Nel's New Day

June 27, 2015

Subsidies for Healthcare–For Now

The day before the Supreme Court made marriage equality the law of the land, it kept the healthcare subsidies for low-income people in King v. Burwell. Thanks to a 6-3 decision, over 6 million people are able to keep their health insurance because the Supremes didn’t allow four words to restrict subsidies to only the states with their own healthcare exchanges. For the second time in three years, conservatives hate Chief Justice John Roberts for retaining the law that expanded health care to an additional 16.4 million people although Justice Anthony Kennedy also voted with the more progressive block of four justices. Roberts wrote, “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”

Hospital operators and insurers largely supported the court’s decision to keep the subsidies that remain in the 34 states using the federal exchange as well as the other states that have either their own exchanges or a combination. The lawsuit was financed by a conservative group, Competitive Enterprise Institute, that found four unlikely plaintiffs who are eligible for subsidies but just don’t like the law. GOP members of the House have voted over 50 times to repeal the law and plan to continue the repeals in lieu of passing laws that would help people.

The court’s decision made the law more secure than if the conservatives had not brought the lawsuit because it holds that the subsidies are a permanent part of the ACA that can be changed only by Congress. Before the ruling, a president might have blocked the ACA by executive action; now changes must be made by a majority vote in the House and a 60-vote margin in the Senate.

Two years ago, Scalia used the term “legalistic argle-bargle” for the court’s rationale in keeping the ACA. In this dissent, he maintained that Roberts’ reasoning was an act of “interpretive jiggery-pokery.” A great irony is that dissenters Scalia, Clarence Thomas, and Samuel Alito declared that the ACA intended subsidies for all eligible consumers regardless of state or federal exchanges three years ago in NIFB v. Sebelius. This year the three of them moved 180 degrees away from their earlier position in opposing the ACA.

The conservative viciousness toward the ruling, although not surprising, was still disgusting. Fox host Andrea Tantaros called the “judiciary, John Roberts included, is now just the water boy for the welfare state.” Breitbart editor Ben Shapiro drew his comparison from the erotic novel/movie Fifty Shades of Grey when he tweeted, “The Roberts Court took the ACA to its Red Room of Pain and then alternatively tortured it and made love to it until it complied.” On Glenn Beck’s The Blaze, Wayne Allyn Root wrote that Roberts’ decision shows that he is being blackmailed by the Obama administration.

GOP presidential candidate Sen. Ted Cruz (R-TX) called the Supreme Court decisions to give health care to low-income people and legalize marriage equality as “some of the darkest 24 hours in our nation’s history.” To him, it’s much worse than the Civil War, two world wars, the attacks on the World Trade Center—I could go on and on.

Rep. Brian Babin (R-TX) believes he has found a way to punish the Supreme Court justices for its decision: he has introduced the “SCOTUScare Act,” requiring “the Supreme Court and all of its employees to sign up for Obamacare.” As many other people—including conservative members of Congress—fail to understand, no one “signs up” for the ACA. The law simply protects people from some unreasonable provisions of insurance companies—lifetime caps, denial because of pre-existing conditions, and skyrocketing premiums not used for medical needs.

Former Texas governor and GOP presidential candidate Rick Perry is a classic example of the GOP approach toward health care for low-income people. Called out for having the largest number of uninsured people in his state—one out of five Texans without health insurance—he said, “We make access the real issue.” Texan uninsured are four times less likely to have regular health care and more likely to die of health-related problems. Insurance would improve their overall health by 7 to 8 percent.

“Texas has been criticized for having a large number of uninsured,” Perry said. “But that’s what Texans wanted.” By not expanding Medicaid, 1.5 million Texans, with a median income of $833, are denied health care. In that state, non-disabled parents must earn less than $,500 for a family of four to gain the existing Medicaid. Texas has lost about $10 billion a year for the expanded program with Texas paying only seven percent of the cost, but Perry said that even $1 in the name of “Obamacare” was a dollar too much.

