Republican leaders of the House and Senate could easily resolve the question in the King v. Burwell lawsuit if they passed a one-sentence resolution that clarified that insurance purchased on the federal health exchanges in the 34 states that chose not to set up their own exchanges was eligible for federal subsidies, as the drafters of the Affordable Care Act clearly intended.
But Republicans apparently have no intention of going for the easy and sensible fix. Sen. John Barasso (Wyo.) the Senate’s No. 3 Republican, told Politico, “Let’s be clear: if the Supreme Court rules against the administration, Congress will not pass a so-called ‘one-sentence’ fake fix.” Other senior GOP misleaders like Senate Majority Leader Mitch McConnell (Ky.) and House Ways and Means Committee Chairman Paul Ryan (Wis.) said Republicans won’t unveil their official plans for responding to King v. Burwell until after the Supreme Court rules. But other Republicans in Congress prefer to let the subsidies lapse and do nothing.
If Congress refuses to act, state leaders could preserve the subsidies by taking over the running of their respective health exchanges. But so far, only Delaware and Pennsylvania have started efforts to establish their own exchanges if the Supreme Court strikes down the subsidies.
Instead, Republican misleaders hold out hope that a Supreme Court decision in favor of the plaintiffs would lead to the collapse of the health insurance exchanges and, ultimately, all of “Obamacare.” Republican governors in Louisiana and Wisconsin have said they wouldn’t take action to restore financial assistance for Obamacare enrollees in their states.
Some Republican misleaders are betting that Americans will blame Obama and the Democrats for anything bad that happens to the health-care system.
Sen. John Thune (R-S.D.), chairman of the Senate Republican Conference, tweeted on June 8, “Six million people risk losing their health care subsidies, yet @POTUS continues to deny that Obamacare is bad for the American people.”
In fact, more than 10 million people have enrolled in private health insurance plans on health insurance exchanges, and 87% of them received tax credits to help them pay for the plans as of March 31, the Department of Health and Human Services reported.
The federal government runs the exchanges in 34 states, where 6.4 million people who currently receive subsidies would lose them if the Republicans prevail. Since these individuals have low or moderate incomes, most are expected to lose their health coverage. The abrupt exit of millions of customers from health insurance rolls is expected to roil the markets in those states, Jeffrey Young wrote at HuffingtonPost.com, because those with expensive medical conditions are most likely to retain their policies, driving up expenses for insurers and leading to rate hikes. Eight million or more people could wind up uninsured, according to the Rand Corp. and the Urban Institute.
In his speech to the Catholic Hospital Association Conference in Washington, D.C. on June 9, President Obama noted that “despite the constant doom-and-gloom predictions, the unending Chicken Little warnings that somehow making health insurance fairer and easier to buy would lead to the end of freedom, the end of the American way of life — lo and behold, it did not happen. None of this came to pass. In fact, in a lot of ways, the Affordable Care Act worked out better than some of us anticipated.”
For example, nearly one in three uninsured Americans have already been covered — more than 16 million people -– driving our uninsured rate to its lowest level ever. And the 85% who had health insurance before the reforms may not realize that they’ve got a better deal now than they did. Americans can no longer be denied coverage because of preexisting conditions, such as having had cancer — or having had a baby. Women can’t be charged more just for being a woman. They get free preventive services like mammograms. And there are no more annual or lifetime caps on the care patients receive.
Medicare also has been strengthened and protected. Small business owners can get tax credits for health coverage. Health care prices have risen at the lowest rate in 50 years. Employer premiums are rising at a rate tied for the lowest on record. The average family premium is $1,800 lower today than it would have been had trends over the decade before the ACA passed continued, he noted.
“And while we were told again and again that Obamacare would be a job-killer — amazingly enough, some critics still peddle this notion — it turns out in reality, America has experienced 63 straight months of private sector job growth — a streak that started the month we passed the Affordable Care Act,” he said. “The longest streak of private sector job growth on record — that adds up to 12.6 million new jobs.
“So the critics stubbornly ignore reality. In reality, there is a self-employed single mom of three who couldn’t afford health insurance until health reform passed and she qualified for Medicaid in her state. And she was finally able to get a mammogram, which detected early-stage breast cancer and may have saved her life. That’s the reality, not the mythology.”
The uninsured rate among US adults declined to 11.9% for the first quarter of 2015 — down one percentage point from the previous quarter and 5.2 points since the end of 2013, just before the ACA took effect. That translates to about 3.6 million fewer uninsured adults. The uninsured rate now is the lowest since Gallup began tracking it in 2008.
Twenty-nine states and the District of Columbia have expanded Medicaid under the federal program to cover families making up to 133% of the federal poverty level. The Kaiser Family Foundation noted that 21 states had not expanded Medicaid to allow their working-poor residents to get coverage, though three of those states were considering some sort of expansion.
Kaiser estimates that nearly 7 million uninsured adults would be eligible for Medicaid but live in a state that has refused the expansion. Of that group, 4 million who live below the poverty line already are ineligible for subsidies in the insurance exchanges. So they’re out of luck, regardless of the Supreme Court decision. .
In Texas, for example, Medicaid expansion under the Affordable Care Act would provide 1,727,000 working-poor Texans with comprehensive health insurance. Without the medical care, which the federal government would pay for, as many as 3,000 uninsured Texans could die this year, health-care experts at the Harvard Medical School and City University of New York have estimated. (The study found that as many as 17,000 people may have died of premature and avoidable deaths last year in the 24 states that rejected Medicaid expansion.
Likewise, Florida Republicans refuse to let Medicaid cover 1,212,000 working poor, so 2,200 could die due to lack of care. Georgia refuses to let Medicaid cover 599,000 and 1,100 could die. North Carolina refuses 511,000 working poor, and 1,100 could die.
All those state officials have to do is accept the federal money, but they refuse because they would rather let thousands of their poor residents get sick and die than let President Obama get credit for reforming health care.
Other states whose Republican leaders are denying medical care to their working poor, including veterans, are Alabama, Alaska, Idaho, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, Oklahoma, South Carolina, South Dakota, Tennesse, Utah, Virginia and Wyoming. There is blood on the hands of these Republican misleaders.
If the Supreme Court is persuaded to strike down subsidies for health care based on what amounts to a drafting error, Americans should not turn on President Obama. They should turn on the obstructionists in Congress and demand the real simple fix: Expand Medicare to cover everybody. — JMC
From The Progressive Populist, July 1-15, 2015
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