King v. Burwell Update

The Story Thus Far: The Supremes are expected to hand down a decision in King v. Burwell this month or the next.  If the Court sides with the plaintiffs, the subsidies for health insurance purchased through exchanges would be eliminated in 34 states, causing about 7.5 million people to lose coverage on the spot. The decision could bring about the catastrophic failure of the ACA.

Republicans are angry with the White House for not creating a “Plan B” to make some provision for the 7.5 million. Of course, if Republicans in Congress gave a hoo-haw about the 7.5 million, it would be the easiest thing in the world to simply amend the ACA to make it clear the law will provide subsidies to all states whether they created their own exchanges or not. The House has managed to vote to repeal Obamacare more than 50 times already, after all; they could divert their attention to a simple fix.

There is an ongoing debate whether a decision to strike down exchange subsidies would hurt Dems or Republicans worse. In a sane world it ought to hurt Republicans, but many have pointed out that voters in the affected states probably don’t know doo-doo from doughnuts — else they wouldn’t be saddled with a bunch of loser wingnuts in state government — and would blame Democrats when their premiums are jacked up.

Anyway, the White House position is that any justice who votes to end exchange subsidies would be a political flunky and damnfool idiot, and they’re banking on at least five justices not being damnfool idiots. We’ll see. But the White House is making no plans.

Republicans are making typical Republican-type plans, which means they are trotting out hazy concepts that won’t work but can’t come up with anything concrete. Jonathan Cohn explains the problem:

Republican leaders in Congress have been promising to craft a detailed Affordable Care Act alternative ever since President Barack Obama signed the law in March 2010. But while Republicans have found time to vote on repealing the health care law more than 50 times — and have worked hard, as they did on Tuesday, to pass modifications that would benefit powerful special interests like the medical device industry — they’ve yet to move a single Obamacare alternative through committee and to the floor. Nor has any committee with relevant jurisdiction held even a single hearing on how to handle the aftermath of a potential Supreme Court ruling that wipes out tax credits in two-thirds of the states.

(For a thorough and thoroughly amusing chronicle of past GOP promises to craft Affordable Care Act alternatives, see the summaries from HuffPost’s Jason Linkinsand Jeffrey Young.)

Republicans’ history of promising and then not delivering comprehensive health care legislation — a history, after all, that goes back decades — hints at a deep, fundamental disagreement with the entire idea. Republicans will talk up the importance of helping people with pre-existing conditions or providing financial assistance to people for whom insurance is too expensive. But creating a truly universal coverage system — in which everybody has access, regardless of income or health — requires taking steps that many conservatives simply can’t abide.

Specifically, universal coverage requires some combination of regulation, taxes and redistribution (from healthy to sick, and from rich to poor) that Republicans tend to find economically destructive, morally noxious or both. That’s true of wholly nationalized, single-payer systems like you find in France or Taiwan. It’s true of universal schemes of regulated private insurance, like they have in the Netherlands, Singapore and Switzerland. It’s even true of programs in the U.S. that have existed for a long time — not just Medicare but also, to some extent, employer-sponsored insurance.

But rather than admit that they cannot come up with a comprehensive health care plan that will actually work, they engage in a sort of legislation theater in which they toss out talking points about Health Savings Accounts (which only work for relatively healthy people with lots of disposable income who need tax shelters) or propose providing subsidies in exchange for killing the mandate (which would cause private insurance companies to pull out of the exchanges). Some of them are still talking about high-risk pools, which have been tried and which consume tax dollars the way a black hole obliterates matter.

But at the state level, some officials are beginning to panic.

Tonight the Wall Street Journal has a fascinating look something we may soon hear a lot more about in a very rushed and chaotic fashion. Last month, an outfit called the Milbank Memorial Fund (as best I can tell a relatively non-ideological foundation focused on health care policy) held a secret one day meeting in Chicago for officials from states who may suddenly find their citizens cut off from Obamacare health care insurance subsidies because of the new GOP challenge to the law.

The verdict. Basically that they’re screwed.

This doesn’t necessarily mean that the Republican legislators in those states are likely to do a damn thing, even if there were a damn thing they could do. However, there’s talk that some state governors might find some work-around that would allow the subsidies to continue, like declare that their exchange is a state exchange, dammit, even if the federal government created it. Maybe they could set up some shell site interface to the federal exchange and call it a state exchange. Whatever.

All I can say right now is that I’m glad I live in New York, which has its own exchange.

29 thoughts on “King v. Burwell Update

  1. Obama and the Democrats passed Plan A.
    Not a perfect plan, but a pretty damn good one, and at least a start that can be improved on.

    It wasn’t up to the President and the Democrats to create a Plan B.
    That, you sociopathic and psychopathic FreeDUMB and LiberTEA loving Teatards, was up to you!

    And you’ve had over 6 years to come up with one, since both Hillary and Obama in the ’08 primaries ran on restructuring health care in this country.

