Health Care

Peggy Noonan Feels the News

She's feeling something. (Flickr/kylebogucki)
When he began his still-brilliant show a few years ago, Stephen Colbert said, "Anyone can read the news to you. I promise to feel the news at you." And there's nobody who feels the news quite like Peggy Noonan, America's most unintentionally hilarious columnist. Pretty much every time she writes a column or goes on television, Noonan can be counted on to tell us about a feeling out there in the land. It's seldom a powerful feeling; instead, it's more often a stirring, an inchoate emotion still in the process of crystallizing. It might be a yearning, or an unease, or a doubt or a fear, but it lingers just out of our perception until Peggy Noonan comes along and perceives it for us. Did you think the impact of yesterday's Supreme Court ruling was that millions of uninsured Americans will now be able to get health insurance, and after 2014 none of us will ever need to fear the words "pre-existing condition" again? Nay , good-hearted Americans: The ruling strikes me as very bad for the...

Supreme Surprise

(AP Photo)
The verdict of the Supreme Court upholding nearly all of the Affordable Care Act is a victory to be savored in the full knowledge that it may be only temporary and includes potentially damaging changes in constitutional interpretation. It is a victory, first of all, for the millions of people excluded from health insurance who stand to gain protection despite their medical history or low incomes. It is a victory for the rule of law in the face of a group of partisan conservative justices who want to immobilize federal power in social policy. It is a victory for the millions of people who have struggled for decades to achieve equal access to health care. And, not least, it is a victory for President Barack Obama and the Democrats in a critical election year. In fact, the outcome of the election will determine the ultimate significance of the Court’s decision. If Mitt Romney and the Republicans win in November, not only will they repeal the main provisions of the Affordable Care Act;...

If Texas Doesn't Expand Medicaid, Two Million Will Be Without Options

(Flickr/ José Goulão)
It's no secret there's a health-care crisis in Texas. The state has the biggest uninsured population in the country with around 6.2 million—or a quarter of all residents—lacking insurance. As a Kaiser Health News report highlighted , poor and uninsured Texans must sometimes wait more than 24 hours in emergency rooms, where treatment is most expensive, while more cost-effective health-care options, like preventative care, are out of reach. The Affordable Care Act was supposed to change all that. It offered new avenues for health-care coverage to people at all income levels by expanding Medicaid. But yesterday's Supreme Court decision made it optional for states to expand their Medicaid coverage. "There's going to be a donut hole in the middle if a state doesn't proceed," says Edwin Park, vice president for health policy at the D.C.-based Center on Budget and Policy Priorities. In Texas, if the state chooses not to expand its services, almost two million people may be stuck in limbo—...

On Medicaid, Republicans Explore New Moral Depths

Florida governor and aspiring Bond villain Rick Scott, looking forward to denying poor Floridians health insurance. (Flickr/Gage Skidmore)
As the lawsuits challenging the Affordable Care Act worked their way up to the Supreme Court, I always found the challenge to the expansion of Medicaid to be the strangest part. Quick context: the program provides insurance for poor people, splitting the cost between the federal government and the states. But the current rules say that each state gets to set its own eligibility standards, which meant that if you live in a state run by Democrats and you're poor, you can get Medicaid, but if you live in a state run by Republicans, you have to be desperately poor to get Medicaid. For instance, in Mississippi, a family of four has to have a yearly gross income below a princely $9,828 to qualify. Because if a family is living high on the hog with their $10,000 a year, they aren't really poor, right? Fortunately, the Affordable Care Act fixed this, by changing Medicaid so that everyone with up to 133 percent of the federal poverty level ($30,657 for a family of four) would qualify. And to...

Sometimes a Loss Is Just a Loss

WikiMedia commons
Given the very strong likelihood that the centerpiece legislation of the Obama administration would be struck down in its entirety, yesterday's decision upholding the Affordable Care Act seems to most progressives like both a relief and a major political victory. But was it actually a legal victory when you examine the opinions closely? Tom Scocca says no : Roberts' genius was in pushing this health care decision through without attaching it to the coattails of an ugly, narrow partisan victory. Obama wins on policy, this time. And Roberts rewrites Congress' power to regulate, opening the door for countless future challenges. In the long term, supporters of curtailing the federal government should be glad to have made that trade. According to Scocca, Roberts engineered a big win for conservatives by fundamentally changing the law but doing so in a way that his opponents couldn't respond—a trick pioneered by Chief Justice John Marshall in Marbury v. Madison . If Roberts planted a time...

