Health

Republicans Have Lost the Obamacare Policy War

David Leonhardt: “Republicans … have made undoing the law known as Obamacare their central domestic priority over the past five years.”

“Yet now most experts believe that Obamacare is here to stay. Even if Republicans win back the White House in 2016, they are unlikely to have as good an opportunity to damage the law as the Supreme Court had … The Republicans can still win the electoral battle in 2016, but they appear to have lost the policy war over health care.”

“How, then, can the court’s ruling in favor of the health law – a ruling whose details were even more favorable to the law’s long-term standing than many court watchers expected – be good for Republicans?”

“The short answer is that it isn’t, not if you believe politics exists as a lever to affect government. The longer answer is that Republicans had already lost the war, well before the court ruled on Thursday.”

“They lost it in 2014, when the law began providing real benefits to millions of people – health insurance to a combination of middle-class, poor and sick Americans who could not have afforded it otherwise. Modern American history makes clear that once the social safety net expands in a major way, it’s almost impossible for anyone to reverse it.”

The Obamacare Fight Continues

New York Times Editorial Board warns that “there are myriad ways the current Republican Congress, future Congresses or a future Republican president could subvert important elements of the law or render it inoperative.”

“It is imperative that in 2016 voters elect people to Congress and the White House in 2016 who will support health care reform. It is equally important that as many uninsured people as possible be reached and enrolled in private plans or Medicaid. The greater the number of people who benefit from the health reform law, the harder it will be to dismantle it.”

“States will have an important role to play in expanding coverage. Some 21 states, the vast majority run by Republican governors, have refused to expand their Medicaid programs to include childless adults and people with higher incomes, as the law allows … Yet the Republicans, gripped by an irrational hostility to helping the poor, would rather hurt the uninsured and damage their state economies by refusing federal money.”

“It has long been clear that the Republicans in Congress have no workable plan for replacing the Affordable Care Act, and can’t even fake it. The Republican presidential candidates think they can energize their base with pledges to repeal reform.”

Obamacare Ruling Round-up

New York Times Editorial Board: “The case challenging the law, King v. Burwell, was always an ideological farce dressed in a specious legal argument, and the court should never have taken review of it to begin with.”

“Thursday’s decision was a powerful defense of the law, stronger than observers might have expected from this court.”

Linda Greenhouse: “Justice Scalia derided the majority opinion as a ‘defense of the indefensible.’ But what would be truly indefensible, I believe the chief justice and Justice Kennedy came to understand, was the Supreme Court itself, if it bought a cynically manufactured and meritless argument and thus came to be perceived as a partisan tool.”

“This whole exercise was unnecessary, the outcome too close for comfort. But there is cause for celebration in a disaster narrowly averted — for the country and the court, which is to say, for us all.”

Ezra Klein: “In the aggregate, there’s a case to be made that the Roberts Court, in general, is coming to liberal decisions more often than was expected … But in this case, even if liberals are happy with the Obamacare decision and conservatives are upset about it, deferring to Congress’s clear intent is supposed to be the way conservative judges rule.”

Theda Skocpol and Lawrence Jacobs: “This new Supreme Court decision, rejecting an ultraright challenge to the nationwide subsidies that allow lower-middle-income Americans to buy affordable private health insurance on state-level exchanges established by the federal government, will speed the already remarkable implementation of health reform. And that progress has been truly rapid by historical standards.”

SCOTUS Opinion Leaves No Room for Doubt

Greg Sargent: Chief Justice Roberts’ “opinion may have precluded any future efforts by a Republican president to use executive discretion to cancel the subsidies for the millions of people on the federal exchange. This option might have been left open if the ruling had been written differently.”

The opinion “ultimately did not base its conclusion on ‘Chevron deference,’ i.e., the idea that Courts should defer to the discretion exercised by an agency (in this case the IRS) when interpreting seemingly confusing or self-contradictory statutes.”

“The court held that it would not presume that Congress implicitly intended to defer such a central decision to the agency. As such, the Court’s task was to determine the ‘correct’ reading of the disputed phrase.”

“A strong six member majority of the court is coalescing around this very clean argument,’ [Yale Law School Professor Abbe Gluck said].  ‘That sends a strong signal to people who politically oppose the law that the court understands the law and is not going to tolerate more of this frivolous litigation that tries to destroy the statute by distorting it.’”

GOP Reaction to Obamacare Ruling? Relief

Vox: “Amid a flurry of official statements declaring shock, outrage, and disappointment after the Supreme Court upheld the Affordable Care Act’s federal insurance subsidies Thursday, Republicans quietly confided they were feeling something else, too: relief.”

