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.
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.
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.
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?
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.
Ronald Dworkin has an article defending the constitutionality of the Patient Protection and Affordable Care Act in the New York Review of Books that offers an excellent primer on the relevant issues. There are two sections I'd recommend in particular. First, in Section II Dworkin does the most lucid job I've seen so far in explaining why the "activity/inactivity" distinction made by the challengers is so weak:
(Flickr/ Planned Parenthood Federation of America)
Texas health officials are telling low-income women not to worry. The Women's Health Program, the Medicaid program serving 130,000 women, will still be there for them. Of course, how it will be paid for and whether enough clinics will be left providing services are still subjects up for debate.
After weeks of pressure, the American Legislative Exchange Council (ALEC) appears to be backing away from long-term efforts at creating barriers to voting (voter-ID laws) and pushing "Stand Your Ground" legislation. The latter allows those who feel threatened in public places to use force; Florida's version is currently at the center of the Trayvon Martin case. Giving in to public pressure, ALEC announced Tuesday that it was disbanding its Public Safety and Elections Task Force, which promoted such legislation and helped see it proliferate.