Give Me Broccoli or Give Me Death!

Scenes from the Supreme Court

Jaime Fuller
It’s only a bit after 8 a.m. and Russell Mokhiber is shouting at a belly dancer in front of the Supreme Court of the United States. Granted, it’s out of concern—it’s the kind of Washington, D.C., summer morning when it feels like the air is one giant dog’s tongue licking your body, and the lady in question, Angela Petry—a middle-aged sandy blonde with the abdominal muscles of an 18-year-old pageant queen—is his wife. She’s been dancing up a storm, a whirl of skin, red and blue silk scarves, and beads dripping from her bosom. “We need to pace ourselves, we’ve got three hours,” Mokhiber says, and he’s right, because the belly dancing is quickly becoming the media darling of the protesters gathered at the steps of the Supreme Court on Thursday morning to hear the ruling by the justices on President Barack Obama’s landmark health-care legislation. Mokhiber, of Berkley Springs, West Virginia, has come as part of Single Payer Action, a group that advocates for striking down the individual-...

What CNN Could Have Done

Oops!
If you were watching cable news when the Supreme Court handed down its ruling, you were probably confused at first. Initially, both CNN and Fox News announced that the individual mandate had been struck down, only to come back a few minutes later and correct themselves, after their screaming chyrons and web site headlines had already gone up announcing the administration's defeat. Let's forget about Fox, since they're just a bunch of nincompoops anyway. The more interesting question concerns CNN. The most common explanation for this screwup is that they have come to value being first over being right, which is true enough. But I think it also suggests that they don't really understand their audience. And by trying to be just as fast as MSNBC or Fox, they lost an opportunity to differentiate themselves. My guess is that the people who work at CNN have in their heads an imagined audience made up of people like them, people who think it matters if a particular piece of news is delivered...

Roberts's Solution to a Non-Problem

(Flickr/dbking)
On the fourth day of the Battle of Gettysburg, General Richard S. (“Bald Dick”) Ewell, riding behind the lines, was hit in the leg by a Union sniper’s bullet. Unfazed, the one-legged general remarked, “It don't hurt a bit to be shot in a wooden leg.” It may be that the federal government was shot in a wooden leg today. Overall, that’s true—the ACA survived, by one vote, a case that could have voided it in its entirety and wreaked havoc on federal power generally. But in particular, in the Court’s major new cutback on federal power—the limits on the use of Congress’s spending power to convince the states to sign on to an expanded Medicaid program—the federal government was wounded by being forbidden to do something it really never wanted to do. The federal government can’t coerce states by threatening to cut off existing program funding as a penalty for refusing to accept more money for new programs, the important opinion said. That means the ACA can go ahead as planned—because the...

A Tale of Two Justices

WikiMedia Commons
John Roberts imagined himself as a consensus-builder after his confirmation to be the 17th chief justice of the Supreme Court, a justice in the mold of John Marshall charged with alleviating divisions on the Court by advocating judicial modesty. Some progressive observers took these claims very seriously. I was inclined to view them as essentially fraudulent. Well, score one for the optimists. Today, the Supreme Court upheld the Patient Protection and Affordable Care Act in its entirety. While this outcome was not shocking, the vote lineup could be to many observers given that the final vote was 5-4. Chief Justice John Roberts joined the Court's four liberal members to uphold the PPACA, while frequent swing voter Justice Anthony Kennedy joined a remarkably radical dissent. The ultimate effects of NFIB v. Sebulius remain uncertain, but at the very least the case compels a re-evaluation of both Roberts and Kennedy. While Chief Justice Roberts deserves substantial praise for not striking...

Why It's Still in States' Interests to Expand Medicaid

(Flickr/ernstl)
For supporters of the Affordable Care Act, it was hard to hear—over the cheering—anything besides the fact that the Supreme Court today kept the law almost entirely intact. But the Court did make a slight change to a crucial part of the ACA: Medicaid expansion. Under the law, by 2014, states are supposed to extend their Medicaid programs to cover people under 65 with incomes up to 133 percent of the federal poverty line. An analysis from the Center on Budget and Policy Priorities shows that means 17 million more people would have access to health care over the next 10 years. Before today, it looked like states didn't have much choice in the matter. If they didn't make the necessary expansion, they would lose all federal Medicaid dollars. In their brief, states argued that wasn't much of a choice—federal Medicaid grants simply constitute too much money to lose. Back in February, Timothy Jost had a very helpful explanation of the states' argument on this point in Health Affairs . As he...

