Health Care

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.

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 them

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. 

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.

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.

Republicans Will Soon Stop Talking about Health Care

foxnation.com

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.

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.

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 don't think the Court's conservative justices could care less if they did.

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. 

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.

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...

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?

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.

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 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.

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.

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