Health Care

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...

The Benefits of Medicaid

The Affordable Care Act
In tomorrow's New York Times , Annie Lowrey has an interesting story about a study researchers were able to do in Oregon when the state had to hold a lottery to give people Medicaid coverage, leading to the perfect conditions for a randomized field experiment on what effect obtaining insurance could have. The results were pretty encouraging: In a continuing study, an all-star group of researchers following Ms. Parris and tens of thousands of other Oregonians has found that gaining insurance makes people healthier, happier and more financially stable. The insured also spend more on health care, dashing some hopes of preventive-medicine advocates who have argued that coverage can save money — by keeping people out of emergency rooms, for instance. In Oregon, the newly insured spent an average of $778 a year, or 25 percent, more on health care than those who did not win insurance. For the nation, the lesson appears to be a mixed one. Expanded coverage brings large benefits to many people...

What Will Conservatives Say If Only the Mandate Is Struck Down?

Looking forward to the FreedomLibertyCare plan. (Flickr/Speaker John Boehner)
There seems to be a consensus building that the most likely outcome from the Supreme Court on the Affordable Care Act is that it will strike down the individual mandate but leave most of the law in place. Just how disruptive this will be to the near future of health care in America is open to debate (see Sarah Kliff for the optimistic take), but there's another question I'm wondering about: How are conservatives going to react? Obviously, they'd prefer it if the law was struck down in its entirety. At the same time, they've centered their criticism on the mandate. This started as a purely opportunistic move, since the mandate was not only unpopular, but it offerend the most likely legal vehicle to undo the ACA. But once that decision was made, they spend the next couple of years talking about how that mandate is the very essence of tyranny. That process of arguing almost certainly convinced them that what they were saying was true. The other provisions in the law range from things...

Losing on Health Reform

An anti-Obamacare ad, in which a D-Day veteran explains how universal health insurance is as great a threat to our freedom as Nazism was.
When the Supreme Court issues its ruling on the constitutionality of the Affordable Care Act, we'll begin a new chapter in this saga, one that will probably (well, maybe) involve sorting through how the law's implementation will work once the individual mandate is struck down. But we've reached the point where there's no denying that the fight over public opinion has been lost, and that ground may never be regained no matter how hard the Obama administration or progressives might try. Perhaps it was inevitable. The administration passed an extraordinarily complex piece of legislation that sought simultaneously to solve a multitude of problems, each in its own way. At its heart was a compromise, an idea taken from conservatives to solve a problem created by the very fact that everyone was so insistent that we maintain the patchwork of private, employer-provided insurance, and this conservative idea provided conservatives the vehicle to get their allies on the Court to strike down the...

Republicans Possibly Pretending to Be Mad At Other Republicans Definitely Pretending to Care About Health Care

Congressional Republicans discuss health care. (Flickr/nkenji)
The Supreme Court will rule on the constitutionality of the Affordable Care Act soon, and that has concentrated some Republicans' minds. It was all well and good to shout "repeal and replace!" when there wasn't really anything they could do about it, but if the Court actually strikes down some or all of the law, they'll be under greater pressure to put their money where their mouths are. The central quandary is this: if the law's least popular provision—the mandate for everyone to carry insurance—is struck down, that means the law's most popular provision—the requirement that insurance companies accept everyone, regardless of pre-existing conditions—has to go as well. Not only that, some other popular provisions, like the requirement that insurers allow young people up to age 26 to go on their parents' insurance, would disappear if the Court strikes down the whole law. Should that happen, President Obama and other Democrats will immediately begin attacking Republicans for taking away...

What the Affordable Care Act Decision Will Mean

President Obama signing the Affordable Care Act.
Sometime soon—probably in three weeks or so—the Supreme Court is going to hand down its ruling on the Affordable Care Act. Given what happened at the oral arguments, there aren't too many people predicting that the ACA will be upheld, although that of course remains a possibility. Those oral arguments now seem like someone smacking us awake out of a dream in which we believed that the Republican-appointed justices might have something in mind other than the partisan and ideological advantage of their side. It was a weird dream, so weird that in the days before the arguments, some people seriously discussed the possibility that Antonin Scalia might be bound by the logic he had followed in previous cases involving the commerce clause and vote to uphold the law. What a joke. But it seems that the only real question is whether the Court will strike down the individual mandate alone, or strike down the law in its entirety. The former will mean one gigantic problem, namely what to do about...

