A crowd of protesters outside the Supreme Court on the first day of ACA hearings (Photo: Patrick Caldwell)
The Supreme Court opened hearings today on the Patient Protection and Affordable Care Act—PPACA if we're going to be technical—but more commonly known as Obamacare. The six hours slotted for oral arguments are spread out across three days, and while the constitutionality of the individual mandate is the main issue at stake, there will be a host of other topics discussed, ranging from severability (whether the rest of the law can stand if the mandate is struck down) to whether Congress was within its bounds when it redefined Medicaid eligibility to include swaths of new people currently uninsured.
Last week I participated in a roundtable that on these issues, along with other GW faculty from public health and law—Sara Rosenbaum, Peter Smith, and Katherine Hayes—as well as former U.S. Senate Finance Committee staffer Mark Hayes and former House Commerce Committee Health Subcommittee Counsel Andy Schneider. You can find a synopsis here and the video here.
Today the Supreme Court begins hearing oral arguments to determine the constitutionality of the Affordable Care Act. It's the timid (or maybe wise) pundit who fears making predictions, so I'll go ahead and say this: the Court is going to uphold the ACA, by a vote of 6-3. Chief Justice John Roberts will join the four liberal justices and Anthony Kennedy in the majority, and Roberts will write the decision. Justices Scalia, Thomas, and Alito will offer a vigorous and at times comically overstated dissent, in which they will decry the end of the freedom that universal health coverage will bring.
When the Supreme Court begins its extraordinary three days of hearings on the constitutionality of the Affordable Care Act, one of the oddities will be an amicus brief challenging the act’s individual mandate from 50 doctors who support national health insurance. They point out the inconvenient truth that, contrary to the administration’s representations, the government did not need to require citizens to purchase insurance from private companies in order to meet its goals of serving the health-care needs of the populace. Congress could have enacted a single-payer law.
The last time Texas Senator Kay Bailey Hutchison took on Rick Perry, things didn't go so well. Hutchison, among the most popular politicians in the state at the time, was the favorite to win the Republican nomination, and instead Perry rode into the general with overwhelming support. Among Hutchison's key problems—besides simply running a bad campaign—a nagging reputation as a moderate, who was at least somewhat pro-choice and who'd voted for the bank bailout. After the disappointing finish, she later announced she wouldn't run for re-election in the Senate. This may be her last year in politics. And evidently, she's decided that it's no time to back down from her political rival.
Today, House Budget Committee chairman and GOP heartthrob Paul Ryan will release his latest budget proposal, and all right-thinking Republicans will line up to express their support (you may remember what happened to Newt Gingrich in May when he criticized a previous version of Ryan's plan and was punished for his heresy, then quickly backtracked). And I have to say, Republicans deserve some credit for this. Not because their plan to privatize Medicare will actually be good for seniors (it won't) or for the budget (it won't). But because in the face of nearly inevitable political damage, they forge right on ahead.
Last week, I mentioned two state legislatures had passed abstinence-only sex education bills. While Wisconsin's governor was already supportive of the measure, in Utah, Governor Gary Herbert was less certain. The measure would have banned any discussion of contraception, or for that matter, homosexuality. The current law in Utah already requires parents to "opt-in" if the course includes discussion of contraceptives, but this measure would have actually removed even the option for students to learn about more than simply abstinence. It had passed overwhelmingly in both chambers, despite protests and opposition from the state PTA and teachers' groups.
The Lone Star State has been in the headlines a lot this week—and not just because South by Southwest is here. First there was the news that the Department of Justice blocked enforcement of the state's stringent and controversial voter ID measure. According to a letter from the DOJ, the state failed to show how it would deal with rural voters or the disparities between Hispanic and non-Hispanic voters in terms of who already has valid photo identification. While the case is already headed to the D.C. District Court, that's hardly the only battle between the feds and Texas lawmakers.
Maybe we can start bringing these books into the classroom too. (Flickr/romana klee)
Here's a way to save time debating women's health. Rather than allow people to fight and debate the issues around birth control and access to healthcare, simply don't tell them key facts about contraception and sexual health. That way, rather than fighting, kids will be blissfully ignorant. Or, you know, rely on the wisdom of my sister's best friend's cousin who says you definitely can't get pregnant if it's a full moon.
Legislatures in both Wisconsin and Utah have passed abstinence-only education bills. It's now up to governors in both states to determine whether or not to make the measures law.
Tigger and Eeyore are battling it out inside me this week. I can’t tell whether to be depressed over what Maureen Dowd calls “the attempt by Republican men to wrestle American women back into chastity belts” or invigorated by the myriad ways women are chronicling it and fighting back. Are women really gonna get dragged back to the scarlet-letter era—why not just repeal the 19th amendment!—or is all this going to set off a revitalized third feminist wave?
Eeyore: In a surreal move, the Arizona Legislature’s Senate Judiciary committee has introduced a bill that would:
It's hard to overstate just how dire the situation is around women's health care in Texas. The state has the third highest rate of cervical cancer in the country and one in four women are uninsured. After cutting family-planning funding by around two-thirds last legislative session, conservative lawmakers are now standing by their decision to cut off Planned Parenthood from the state's Women's Health Program, a move that ended $35 million in federal funding.
One of the main features of the Affordable Care Act is the creation of 50 state-based health insurance exchanges, online marketplaces where people and small businesses will be able to easily compare competing plans and select the one they prefer. If you're buying insurance on the individual market after the beginning of 2014 (but not if you get your insurance through your employer like most people), your state's exchange is where you'll go. While the federal government establishes a baseline of requirements for what plans offered through the exchange must contain, each state will determine exactly how theirs will work.
But after the ACA was passed, and especially after the 2010 election where Republicans won huge gains at the state level, a lot of states run by Republicans refused to take any action to create their exchanges. Like a Catholic bishop looking at a package of birth control pills, they retched and turned away, not wanting to sully their hands at all with involvement in President Obama's freedom-destroying health care plan. But the law also provides that if a state doesn't get around to creating its exchange, then the federal government will just do it for them.
Which is why I've always found the actions of Republicans on this issue puzzling...
The Affordable Care Act (ACA) is the landmark piece of policy for Obama's first term. Save perhaps his response to the Great Recession, the ACA is likely to be the primary measure by which his presidency will be judged in the history books. As long as it is fully implemented, it should help millions of uninsured Americans by shifting more people onto Medicaid, providing subsidies for low-income workers, and forbidding insurance companies from excluding customers based on past illness.