Many GOP members in Congress know that the King ruling saved them from disaster because they had no plans if they had won. Rep. Paul Ryan (R-WI) smiled at the ruling, and a GOP congressional member said “that fight could have killed us.” The candidates now  focus on electing a GOP president to get Congress closer to repealing Obamacare. They talk about putting the patient back in charge of their health care—all patients, that is, except women.

Candidates may wish to use caution, however, in using anti-healthcare for their platforms. In April, an Associated Press-GfK poll showed that 56 percent of the people wanted a ruling in favor of subsidies in contrast to the 39 percent opposition. Another 51 percent wanted Congress to subsidize premiums in all states. In CBS News/New York Times polling, 47 percent of people approve of ACA, the highest percentage thus far and more than the 44 percent who oppose the ACA.

A question is why so many people are opposed to the ACA when so few people are actually affected by it. The relentless pounding from conservatives against the law is a big reason, but even more, people blame the ACA for any problem in the health care system. Too few doctors? Rising costs of premiums and health care? Deductibles too high? It must be Obamacare. Premiums go up every year, but the cost has increased less since the law went into effect. Out-of-pocket costs are going up faster than wages, but that didn’t start with the law. Higher deductibles began before the law. Most people don’t remember the problems before the ACA’s protections went into effect, and the conservatives work every day to erase their memories.

uninsured

The SCOTUS ruling helped over 6 million people, but it didn’t do anything for the 4.3 million people prohibited from getting coverage in the 22 states that refuse to expand Medicaid. Ten of these states are former Confederate states, and most are former slaveholding states. About 61 percent of the people in the Medicaid gap live in Florida, Texas, Georgia, and North Carolina. In the states with expanded Medicaid, early detection and treatment of chronic diseases such as diabetes saves money from more advanced costs. Hospitals in states with expanded Medicaid save money by reduced uncompensated costs of treating the uninsured. Baton Rouge General Medical Center Mid Center (Louisiana) recently had to close its emergency room. It’s also notable that many GOP presidential candidates come from states that reject healthcare for low-income people.

Another 36 million people earn too much for Medicaid eligibility and can’t afford health insurance. The solution for this would have been the single-payer system that the Republicans proposed over two decades ago but refused under President Obama because they didn’t want to make him look successful.

Satirist Andy Borowitz wrote a column four years ago, entitled, “Republicans: Trillions Could Be Cut from Budget if We Eliminate Empathy – Humanity Also on Chopping Block.” The problem with satire is that it is sometimes true. Borowitz has brilliantly described the GOP position of 2015. He attributed this statement to then Rep. Eric Cantor (R-VA), who lost his position to another legislator with even less humanity, but the problem remains:

“Once congressional Republicans eliminate such empathy-laden budget items as lunches for poor children, medicine for the indigent and oxygen for seniors, … we can move from cutting empathy to cutting humanity.”

“With humanity removed from the budget, he said, ‘That’s where the real savings come in.’

“By eliminating the food, medicine and oxygen necessary to sustain human life, ‘We will reduce the single biggest drain on the U.S. economy: people.’”

In a supreme touch of irony, Chief Justice John Roberts held up the marriage laws of Kalahari Bushmen, the Han Chinese, the Carthaginians, and the Aztecs as examples of “a social institution that has formed the basis of human society for millennia.” The Bushmen are Botswana’s poorest citizens, the Chinese are hated by most conservatives, the Aztecs believed in human sacrifice, and the Carthaginians followed a polytheistic religion—possibly with infant sacrifices.

With these societies used as models for the conservatives, the GOP has truly lost its humanity.

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1 Comment »

  1. Hadn’t thought of this! “The court’s decision made the law more secure than if the conservatives had not brought the lawsuit…”

    Like

    Comment by Lee Lynch — June 28, 2015 @ 9:32 PM | Reply


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