Health Care

Roberts's Switch in Time

WikiMedia Commons
Jan Crawford has a blockbuster story in which two sources confirm what many people inferred from the structure of the opinions—that Chief Justice John Roberts initially voted to strike down at least some parts of the Affordable Care Act before switching his vote. The story reveals some interesting things about Roberts and the Supreme Court, although we should also be careful about taking all the claims at face value given that they clearly reflect the positions of justices and/or clerks with an ax to grind. The most obvious takeaway from the Crawford piece is that there was a fairly substantial rift created on the Court by Roberts's eventual decision to uphold the bill. While some details about the internal deliberations of the Court generally leak out eventually—as clerks have less to fear in terms of reprisals or as court papers are released by retired justices—for these details to emerge less than a week after a decision is handed down is extraordinary. Clearly, some of the...

Maggie Gallagher and I Agree to Agree

So my three-part series last week on whether or not marriage equality is radical (in brief: who cares ?; yes ; and no ) drew the attention of Maggie Gallagher, longtime opponent of same-sex marriage. It was kinda fun to be called "always interesting and honest." I've known for a long time that she and I agree about the symbolism of allowing two people of one sex into marriage—it's why we were paired several times in debate. As she says, quoting me whole : Graff also acknowledges that Blankenhorn’s (and mine!) core concern is not irrational. Gay marriage furthers the disconnection of marriage from procreation; it helps in an ongoing way to sever the link between sex and diapers. I just think the change is a good idea, while she thinks it's a bad one. I have long wondered, though, why she's fighting this particular rearguard action. Our 1.5 percent of the population is hardly a very important symbol. Why doesn't she focus on the real source of this disconnection—same-sex couples are...

Reading the Tea Leaves in the Supreme Court Opinions

Jaime Fuller
Two features of the scene in the courtroom at the Supreme Court Thursday flow together to spark curiosity. For one, the justices appeared unusually agitated. Justice Sonia Sotomayor looked as if she’d been up all night, for example, while (as Tony Mauro also noted) Justice Antonin Scalia was downcast and tight-lipped. Had something happened in the days or hours before the opinion to spark this emotional response? In his bench dissent, Justice Anthony Kennedy stressed that the act had been so mutilated by the Court’s decision that it should be struck down in its entirety. That struck me at the time as odd. The Medicaid expansion, as I explained yesterday, is an important part of the act. Even so, it’s not the heart of it—that was the individual mandate. The government had argued that, if the Court struck the mandate, it should also strike the provisions guaranteeing that the people with “preexisting conditions” can’t be turned down for insurance and barring insurers from discriminating...

Court Stays Clear of Tinkering with the First Amendment

(Flickr / mr_mayer)
Xavier Alvarez got twin pieces of good news Thursday. First, thanks to the Court’s decision in the Health Care Cases, Medicaid in California may soon be funded to supply mental-health services to crazed compulsive liars like him. Second, and of more immediate interest to him, he won’t be doing a year in the federal slam for falsely claiming to have won the Congressional Medal of Honor. United States v. Alvarez was second banana on the Supreme Court stage Thursday, blasted out of the headlines by the stunning decision upholding the Affordable Care Act. But the case had been closely watched in the First Amendment community. That’s because it represented an attempt by the government to find a brand-new, gaping hole in free-speech protection—a First Amendment exception for liars like Alvarez. Alvarez, as has been reported earlier , is a half-crazed poseur who likes to claim, among other things, to have played for the Red Wings, to be the ex-husband of a Mexican movie star—and to hold the...

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...

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