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.
The Supreme Court's decision on the Affordable Care Act, particularly Justice 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 quickly.
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.
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 don't think the Court's conservative justices could care less if they did.
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.
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.
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...
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?
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.
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 these popular benefits. After all, the overturning of the ACA is a Republican project from start to finish, from the lawsuits brought by Republican attorneys general to the Republican judges on the Court who will undo it. So what do you do if you're a Republican member of Congress? Well, you start pretending that when you get around to that whole "replace" thing, you'll keep the stuff everybody likes.
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.
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.
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. Other than an eternal desire to limit the ability of patients to sue for malpractice (which is as much about hamstringing trial lawyers, who donate a lot of money to Democrats, as it is about improving health care), Republicans only propose anything intended to improve the health care system when political events make it impossible for them to remain silent.
Which is why it's reasonable to be highly skeptical whenever congressional Republicans start talking about what they'd like to do on health care. That's the proper spirit to take the latest news on how conservatives are positioning themselves:
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...
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.