The Supreme Court had reached a decision. The excitement grew in intensity as news of the ruling spread across the capitol. Washington was awash in celebrations, both public and private. Private because this was news that some could only appreciate, secretly, among their closest friends and compatriots. The Supreme Court codified a reality some of us have recognized for years.
The Patient Protection and Affordable Care Act (PPACA) is here to stay.
Thursday, June 25, 2015 was a wonderful day for politicians. Big wins across the board. You, Joe and Jane Public, will be OK. We are always OK. Some of us have been helped by the legislation. Some of us have been hurt by it. But we will, at worst, survive. The biggest winners were our politicians.
This blog has long contended that the PPACA was a poorly written law. The Supreme Court has now made that official. In an effort to make health insurance affordable, the law included Tax Credit Subsidies which would be based on an individual’s income. The catch was that you had to apply through an Exchange, in essence a government run online marketplace. The PPACA seems to have limited the access to the Tax Credit Subsidies to those applying through an exchange “established by a State”. In other places within the law it appears that any government run exchange would do. Many of us viewed this, in 2010, as part of the law’s efforts to force the states to participate. States controlled by Republican governors and legislators took the challenge and refused to create exchanges. The federal government gave us Healthcare.gov and moved forward. Now we have millions of Americans across the country covered by subsidized insurance. That was the reality the Supreme Court faced.
The number one place for clear-eyed Supreme Court analysis is SCOTUSblog. Here you will find brilliant articles arguing both sides of the issues facing the Court and the minutia that will find its way into totally unrelated cases 50 to 100 years from now. The posts following this decision are fiery and passionate. Don’t let the legalese fool you. These writers are playing for keeps.
Our politicians are the polar opposite. Democrats and Republicans aren’t searching for intellectual discussions. Both sides are too busy mining our emotions, mostly our deep pools of fear and resentment.
Our Democratic friends will tell us how hard they have had to work to protect us from ruin and the Republicans. We will be told that any flaws in the PPACA are due to Republican recalcitrance to progress and the new law. NOW, now that the Supreme Court has fended off the last real challenge, all of the promises of the PPACA will be realized. And when they aren’t? When premiums continue to increase and more and more businesses choose to drop their employer sponsored group policies, there will still be plenty of Republican resistance to blame.
Our biggest winners were the Republicans. This blog noted on November 3, 2010, the day after the Republicans won the House, that the GOP had no real interest in repealing the PPACA. We have had over 50 cynical show votes since then. Repeal the law and they would own the problem. Resist the law and the Republicans are free to complain, with a total absence of intellectual honesty, about the specific provisions of the law without any obligation to provide an alternative.
There have been some readers who doubted this last assertion. Privately they championed one Republican leader or another who promised to reveal an all-encompassing alternative to Obamacare much the way Richard Nixon had a secret plan to win the war in Vietnam. King v. Burwell forced the GOP’s hand.
No one knew how the Supreme Court would rule on King v. Burwell. It could have gone either way. As it was, Chief Justice Roberts was forced to perform intellectual somersaults to author this decision. He was absolutely correct in his assertion that the elimination of the subsidies for most of the country would have destroyed the insurance market. We would have sunk into a death spiral. That makes him the most important insurance commissioner in the country. And to the extent that the country might be better off with the law than with the chaos we would have endured, I am pleased with the decision. But I couldn’t have predicted it. No one could. So the Republicans were forced to plan for either decision.
Senator Ron Johnson (R-WI) and his plan were the subject of the May 11th post of this blog. I found it to be the most realistic because its main goal was to do nothing. Senator Johnson wanted to leave the subsidies in place but eliminate the employer and individual mandates until after the next election. You know when you are in trouble when doing nothing is your best option.
The Washington Post published “Your pocket guide to Obamacare replacement plans” last Tuesday, two days before the ruling. The Post highlighted the top 6 Republican options. They thought that Senator Johnson’s plan had the best chance of moving forward. Now all of those plans can be tossed.
Instead of having to deal with details and numbers, we will be treated to Senators, Congressmen, and most vociferously, by Presidential candidates discussing patient centered care, the free market system, and the holiness of the doctor-patient relationship. Yada Yada Yada.
All Sizzle and No Steak
The Patient Protection and Affordable Care Act is a poorly written law built more upon good intentions than a solid foundation of how insurance works. Nothing changed this past week. The Democrats will focus on the victories. The Republicans will highlight the failures.
Does anybody feel like celebrating?
Photo credit – ME!