Republicans Will Soon Stop Talking about Health Care

foxnation.com
The Supreme Court's decision on the Affordable Care Act (ACA), particularly Justice John Roberts siding with the liberals, took most everyone by surprise this morning. But if you tune in to Fox News or surf around the conservative blogs, they seem to be taking it somewhat philosophically. They're not happy, but there's little rending of garments and gnashing of teeth. Mostly they're saying, well, we'll just have to win this in November ( see here for a representative sample). There's also a good deal of discussion of the fact that the Court declared that the requirement to carry health insurance is permissible under the government's taxing power. After all, if there's one thing Republicans know how to do, it's complain about taxes. Mitch McConnell quickly took to the floor of the Senate to condemn the decision, and no doubt Mitt Romney will soon say something so vague that no one can determine what he actually thinks. But here's my guess: Republicans are going to drop health care very...

The Fate of Health-Care Reform

In anticipation of the Supreme Court's historic ruling on the Affordable Care Act tomorrow, we've collected the Prospect's most important pieces about the law and its fate at the Supreme Court.

Ten Reasons American Health Care is So Bad , Ezra Klein (November 2007) Of all the countries surveyed in a recent poll, Americans were the least likely to report relative satisfaction with their health care. Here are ten major ways our system is failing us. The Cost of Delayed Reform , Harold Pollack (July 2010) The temporary federal high-risk pools won't reach most of the medically uninsured. Is Roberts the Real Swing Vote on the Affordable Care Act? , Adam Serwer (February 2011) Why the Chief Justice might vote to uphold the ACA. The Medicare Bind , Paul Starr (September 2011) Democrats should defend Medicare. But if they want to accomplish much else, they will have to change it. The Court Will Rule—And Then? , Harold Meyerson (November 2011) No matter the outcome, a judicial review of the Affordable Care Act can only hurt Democrats. Will the Supreme Court Overturn Obamacare? , The Monkey Cage (November 2011) Two political scientists calculate the probabilities. In Dire Health ,...

On "Owning" Health Care

These guys aren't too worried about owning health care.
In the search for silver linings to a Supreme Court decision striking down part or all of the Affordable Care Act, many people have suggested that should it happen, Americans will turn all their displeasure about the health care system on conservatives. Specifically, it is that that they will "own" the health care system. James Carville says that if the ACA is overturned on a 5-4 vote, "The Republican party will own the health care system for the foreseeable future." Former Solicitor General Walter Dellinger says , "If the court were to strike down this major reform effort, 40 years in the making, the court would own the resulting health care system for the next decade and beyond. It’s a slightly highbrow version of the universal rule: 'You broke it, you bought it.'" The Republican party is one thing, but the Supreme Court "owing" health care? What does that mean? That people will be protesting outside the Court when their premiums go up? First of all, they won't, and second of all, I...

Tom Corbett's Scary Plan for Pennsylvania Welfare

(Flickr/401K 2012)
Pennsylvania Governor Tom Corbett's first stab at a budget for this year left the education community shaking. The Republican had balanced the budget in part through deep cuts not only to the state's colleges and universities but also to school districts. That's terrifying news for a state where some districts are already considering ending kindergarten to balance budgets. Miraculously, thanks to unexpectedly high tax collections, the state's schools have been spared the chopping block. But Corbett's other proposal, major funding cuts for human services, still looks alive and kicking. State lawmakers only have until Saturday if they want to pass a budget on-time. Over the weekend, according to The Patriot News , the governor and GOP leadership agreed to spend $26.66 billion —$1.5 billion more than Corbett's initial draft. But the governor is pushing the legislature to approve a proposal that would combine several human services programs into single block grants. The change also come...

Floors and Ceilings In Health Care

Flickr/Francis Bijil
When Rick Santorum said during the campaign that inequality is a good thing, a lot of people were surprised. Santorum was attacking a straw man—he was arguing that everyone shouldn't have precisely the same income, while no one actually believes that they should—but it was revealing. One of the questions that we've neglected to ask in our health care debate is just how much inequality we are willing to tolerate—or in the case of conservatives, want desperately to maintain—in this particular arena. Conservatives like Santorum have an ideological commitment to inequality, the idea that some people simply deserve to have more than others. While conservatives used to believe that the identity of those who get more should be determined by birth (inherited membership in a favored class), these days they say that it should be determined by merit , which they tend to define tautologically as the state of being wealthy. Wealth is determined by merit, so if you're wealthy, it's because you're a...

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