“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
“Is Rubio Really Hillary’s ‘Nightmare’?”: If This Is Her Nightmare, Hillary Is Getting A Good Night’s Sleep
Well, 14 more Republicans announced their candidacies, but clearly, Marco Rubio was the It Boy on the Republican side this week. It started last weekend with a Times article advancing the idea that Rubio as the GOP nominee is a “scary thought” for Democrats for all the reasons you can reckon on your own—he’s Latino, he’s young, he’s charismatic, he has a “million-dollar smile” (not kidding!), and of course he might be able to defeat her in “vital” Florida with its 29 electoral votes.
Mmmm, okay. He is most certainly Latino and young, not much arguing with those. He is reasonably charismatic. He has about a $627,000 smile, which isn’t a million (a little too on the boyish and elfin sides to project the proper Reaganesque, enemy-smiting mien) but isn’t peanuts.
I would add other and I think even more substantive claims for him. He’s not stupid, in policy terms, and more to the point isn’t intentionally stupid, constantly playing down to his most rigid base’s lowest common denominator. He does that only about 78 percent of the time, which in the context of today’s GOP is almost impressive. I could picture a President Rubio dragging the party to a couple of places where most of it really would prefer not to go. Not a lot of places, but a couple, which is two more than most of them would do.
But is Rubio really Clinton’s nightmare candidate? First of all, let’s say this. Elections are far less about the dollar value of smiles and whether a candidate colors her hair than journalists would like to think. They’re more about what the political scientists call “the fundamentals,” by which they mainly mean the economy. If the economy is still chugging along in the fall of 2016, creating 225,000 jobs a month—and by that time, if the streak holds, wages would probably be going up as well—then nobody is Clinton’s nightmare. All right, two other ifs: no terrorist attack, and no giant, quid-pro-quo Clinton scandal. If all that holds the only drama ought to be whether she tops 350 electoral votes.
But if all that doesn’t hold, then we have a race. I suppose Rubio is as plausible as any of them and more than most of them. But let’s stop and take a look at the bases of these nightmare claims. There are two.
The first is that he’ll compete with her among Latinos. The data point you’ll often see invoked here is that when first running for Senate in 2010, Rubio drew 55 percent of the Latino vote against two opponents. That he did. But here are two reasons that impressive number doesn’t necessarily translate to a presidential race.
Number one, neither of his opponents that year had much going for them among Latinos. Independent Charlie Crist wasn’t really trusted by anyone because of his party flipping, and Democrat Kendrick Meek just never fired, as they say in the horse-racing business. Number two, voters understand, Latino voters included, that a vote for senator and a vote for president aren’t the same kind of vote. For the Senate, independent and even a few Democratic Latinos would be more willing to cast an “identity” vote, just for the sake of seeing one of their own (more or less their own, since there are many different kinds of Latinos in Florida) in the Senate. The candidate’s positions matter, of course, but if voters know he’s only one of 100 in a body that never does much anyway, positions aren’t dispositive.
But a presidential vote is a different thing. There, you’d better believe positions matter. And here, Rubio has the same problems with Latino voters all the Republicans have.
Spend a few minutes on this web page, brought to you by the Seattle-based Latino Decisions. The polling I’m about to cite is from last November, so things may have changed. But still. It’s a bucket of icy water on the nightmare thesis.
Rubio favorable-unfavorable among Latinos: 31-36. Rubio favorable-unfavorable among Latinos in Florida: 39-42. In seven states with sizable Latino voting blocs, Rubio was underwater in six of them (all but Texas). Oh, and in six of the seven states (all but Florida), Clinton’s favorable numbers among Latinos were more than twice Rubio’s.
Why would this be? Are Latinos uniquely immune to the charms of high dollar-value smiles? No. The answer is his positions. Latinos support a path to citizenship, President Obama’s executive actions, and Obamacare. Rubio opposes them all. Those positions, especially on immigration, are deal breakers for a big majority of Latino voters, most of whom don’t feel an intense natural bonhomie for Cuban-Americans, who’ve always been seen to occupy a different political space from Mexicans, Puerto Ricans, Dominicans, and Central Americans.
