legalistic fundamentalism the justices must consider, the constitutional equivalent of a guy trying to beat a ticket for driving 95 mph in a school zone because a typo reads “ozone.”
The wonder is that the Court elected to hear the case at all after a three-judge appeals court in Richmond rejected it unanimously.
And the scary question is why?
By: Gene Lyons, The National Memo, March 4, 2015
“Interpreting A Statute Requires Reading All Of It”: Challenge To Affordable Care Act Hinges On 4 Words In Isolation, Not The Full Law
When the Supreme Court hears oral arguments in King vs. Burwell, all eyes will be on Chief Justice John G. Roberts Jr., to try to figure out which way he’s leaning. After all, this case is the latest challenge to the Affordable Care Act, and the last time the law was before the high court, Roberts was the deciding vote in favor of the government. There’s one very good reason to think the chief justice will rule for the government again: He’s too good a lawyer to do otherwise.
King is all about the meaning of the Affordable Care Act, specifically, whether the law makes tax credits to low- and middle-income Americans available to all individuals who qualify based on income, or only to those who live in states with state-run healthcare exchanges. The plaintiffs argue that tax credits aren’t available to individuals who purchase their insurance on exchanges run by the federal government. But it’s difficult to imagine a legal mind like Roberts’ agreeing with an argument as weak as the one the plaintiffs have offered.
Interpreting a statute requires reading it carefully — all of it. You can’t just look at a few words in isolation. As Justice Anthony M. Kennedy wrote in 2006 (in an opinion that Roberts joined), “Interpretation of a word or phrase depends upon reading the whole statutory text, considering the purpose and context of the statute, and consulting any precedents or authorities that inform the analysis.”
When you look at the entire law, it’s clear that tax credits should be available on all exchanges, both state and federal. The statute defines who qualifies for a tax credit based on income level (not state of residence), and it also makes clear that federal exchanges are the functional equivalent of state-run exchanges by requiring that states set up exchanges, but allowing the federal government to set up “such exchange(s)” in their stead if they elect not to.
To now argue otherwise, the plaintiffs in this case rely on just four words in the law — “established by the State” — that appear in the formula for calculating the amount of the credit (not in the provision defining which individuals qualify for it). But a careful reading of the statute shows that those four words are there to make clear that the relevant exchange for calculating the amount of the credit is the exchange in the state where the individual purchased his or her insurance (state-run or not).
This problem is fatal to the plaintiffs’ argument, as the chief justice should surely recognize. But there are many other problems with their argument, as has become increasingly clear in the run-up to oral argument. Most significant, the plaintiffs have long maintained that Congress intentionally limited tax credits to encourage states to set up their own exchanges. The members of Congress who led the passage of the law have always said otherwise. As a number of the chairs of the committees that crafted the Affordable Care Act wrote last year, “None of us contemplated that the bill as enacted could be misconstrued to limit financial help only to people in states opting to directly run health insurance marketplaces.”
Indeed, the evidence against the plaintiffs’ case on this point is so strong that in their most recent filing with the Supreme Court, they argue that it is “irrelevant whether Congress subjectively intended” to limit the tax credits. The plaintiffs may hope that these holes in their legal argument don’t matter. But these points should matter to the chief justice and the rest of the court.
There’s already been a great deal of speculation about why Roberts might rule for the government. Some pundits and court watchers have pointed out that a ruling for the plaintiffs in this patently partisan attempt to gut the Affordable Care Act might impair the legitimacy of the court. Others in the legal and business communities have noted that a ruling against the government would result in significant chaos and disruption to insurance markets in the affected states because the tax credits are necessary for the law’s other market reforms to work properly.
These points are both right. But if the chief justice votes for the government, as he should, the reason may be far simpler: He’s too good a lawyer to do otherwise.
By: Brianne J. Gorod, Appellate Counsel at the Constitutional Accountability Center, was an author of the brief filed on behalf of some members of Congress and state legislators in King vs. Burwell. She wrote this for the Los Angeles Times; The National Memo, March 2, 2015
“Obamacare By Any Other Name”: An Unnecessarily Complicated Way To Undo Harm Caused By A Crisis Of Their Own Creation
This is kind of brilliant; it might be the perfect illustration of the state of the modern GOP. The Examiner’s Byron York is reporting that a group of GOP senators is working on a plan to undo the damage that would be done if the Supreme Court rules against the government in King v. Burwell.
For those not familiar with it, the case, which the court will hear next week, turns on the question of whether people who buy health insurance in federal exchanges (in the 34 states that didn’t set up these Obamacare-mandated marketplaces) are eligible for tax subsidies to help pay for health care.
If the court does knock out the subsidies, it could cause havoc in insurance markets – a recent RAND Corporation study estimated that 8 million people could lose their insurance, while the American Academy of Actuaries warned Secretary of Health and Human Services Sylvia Burwell this week that companies could be facing insolvency if the King ruling drives the markets into death spiral territory.
So on the one hand conservatives would come close to achieving their goal of wrecking Obamacare at any cost; on the other hand, they’re starting to realize there would actually be, you know, a cost, both in human and political terms. “We’re worried about ads saying cancer patients are being thrown out of treatment, and Obama will be saying all Congress has to do is fix a typo,” one senior GOP aide told York. (No doubt the actual fact of cancer patients being thrown out of treatment would also be upsetting to this aid.)
So Republicans are looking for a way to restore the government expenditures they have worked so hard to eliminate. Well, not the actual expenditures; a totally different set that would perform the same function but – this is important – would be called something else that didn’t have the word “Obamacare” in it. “GOP lawmakers have decided to keep the money flowing,” York wrote. “Maybe the payments won’t be called subsidies, but they will be subsidies. The essence of Obamacare – government subsidizing the purchase of health insurance premiums – will remain intact.”
Of course, the senior GOP aide’s hypothetical Obama would be correct: All Congress would have to do to fix a harmful King decision would be to pass a law saying that people in the federal exchanges are in fact eligible for the subsidies. But the modern GOP isn’t big on taking the most direct route to the conclusion at which they’ll inevitably arrive. (See, for example, the current ritualistic huffing and puffing from House Republicans – yes, we’ve seen this show before – and various fallback positions en route to the inevitable full, clean funding of the Department of Homeland Security.)
This is the apotheosis of the 21st century GOP Congress: It is seeking an unnecessarily complicated way to undo or prevent harm caused by a crisis of its own creation. This is the fiscal cliff, again; this is the shutdown fight, again; this is the debt ceiling fight(s) all over again.
And it’s also important to keep in mind that this effort to undo the GOP’s avowed goal is angels-on-the-head-of-a-pin stuff. Five years on, the GOP has yet to produce a plan encompassing the latter half of their “repeal-and-replace” mantra; merely ensuring insurance for 8 million people is presumably an easier lift, but no one should hold their breath waiting for a unified Republican plan. This is especially true given that the party’s activist base will label any such effort as an embrace of Obamacare.
Probably nothing will see the light of day. But if the GOP can produce a bill to fix its problem, you can bet that first we’ll repeat the same kabuki where GOP hardliners dream up the demands they’ll make in exchange for ending ongoing harm to the economy. To borrow a maxim from “Battlestar Galactica,” all of this has happened before, and will happen again.
By: Robert Schlesinger, U. S. News and World Report, February 27, 2015
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