“So even though Chief Justice John Roberts wrote another opinion upholding the health-care law, the conservative actually did Republicans a favor. The 6-3 ruling spares House and Senate GOP leaders from having to act. And it liberates Republican primary contenders from having to talk about subsidies. Instead, Republicans can return to the safe ground of ‘repeal and replace’ Obamacare rhetoric rather than having to go down the far riskier road to action.”

A lot of Republicans “weren’t looking forward to spending the rest of this Congress talking about how to put Obama’s law back together. It would have been a messy process, with no guarantee that they could get a plan through either or both chambers. And, of course, there’s little chance that they could have found common ground with Obama to sign their fix.”

“That is, they were facing a whole lot of work with little likelihood of having anything to show for it at the end of the process — other than yet another highly charged political battle over the same law.”

Supreme Court Upholds Obamacare Subsidies

New York Times: “The Supreme Court ruled on Thursday that President Obama’s health care law may provide nationwide tax subsidies to help poor and middle-class people buy health insurance.”

“Chief Justice John G. Roberts Jr. wrote the majority opinion in the 6-to-3 decision. The court’s three most conservative members — Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. — dissented.”

“Chief Justice Roberts wrote that the words must be understood as part of a larger statutory plan.”

“’In this instance,’ he wrote, ‘the context and structure of the act compel us to depart from what would otherwise be the most natural reading of the pertinent statutory phrase.’

“’Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,’ he added. “’f at all possible, we must interpret the act in a way that is consistent with the former, and avoids the latter.’”

Jonathan Cohn: “The decision is a major defeat for conservatives, who have been trying to wipe Obamacare off the books ever since its enactment in 2010. The sweeping reform law, a key component of President Barack Obama’s legacy, now appears to be secure at least through the 2016 elections. Its fate beyond that will depend on who becomes president next year — and whether Republicans in Congress are willing to keep fighting for repeal.”

How Effective Are Obamacare Subsidies?

Robert Pear and Margot Sanger-Katz ask, have the Obamacare subsidies succeeded?

“By many measures, the answer is yes. More than seven million people are enrolled in the federal health insurance marketplaces, and a majority of them — 87 percent — receive subsidies in the form of tax credits to help pay their premiums, the government says. Without subsidies, many would be unable to buy insurance.”

“The subsidies also appear to have drawn substantial numbers of younger, healthier Americans into the new insurance markets, stabilizing premiums, even for people who pay the full cost themselves.”

“The effects would be felt around the country, but disproportionately in the South … The subsidies were larger, and therefore more effective in expanding coverage, for eligible people with the lowest incomes, and less effective for people with higher incomes.”

“Although they reduce the direct cost of buying insurance for many consumers, the subsidies do not by themselves hold down the overall cost of insurance, which is driven in part by health care costs.”

“The marketplace plans have proved less popular among higher earners, raising questions for some experts about whether the subsidies are adequate.”

Modest Increases Projected in Some States for Obamacare Plans

Kaiser Family Foundation Newsletter: “A Kaiser Family Foundation analysis of ACA plans in major metropolitan areas in 11 states where data are available, including the District of Columbia, finds that preliminary 2016 premiums for benchmark silver plans grew modestly, but increased more sharply this year than last year. The average increase for benchmark plans across the cities is 4.4 percent for 2016 compared with a 2 percent increase nationwide in 2015.”

“Premium changes for the benchmark plans vary significantly across the cities in the analysis, ranging from a decrease of 10.1 percent in Seattle to an increase of 16.2 percent in Portland, Ore. Complete 2016 rate information isn’t yet available for all states.”

Silver Premium Percent Change from Previous Year

“In 2016, the number of insurers offering coverage stayed the same or increased in nine states, but decreased in Michigan and the District of Columbia, according to the analysis.”

 

 

GOP Governors Walk Political Tightrope With Obamacare Subsidies Case

Politico: “If the Supreme Court rules against Obamacare subsidies, the four governors running for president will face a harsh choice: Let tens of thousands of people get kicked off their health plans, or try to create a state exchange and lose credibility with a virulently anti-Obamacare Republican primary base.”

“Louisiana’s Bobby Jindal, Wisconsin’s Scott Walker, New Jersey’s Chris Christie and Ohio’s John Kasich all refused to set up Obamacare exchanges, as did most other GOP governors. Their states would be directly affected if the court rules that the health law’s subsidies can go only to people living in states that did establish the new online Obamacare markets.”