Now as I say that was last November. Things have probably shifted a little in his direction since then, just because some people may have forgotten his lame immigration reversal. I called four pollsters to try to get current numbers on Clinton vs. Rubio head-to-head among Latinos, but oddly, none had anything current based on large enough sample sizes. If we start to see such numbers and Rubio is with 15 points or so, then Clinton should worry a little. But the overall numbers, in which she has essentially the same narrow-ish lead over Rubio that she has over everyone else, don’t suggest that he’s doing much better among the small subsets of Latinos in these polls than any other Republican is.
And now, to our second point (remember, there was a second point way up there!): “vital” Florida. I really wish people who write about politics would bother to understand the electoral map. This is a longer conversation and another column but please remember: Florida is vital to Republicans, but it’s gravy for Democrats. Obama won Florida in 2012, but if he’d lost it, he’d still have received 303 electoral votes.
Think of it this way: The Republican can win all the normal red states plus the violet quartet of Ohio, Virginia, Colorado, and Nevada, as well as Iowa and New Hampshire—two states that have gone Republican just once each since 1992—and still have only 262 electoral votes. The Democrat can afford to lose Florida and still have a number of paths to 270. The Republican cannot.
Rubio has some strengths the others don’t. But if all this adds up to a nightmare, I’d think Clinton is sleeping pretty well at night.
By: Michael Tomasky, The Daily Beast, May 29, 2015
“Shocking Sloppiness Won’t Doom The Health Reforms”: Republican Politicians Will Have A Lot Of Angry People On Their Hands
How many politicians, aides, lobbyists, lawyers, insurance moguls, professional groups, and interns — both the political and medical kind — agonized over the details in the Affordable Care Act? The number is big.
But despite thousands of hands in the kitchen, the final product included four words that cast doubt on a cornerstone of the reforms — subsidies for those buying coverage on federal health insurance exchanges. Unbelievable.
Diehard foes of the reforms have weaponized those words as a means to kill the law. They argue in the Supreme Court case King v. Burwell that specifically offering subsidies for plans bought on exchanges “established by the state” means no help for those going to federal exchanges.
Since the program started, low- and middle-income Americans have been receiving tax credits for coverage on both types of exchanges. Almost everyone assumes that’s how it’s supposed to be.Take away subsidies for federal exchanges and only the sickly will join it. The economic structure underpinning guaranteed coverage will collapse as premiums charged for plans on federal exchanges soar and the healthy stay away in droves.
The plaintiffs, though they come from the right, are doing their Republican colleagues no favors. You see, when the Affordable Care Act created federal exchanges in states that had not set up their own, leaders in Republican-controlled states could noisily defy President Obama while taking few political risks. They could refuse to set up state exchanges knowing that their constituents would enjoy subsidized coverage on the federal exchanges.
Lose those subsidies and Republican politicians are going to have a lot of angry people on their hands. Some 7.5 million Americans receive subsidies on federal exchanges.
Hypocrisy now crashes over the Republicans’ wall of opposition to the Affordable Care Act. Politicians are currently rewriting the story of their obstruction of a law that they dread could come apart.
An exasperating example is Olympia Snowe, a former senator from Maine who fancies herself a moderate Republican. During the battle for the bill’s passage, she strung Obama along for months, pretending that she might provide him at least one Republican vote. (Why Obama indulged these stalling tactics… perhaps his memoirs will tell.)
Anyway, Snowe recently commented that the little words at the heart of the Supreme Court case were unintended. “Why would we have wanted to deny people subsidies?” she said. “It was not their fault if their state did not set up an exchange.”
So why did she vote against the bill? She also railed against “Obamacare” as a “government-run health care system,” not that this was the case. Until Snowe left the Senate in 2013, she worked with her party to undercut the reforms.