    You keep saying you have one.
    Is it a secret one, only to be revealed if PPACA is overturned by 5 sociopaths on the SCOTUS?
    Or, do you have a large kennel of dogs who keep eating your health care homework?

    Or, more likely, you feckin’ eedjits don’t give a fig, because you figure that you can lay the newly uncovered sick and dying at the feet of the Democrats, and blame them for your mess?

    You can correct the 4 or 5 words that caused this stupid case to go the SC in about 3 minutes – if, you cared to, that is – and work with the more than willing Democrats who want to fix it.
    But, Democrats is icky, and working with them to fix something will piss-off your base – which only likes death and destruction. As long as it’s not them dying and/or being destroyed!

    But that’s 3 minutes out of your day that you think is better spent glad-handing donors, and bitching about the Democrats on (DUMB)FUX “news,” and with your Reich-Wing radio and Op-ed cronies and pals.

    What twisted “people” our conservatives are!

    Here, as I’ve said before, is their real plan:
    Die fast.
    Die quiet – no whining!
    And die cheaply – unless, of course, some of your Big Medico and Pharma pals can make more money if you suffer from a long and lingering death.

    Hey, when you’re dead, you won’t need your house, right?
    And your family will want to move, because there are too many memories of you in it, right? They’ll want to downsize to a shack or a refrigerator box under an overpass.

    So, why shouldn’t some corporation make money off the house you don’t need, and y0u family won’t -CAN’T!!! – want to stay in!

  2. Various friends have tried to get me to move out of NYC. But I’ve stayed. Now I have a solid reason to point to: I get discounted cost health care at NYC clinics. I’m not working right now and have no income. I do have assets though. But NYC’s Health and Hospitals Corp. has it’s own insurance plan of sorts. Through the Options program I can be seen at a City clinic and I have a copayment for doctor’s visits and medication. A very reason I think to stay in the City.

  3. This will get ugly if it goes badly for ACA, and it will be a blame game demanding multiple buckets of popcorn and several consecutive Super Bowl Halftime performances to drown out the wails of the dying.

  4. One thing that bugs me is the media. There were no questions to the Republican Congress about whether they’d “reach across the aisle” to provide this obvious fix, to show their willingness to work with Democrats. Were the situation reversed, such questions would have been asked.

  5. Hope Roberts and/or Kennedy votes with the non-idiots this time.

    Without subsidies, the affordable care act is anything BUT. My first year premium would have been 50% higher than my private plan, and my second year would have seen an additional 40% jump. And I had a good, solid bc/bs plan– not a “deficient” plan, as the Prez puts it. Dang, I wish we’d gotten single payer…,

  6. You know, I’m gonna pull a Dean Baker on you and point out that you shouldn’t be saying “Republicans are angry…[because]” in the first sentence of your second paragraph. It should be “Republicans are claiming they are angry… [because]”. Neither you or I are mind readers, but the fact that, as you then immediately point out, could easily correct this problem at any time strongly suggests that they’re just making a claim to be angry for the reason in that first sentence. And that the claim is fairly obvious bullshit.

    It’s just important to keep hammering on them (as you do, rightly) but part of that is trying to be careful to never let them get away with their professed but obviously false stated motive for doing X.

    • JDM — They are not claiming to be angry. It’s been obvious for some time they are pissed at the Obama Administration for not coming up with a Plan B. One does not have to be a mind reader to know when someone is angry.

  7. I don’t trust either party to govern effectively. Democrats pushed through this disaster without bothering to read it. Republicans continue to fund it despite campaigning to the contrary. Maybe the federal government should stay out of the health care business and SCOTUS should learn how to read.

    • TS — You must be new here. One, the ACA is not a disaster. Overall it’s worked pretty much as it was designed to work. About 10 million people have health insurance now who didn’t have it before, and the ACA has saved the federal government a ton of money. You wouldn’t have heard that on Faux News, but it’s the truth.

      Republicans can’t defund it without passing a law in both houses of Congress that would be signed by the President, and that’s not going to happen until Republicans take the White House. That’s because the ACA is considered mandatory spending not subject to annual renewal and appropriations of Congress. Its source of funding is derived from the law itself not from an appropriations process. But it would be stupid to defund it, because defunding it would actually cost more money than keeping it.

      And, finally, the cute talking point that nobody read the ACA before it was passed is a huge, and stupid, exaggeration.

  8. the federal government should stay out of the health care business

    We’d be alone in the industrialized world if we did that, plus there are those 50 mainly-successful years of Medicare to wish away.

  9. It’s the classic case of –

    “Be careful what you wish for –
    you might get it.”

    For all the ginned up fury about Obamacare, fatally wounding it may turn out to be a popular with the voters as shooting Bambi. And the GOP sees no way out of the trap they constructed.