“They can say it’s a Washington problem. But if gridlocked Washington can’t fix it, they’d be stuck with no good answers for their own citizens losing coverage — other than trying to deflect blame to President Barack Obama and Obamacare.”

“Or they could undertake the politically and economically challenging task of trying to create a state exchange, after shunning them a few years ago. But that would put them in the difficult position of fixing a law they’ve vowed to repeal; doing anything that looks like salvaging the Affordable Care Act is not going to go over well with GOP primary voters.”

For the First Time, More Approve of Obamacare

CBS News: “As the U.S. Supreme Court prepares to issue a ruling that could impact the Affordable Care Act, 47 percent of Americans now approve of the health care law, the highest in CBS News and New York Times polling (although support is still short of a majority). For the first time, more Americans now approve than disapprove of the ACA, but by a narrow margin.”

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“Most Republicans (72 percent) continue to oppose the law, while most Democrats (70 percent) support it. Independents are split. Still, few Americans (just 9 percent) think the health care law is working well and should be kept as it is, and 31 percent want the law repealed entirely. Most – 55 percent – think that there are some good things in the law, though changes are needed to make it work better. More than half of Republicans would like to see the entire law repealed.”

“One part of the law that a majority would like kept in place is the subsidies to help low and moderate income people buy health insurance. Seven in 10 think the U.S. Supreme Court should rule to continue this financial assistance. Half of Republicans, however, disagree.”

 

Most Oppose Lower Court Ruling on Obamacare Subsidies

Washington Post: According to the latest YouGov.com poll, “even on an issue such as Obamacare, Republicans are not all that excited about the court upsetting a legislative action, even one with which they disagree: ‘Americans tend to oppose (40%) rather than support (26%) the lower court’s ruling that subsidies cannot be provided, but 34% are not sure either way, and only 33% of Americans actually say that they have been following the news of the threat to federal exchange subsidies. Most Democrats (54%) oppose the ruling to end these subsidies, while independents tend to oppose (38%) rather than support (24%) ending them. 38% of Republicans support this ruling, but 37% aren’t sure and 24% oppose the ruling.’”

“That is a remarkably low number of Republicans who support a court order dumping the federal exchange subsidies. Republicans would be wise not to engage in too much chest-beating over court evisceration of Obamacare, and to rather take this as an opportunity to assure Americans who have relied on the exchanges that they will not be left in the lurch. Moreover, they’d be smart to advance their own, conservative alternatives to Obamacare.”

White House Emphasizes Economic And Health Benefits of Climate Plan

National Journal: “Acting on climate change can avert tens of thousands of premature deaths and save billions on electricity and infrastructure costs by the end of the century, according to a report released by the White House today.”

“The White House is aggressively pushing the message that action on climate change can produce economic and public health benefits, doing so amid attacks from the right that the regulations are too costly and will produce minimal benefits. House Republicans this week will hold two votes on bills that would scale back or block emission rules on power plants.”

“According to the [EPA’s Climate Change Impacts and Risk Analysis,] scaling back the climate plan would have impacts across myriad sectors, from transportation to agriculture. For example, the report predicts that anywhere from 720 to 2,200 bridges would become structurally deficient as a result of extreme weather and storms by 2100.”

“The report also predicts that implementing President Obama’s climate action plan and reaching a global deal would avert 57,000 deaths from poor air quality and another 12,000 deaths from extreme temperatures by the end of the century.”

GOP Still Struggling to Define Their Obamacare Victory

National Journal: “The GOP still has no idea what a health care victory looks like. The reason the party fails over and over again is Republican health plans are the policy equivalent of what the tech industry calls vaporware—products that are perpetually in development, and are sometimes even previewed or demonstrated, but never quite make it to market. This is the way it always is for Republicans and health policy: a handful of options but no consensus—and the real plan, whatever it turns out to be, is coming soon, but not yet.”

“Regardless of how the Supreme Court decides this month on King v. Burwell, which challenges the legality of the administration’s decision to allow private insurance subsidies in federally run exchanges, what the episode reveals, yet again, is the Republican party’s historic failure to truly engage with the difficult realities and trade-offs of health policy—and how that failure has crippled the party’s ability to respond even when faced with events like big Supreme Court decisions that should force them to come up with an actual plan.”

“But in another sense, Republicans have already lost, because when it comes to larger health policy goals, the party effectively doesn’t have any beyond the repeal of the Obamacare. In the long term, Republicans can’t win this fight because they don’t know what winning means.”