But get this: At the time of the bill’s writing, Snowe proposed letting Americans buy cheaper drugs from Canada. It was OK, apparently, for a foreign government to help struggling Mainers obtain health care, but not OK for their own to do so.
One expects the health reforms to survive this latest assault. The best outcome would be the Supreme Court’s confirming that the words were a mistake and that yes, subsidies for the federal health exchange are legal.
If the court says no, politicians in states relying on federal exchanges could swing into action and set up some form of state exchange. And the Obama administration would probably make it easy for them.
The bipartisan takeaway here is the appalling state of American governance. We now hear from all sides that omission of subsidies for the federal exchanges was “sloppy,” “careless,” “inadvertent,” “a drafting error.” Actually, it was inexcusable.
But let’s move on.
By: Froma Harrop, Featured Post, The National Memo, May 28, 2015
“The Right’s Collective Amnesia And Fantasia”: Former Republican Senator Admits The Obamacare Court Challenge Is Built On Lies
For months, when the Affordable Care Act was still swimming upstream through the legislative process, President Barack Obama and Senate Democrats courted Senator Olympia Snowe, a Republican from Maine, thinking she would respond rationally to enticements and provide Democrats bipartisan cover to reform the U.S. health insurance system.
Their efforts ultimately failed. Snowe, like every other Senate Republican, voted against the health reform bill in 2009 and 2010, and then joined Republicans in their various efforts to undermine or repeal the law, until she retired in 2013.
But now it looks like all the time Democrats wasted on negotiating with Snowe, and allowing her to help shape the legislation, has paid off. Snowe has, to my knowledge, become the first contemporaneous Republican senator, current or former, to acknowledge that a Supreme Court challenge meant to cripple Obamacare is built on a tissue of lies. If the Court sides with Obamacare opponents, her comments will become incredibly relevant to the ensuing political shitstorm.
“I don’t ever recall any distinction between federal and state exchanges in terms of the availability of subsidies,” Snowe admitted, according to New York Times health reporter Robert Pear.
“It was never part of our conversations at any point,” said Ms. Snowe, who voted against the final version of the Senate bill. “Why would we have wanted to deny people subsidies? It was not their fault if their state did not set up an exchange.” The four words, she said, were perhaps “inadvertent language,” adding, “I don’t know how else to explain it.”
There are two intersecting argumentative threads that one must untangle to really understand King v. Burwell. The first, specialized one addresses the question of what the text of the Obamacare statute means. Does it, in all its interlocking, cross-referenced parts, provide authorization for the IRS to issue subsidies to all exchanges? Or does it prohibit those subsidies in the three dozen states that have availed themselves of federal fallback exchanges, through Healthcare.gov? Only the most cribbed reading of the law—literally less than a sentence of the whole text—suggests the latter.
The second thread is, if anything, even more straightforward: What were the framers of the Affordable Care Act trying to do? Were they trying to stitch together a harmonious system across all state borders, with subsidies available everywhere? Or were they trying to coerce states into setting up their own exchanges by threatening to withhold subsidies from their citizens, and impose chaos on their insurance marketplaces? There is no evidence to suggest that the goal of the Affordable Care Act was the latter.
These threads invariably become entwined for two reasons. First, if Congress was trying to create an incentive for states to set up their own exchanges, then its failure to provide those states clear notice of the threat in the law raises serious constitutional concerns. But also, judges have consciences and intellectual standards, too, and may in some cases allow their understanding of the political history of the Affordable Care Act to influence the way they think about what the text of the law actually conveys. This explains why conservatives have been engaged in a year-long campaign to revise the history, and assert that the framers of the ACA knew all along that threatening the states would leave the law vulnerable to ruin, but did it anyway.
Pear’s article largely elides the textual question—if anything, it proceeds from the assumption that Obamacare opponents have a better legal case than they really do. But at the same time, it is devastating to the spin that Republicans are putting on the ACA’s history to bolster the plaintiffs in King.
