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. “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...

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. Is Roberts the Real Swing Vote on the Affordable Care Act? , Adam Serwer (February 2011) Why the Chief Justice might vote to uphold the ACA. The Medicare Bind , Paul Starr (September 2011) Democrats should defend Medicare. But if they want to accomplish much else, they will have to change it. The Court Will Rule—And Then? , Harold Meyerson (November 2011) No matter the outcome, a judicial review of the Affordable Care Act can only hurt Democrats. Will the Supreme Court Overturn Obamacare? , The Monkey Cage (November 2011) Two political scientists calculate the probabilities. In Dire Health ,...

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...

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. State lawmakers only have until Saturday if they want to pass a budget on-time. Over the weekend, according to The Patriot News , the governor and GOP leadership agreed to spend $26.66 billion —$1.5 billion more than Corbett's initial draft. But the governor is pushing the legislature to approve a proposal that would combine several human services programs into single block grants. The change also come...

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...

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