  10. If the ACA goes down and the OMG party manages to take Medicare with it, I’d have to consider committing suicide, being elderly and poor. But I wouldn’t be able to find any drugs to do it with, so I’d have to shoot myself…if I could afford a gun and the ammo.
    Maybe a knife. At least I own those. 😛

  11. I don’t see any way Medicare can be done away with. There are too many hospitals, home care and nursing homes that could not survive without it. There would be a revolution for sure.

  12. This reminds me of a law that was passed in Florida back when Jeb Bush was the Governor. The law was part of the get tough on crime, three strikes you’re out package with the mandatory minimums. One part of the law was worded to the effect that the use of a firearm in the commission of a drug felony carried with it a mandatory life sentence.
    No sooner had the law been passed when some guy was arrested in a drug deal where his usage of a firearm in the drug deal was only as payment/exchange for the drugs. His arrest set up a classic letter and spirit of the law conflict. He violated the law to the letter, but found sympathy and regret even among the legislator who wrote the law. It was not their intention of firearm usage as they had envisioned it and they never considered the use of a firearm solely as a form of payment.
    There is a similar dynamic with the ACA where the Repugs have found a letter of the law chink that they want to exploit to destroy the ACA. I doubt that the Repugs will succeed in their final attempt to destroy’s such a petty quibble, a final act of desperation by bitter Repuglicans grasping at straws.

  13. Off topic… I hear that Bobby Jindal is going to announce his candidacy for president this month. There might not be enough room left in the clown car for him, so he might end up as the hood ornament.

  14. “Democrats pushed through this disaster without bothering to read it”

    That’s BS and you should know that. The bill has a technical error that your buddies on the right are trying exploit through frivolous legal proceedings in the hope of finding tea-tard “activists judges” that will effectively overturn the ACA. This should have been remedied by a simple “technical correction’ but the wing-nuts so hate Obama they won’t do it. So go peddle your FAUX news bumper sticker talking points elsewhere!

  15. “so he might end up as the hood ornament”

    Oh no he’ll be in the trunk with Ben Carson!

  16. TS – your name should be BS for what you are shoveling.. The GOP has postured on the subject for years with a ‘repeal & replace’ public platform. They have voted to repeal 50 times but nothing solid on the ‘replace’ front is forthcoming. 10 million people have health care who did not before. Until the GOP can do better than that – or do as good for less money, they can shove their plans to leave Americans without medical care.

  17. Maya, it’s not a question that they’re angry, but why. If they actually angry with the White House for the reason they claim, and which repeated for them, they would simply and easily correct the problem themselves. They don’t need the White House to do anything for them.

    So while they are angry with the White House, it cannot be for the reason they claim and which you repeated for them. They’re angry for some other reason; I’d suggest just as theater to score political points.

    I thought I’d made that clear in my comment; I’m sorry if it wasn’t.

    • JDM “Maya, it’s not a question that they’re angry, but why. If they actually angry with the White House for the reason they claim, and which repeated for them, they would simply and easily correct the problem themselves. They don’t need the White House to do anything for them.”

      They could but they won’t; that’s the point. They want the White House to “fix” the issue so that somehow ending the subsidies in 34 states won’t cause any pain. This problem would be very easy to fix through legislation, but the Republicans in Congress won’t do it for the reasons explained in the post. In other words, they want the White House to get them out of the corner they painted themselves into, and they are furious that the White House isn’t doing anything.

    • JDM — I wrote about the corner the GOP painted itself into last March. Basically they want King v. Burwell to kill Obamacare, but they don’t want to be blamed for the chaos that is likely to ensue. At the same time, they cannot themselves enact any workable measures that might prevent the chaos without violating deeply held wingnut principles. So, they pretend to have a plan B in the works, but what they really want is for Obama to fix it for them.

  18. Maha is apparently not liked by my tablet’s autocorrect. Have you considered changing your name; it seems Apple would appreciate it. 🙂

  19. Swami, per the Lawyers Guns and Money blog, it’s even a bit worse than that. The SCOTUS in the past has agreed that if there’s some ambiguity in the law, the relevant regulatory agency can define it as they see fit – and let Congress determine if that’s not what they wanted. The IRS has ruled that the intent is clear. If the SCOTUS ruled against this, they’d be violating their own precedent (and a very appropriate precedent) as well as ignoring the intent of the law’s authors.

  20. You throw lifesavers and ropes to the people on the sinking ship – NOT THE RATS!!!

  21. Oh no he’ll be in the trunk with Ben Carson!

    I think Christie’s spare tire will take up the whole trunk.

  22. My thoughts: I think the Court will not accept the plaintiffs’ argument; the vote might even be 6-3. If they do accept it, on the following day Democrats in the House and Senate will introduce the “one page fix” that everyone agrees is the ultimate solution. Now the onus is on the Republicans to pass it, or it will be “their” citizens that are hurt.

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