Inconsistent Mandate

(Flickr/Gage Skidmore)
Barack Obama and Mitt Romney's stances on health insurance mandates stand as one of the great ironies of the 2012 presidential race. At various points both have opposed the mandate and both have advocated for the idea, successfully forcing the measure into legislation. The only problem is that they have evolved in opposite directions. The Obama campaign made the strategic decision to carve out a niche as the anti-mandate candidate during the 2008 Democratic primary. "It forces everyone to buy insurance, even if you can't afford it, and you pay a penalty if you don't," said one ominous ad from the 2008 campaign that Obama used to attack Hillary Clinton. That staunch opposition of course changed once Obama assumed office and faced the realities of crafting legislation. His team realized any measure that prevented insurance companies from discriminating on the basis of pre-existing conditions would collapse without a mandate, as healthy individuals would flee the market, leaving only the...

Health Care Play-Acting

GOP.gov
I've written many times, by way of explaining congressional Republicans' actions on the issue of health care, that it just isn't something that conservatives as a group care very much about. They have other interests, like taxes and the military, that they'd much rather spend their time on. This may strike some as unfair, but I think it's pretty clear from everything that's happened over the last couple of decades that it's true. There are a few conservative health wonks, but not nearly as many as there are on the liberal side. I can't think of any conservative journalists who are deeply conversant with the policy challenges and details of the health care system, while on the liberal side we have a number of such people, like Ezra Klein and Jonathan Cohn. Liberals have organizations dedicated to reforming the health system and achieving universal coverage; conservatives have organizations dedicated to stopping liberals from reforming the health system and achieving universal coverage...

What Romney Won't Do On Health Care

Maybe you don't want to know.
Despite what the average voter probably thinks, presidential candidates keep the overwhelming majority of the promises they make. And most of the ones they don't keep aren't because they were just lying, but because circumstances changed or they tried to keep the promise and failed. But that's in the big, broad strokes, while the details are another matter. It's easy to put out a plan for, say, tax reform, but even if you achieve tax reform, it's Congress that has to pass it, and they will inevitably shape it to their own ends. This happened to a degree with President Obama's health care reform: it largely resembles what he proposed during the 2008 campaign, but not entirely. He had said he wanted a public option, for instance, but eventually jettisoned that, and had rejected an individual mandate, but eventually embraced it as unavoidable. Which brings us to Mitt Romney's health care plan. In its details, it's quite horrifying. Jonathan Cohn has done us the service of giving it a...

The War on Contraception Enters the Courts

WikiMedia Commons
Forty-three Roman Catholic plaintiffs—including the archdiocese of New York and the University of Notre Dame—have filed lawsuits alleging that the Obama administration's contraceptive coverage requirements violate the First Amendment and the Religious Freedom Restoration Act. In case there were any doubts about the political nature of the lawsuits or the unpopularity of this war on contraception, as Salon 's Irin Carmon points out , the Notre Dame lawsuit alleges repeatedly that it would be required to cover "abortifacients” or “abortion inducing” substances although the regulation explicitly excludes them (and the claim that emergency contraception induces abortion is erroneous.) That the lawsuit is cultural warfare, however, does not in itself mean that it is without merit. Should the courts take these claims seriously? Will they? On the first question, I have argued at length elsewhere that both the constitutional and statutory arguments should be rejected. To allow institutions...