Here, for instance, is Snowe’s erstwhile colleague, Senator Orrin Hatch, who served with Snowe on the committee that drafted Obamacare, claiming that the law’s drafters, not its enemies, are falsifying the historical record to influence judges.
“The Democrats were arguing that the only way to get the states to sign up is to put the pressure on them by making them have to do a state exchange, so it’s kind of disingenuous for them to come in now and say they didn’t mean that,” Hatch told reporter Todd Zwillich in this DecodeDC feature. “I’m not the only one that knows that. Their attitude was, you’ll never get all the states to sign up if you don’t force them. Yeah, I don’t think there’s any doubt in the Democrats’ minds they wanted to do that because they were afraid the states wouldn’t form their own exchanges. Now they’re trying to say they didn’t say that, but they did.”
With respect to King, almost every Republican member of Congress is, like Hatch, caught in the grip of the right’s collective amnesia and fantasia. The spectacle of it is breathtaking to sentient observers of the health reform process, but ultimately meaningless if the Supreme Court does the right thing in June, and rules for the government. If it doesn’t, the textual argument will effectively be over. But, for the purposes of reading such a bad decision into its proper context, addressing the ensuing chaos, and clarifying for the record for the public, the historical argument will take on even greater significance—which makes Snowe’s contribution extremely valuable.
By: Brian Beutler, Senior Editor, The New Republic, may 27, 2015
“Jeb Once Again Turns To His Apple Watch”: A Wrist Gadget As Part Of His Vision For A Replacement Healthcare System
Jeb Bush caused a bit of a stir last week, telling an audience that he intends to destroy the Affordable Care Act, replacing it with a “consumer-driven” system, part of which includes his new Apple Watch.
“On this device in five years will be applications that will allow me to manage my health care in ways that five years ago were not even possible,” he said. “I’ll have the ability, someone will, you know, because of my blood sugar, there’ll be a wireless, there’ll be, someone will send me a signal…. We’ll be able to guide our own health care decisions in a way that will make us healthy.”
Yesterday, campaigning in New Hampshire, the Florida Republican returned to the same subject:
“We’re on the verge of a revolution in this regard, where we’ll be able to know all sorts of things with, you know, devices like this. I got beat up by the left because I showed my, you know, Apple Phone – this device will have the ability to measure your sugar content, to measure your heartbeat, to measure whether you’re taking your drugs in the proper way. And you’ll be able to wirelessly send text messages to your health care provider or to your loved one, or whatever, so that you can get back on track.”
It seems the former governor isn’t entirely clear on why he “got beat up.”
The point isn’t that wearable tech is irrelevant (he said “phone” yesterday, but I assume he meant “watch”). It’s easy to imagine devices that can help people manage chronic conditions like diabetes. Indeed, the Florida Republican makes it sound as if these advancements are on the horizon, but in many instances, the technology already exists.
That’s not the problem. Rather, the area of concern is that Bush intends to scrap the Affordable Care Act, which would eliminate health security for millions of families, and he included a wrist gadget as part of his vision for a replacement system. Sarah Kliff added last week:
Bush endorses the idea of “someone” sending him a signal on his Apple Watch when his blood sugar is low. I like that idea, too! It would help diabetic patients, like Bush, better manage their care.
But here’s the challenge: there is not some army of benevolent people out there monitoring blood sugar. There are health-care providers who do this, and to get signed up for their blood sugar monitoring programs, you typically need health insurance. In this way, the type of consumer-powered health market that Bush describes is one that relies on Americans having access to health services – and using that access to make better decisions about their health care.
Jeb Bush didn’t get “beat up” because he pointed to his fancy gizmo; he got “beat up” because he pointed to his fancy gizmo while making the case against the existing U.S. health care system.
By: Steve Benen, The Maddow Blog, May 22, 2015
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