States Lag on Health Exchanges

(Flickr/GenBug)
Once the law is fully implemented, health care exchanges will be the part of the Affordable Care Act we likely notice most. The exchanges were designed to turn health insurance into something approximating a real market—unlike the current system which creates a myriad of blocks that prevent the consumers from purchasing health insurance as they would any good, forcing families to either receive insurance through their employer, pay exorbitant costs for individual, or go without any coverage. The exchanges—along with subsidies for low and middle-income Americans—will ease that burden, allowing consumers to select a plan from a central hub without worrying about pre-existing conditions affecting their coverage. Liberals shouldered a number of defeats in 2009 and early 2010 as the Affordable Care Act snaked through the grind of congressional dysfunction. The failure of a public option ate up most of the attention at the time, but a minor shift in how the exchanges would operate might...

Repeal and Pretend to Replace

(Flickr/Gage Skidmore)
Maybe Republicans aren't so opposed to health care reform after all. After grandstanding against the Affordable Care Act for the past few years, Republicans aren't ready to let the entire bill die should the Supreme Court overturn the law later this summer. Congressional Republicans are crafting a contingency plan to reinstate some of the popular elements of the bill in that scenario, according to Politico . It's a clear indication that the GOP has learned the same lesson as Democrats: while the all-encompassing idea of Obamacare may fair poorly in the polls, voters typically support individual elements of the bill. The Republicans would reportedly like to maintain the provision that allows young people to stay on their parents' health insurance until they turn 26 and rules that close a donut hole on Medicare's prescription coverage. Most notably, they would also reinstate the ban on insurance companies denying coverage based on preexisting conditions. That last part reveals why these...

What Romney's Medicare Plan Actually Does

(Flickr/Images of Money)
DC journos have spent much of the 2012 election trying to answer the question of how exactly a President Romney would governor. On one side, there are the skeptics who never bought into Romney’s rhetoric during the Republican nomination. They argue Romney is, at heart, still a moderate northeastern governor, a businessman unsuited for the extremism that has come to dominate his party. Others are equally convinced that Romney must be taken at face value. Sure he might have positioned himself in the middle while he governed a state dominated by Democrats, but he has spent the past five years running for president full-time, aligning himself with every right-wing whim over the course of his two campaigns. He’s the Republican who sought the endorsement of Ted Nugent, discarded a gay spokesman, and calls corporations people. Lest we forget, it was Romney who was poised to run as the right-wing challenger to John McCain and Rudy Giuliani in 2008 before Mike Huckabee swooped in to steal the...

Striking Down the PPACA: Still Not A Desirable Outcome

WikiMedia commons
Jon Rauch has an imaginary dialogued with the late Ted Kennedy in which he argues that a Supreme Court decision striking down the Affordable Care Act (a k a the PPACA) might actually be good for liberals. "If the Supreme Court guts another important law and conservatives cheer even louder," Rauch argues, "their credibility as advocates of [judicial] restraint will be shot.” And, in addition, striking down the PPACA would put us on the path to national health insurance. Perhaps, then, striking down the PPACA is something that progressives should secretly wish for? Racuh's argument is a little bit different than contrarian arguments based on the legitimacy of the Supreme Court , but I don't find them any more convincing. First, Rauch's argument is a variant of the argument that judicial decisions produce a unique amount of backlash, which means an inevitable reference to Roe v. Wade : You bet. Remember Roe v. Wade, the 1973 case that made abortion a constitutional right? At the time, it...

Planned Parenthood Can't Catch a Break

(Flickr/WeNews)
Planned Parenthood staffers might have been inclined to celebrate last Friday. That afternoon, the 5th Circuit Court of Appeals had ruled Texas could not exclude Planned Parenthood from its Women's Health Program . On Monday a district judge had granted an injunction, forcing the state to pay Planned Parenthood clinics that served the WHP clients—low-income women who are not pregnant. The injunction was short-lived—the state attorney general appealed the decision to the 5th Circuit, which granted an emergency stay, allowing state health officials to start kicking out the Planned Parenthood clinics. By Friday, the 5th Circuit had reversed the decision, granting a temporary injuction while Planned Parenthood's lawsuit against the state proceeds. While long-term fates are up in the air, this news was the best the organization has heard in quite a while. But any celebration would have been short-lived. By Friday night, the organization was already getting bad news. Texas may now have to...

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