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A Legal Argument That Could Bring ObamaCare Crumbling Down

law-gavel-flag

While much of the news coverage of the Affordable Care Act over the past several months has been devoted to the failures of the Federal Exchange website, the relatively low sign-up numbers, the issue of whether or not enough young and healthy people will sign up to balance out the demographics of the PPACA’s insurance risk pool, the number of people finding their pre-existing coverage canceled, there remain other threats to the law slowly making their way through the courts that haven’t gotten much attention. One of those, of course, are the numerous lawsuits that have been filed around the country relating to the mandate established by the Dept. Of Health And Human Services that requires all employer-based health insurance policies to include birth control coverage. Dozens of lawsuits have been filed by religious organizations and small corporations owned by individuals asserting that the mandate violates their rights under the First Amendment and the Religious Freedom Restoration Act. As I’ve noted, the Circuit Courts Of Appeal have largely split on the question of whether that mandate violates either the Amendment or the RFRA, and the Supreme Court accepted an appeal in one of those cases late last month. Of course, even if the religious institutions and employers ultimately win their argument regarding the mandate, it will only have a tangential impact on the PPACA itself.

There’s another legal challenge floating out there, though, that hasn’t received nearly the amount of attention that the birth control issue has. It’s not a Constitutional argument per se, but if it were to succeed in Court it could bring the entire financial structure of the PPACA crashing down:

It all started in 2011, when Jonathan H. Adler, a conservative law professor at Case Western Reserve University in Ohio, shot an email to his friend Michael Cannon, a health policy expert at the libertarian Cato Institute in Washington, D.C. Adler thought he had spotted an error in Obamacare that could unravel a significant portion of the law.

At issue are the federal subsidies for individuals buying insurance in their state’s health care exchanges. The law stipulates that those subsidies should be allotted for plans purchased “through an Exchange established by the State under Section 1311” (italics added), a reference to the section of the law that establishes state-run exchanges.

Adler wondered: Did the law provide subsidies for only state-run exchanges and not federal ones? The law requires that the federal government step in to create an exchange when a state declines to do so. But does it fail to give subsidies to the residents of those states?

It may seem like a small problem, but if true, it spells disaster for the Affordable Care Act. Without subsidies, health care on the individual market becomes unaffordable. Without an affordable option, the individual and employer mandates disappear. In other words, the entire law could come crashing down in the 36 states that have opted not to run their own exchanges.

Adler and Cannon first discussed their argument in an Op-Ed in The Wall Street Journal:

The law encourages states to create health-insurance exchanges, but it permits Washington to create them if states decline. So far, only 17 states have passed legislation to create an exchange.

This is where the glitch comes in: ObamaCare authorizes premium assistance in state-run exchanges (Section 1311) but not federal ones (Section 1321). In other words, states that refuse to create an exchange can block much of ObamaCare’s spending and practically force Congress to reopen the law for revisions.

The Obama administration wants to avoid that legislative debacle, so this summer it proposed an IRS rule to offer premium assistance in all exchanges “whether established under section 1311 or 1321.” On Nov. 17 the IRS will hold a public hearing on that proposal. According to a Treasury Department spokeswoman, the administration is “confident” that offering premium assistance where Congress has not authorized it “is consistent with the intent of the law and our ability to interpret and implement it.”

Such confidence is misplaced. The text of the law is perfectly clear. And without congressional authorization, the IRS lacks the power to dispense tax credits or spend money.

What about congressional intent? Law professor Timothy Jost suggests that since ObamaCare requires all exchanges to report information about premium assistance, and it would be silly to impose that requirement on federal exchanges if their enrollees were not eligible, that shows Congress could not have intended anything but to provide assistance in federal exchanges. At least, he argues, there’s enough ambiguity here about Congress’s intent that federal courts will permit the administration to resolve it.

Not so fast. The Supreme Court has increasingly limited such deference to cases where the text of the law—rather than Congress’s intent—is ambiguous. In this case the language of the law is clear, as even Mr. Jost admits.

The health law’s authors in Congress deliberately chose to pass the bill with known imperfections and to use the reconciliation process to make only limited amendments. Writing a perfect bill would have required too many votes and risked failure. If what they passed was an imperfect bill with no premium assistance in federal exchanges, then that is what Congress intended.

And there are plausible reasons why Congress may have wanted to limit assistance to state-run exchanges—including encouraging states to create exchanges so that the federal government doesn’t have the burden.

If Cannon and Adler are correct, then the implications are rather obvious. The majority of states declined to establish exchanges of their own, and thus the people who live in those states are required to go through the Federal Exchange to obtain insurance coverage if they need it. Many of those people would be eligible for tax subsidies to cover premium costs based on their annual income, which would quite obviously alleviate the financial sting that might be felt in cases where the premium cost of new coverage is higher than whatever coverage they had before might have been. If it turns out, though, that participants in the Federal Exchange are not eligible for the subsidies, then it’s going to have a huge impact on how many people sign up for coverage and on public perception of whether the PPACA is actually working. After all, one of the primary selling points of the PPACA was that it would bring the cost of insurance coverage down in part thanks to the subsidies provided for in the law. This is problem that could impact tens of millions of people in the end if it spreads out to small businesses who also try to obtain coverage through the exchanges in the year to come, and it may lead many participants to risk dropping out of the program entirely simply because they cannot afford coverage without the subsidies. The ultimate impact of that eventuality on the soundness of the risk pool should be rather obvious.

Proponents of the PPACA, quite understandably, dismiss the arguments that Cannon and Adler make:

“I think it’s a case without merit,” said Sara Rosenbaum, a health care expert at George Washington University. “The plaintiffs have seized on a few words in a statute, they’ve taken the words completely out of context, and they have ignored numerous other parts of the statute that make their interpretation of the law basically senseless.”

Defenders of the law argue that the phrase “established by the State under section 1311″ does not exclude federally-run marketplaces. Their legal argument is simple: the law defines an “Exchange” as established by the state, then orders the federal government to establish the exact same exchange, denoted as “such Exchange,” if a state fails to act. In other words, it authorizes the government to act as the state and set up an exchange as it is defined in section 1311. Whether a particular section of the law references an “Exchange” or an “Exchange established by the state” is the same thing as referring to the law variously as the “Affordable Care Act” and “Obamacare,” two terms with identical meaning, because a federally-run exchange is, for the purposes of the law, the same as a state-run exchange.

“[T]here is nothing extraordinary about the Secretary acting for, or stepping into the shoes of, or standing in for, or representing, the State,” former Justice Department lawyer Rob Weiner wrote in an amicus brief in Carvin’s case. “This type of legal substitution happens all the time.”

Presently, there are four cases pending in U.S. District Courts around the country where this argument has been raised. While none of those courts have issued an opinion yet, its only a matter of time before that changes. Indeed, I’d expect to see those opinions slowly trickle out after the first of the year. Whichever way these four Judges go on the questions at issue in the case, it’s an absolute certainty that the question while find its way to the various Circuit Courts of Appeal and, ultimately, the Supreme Court.

As for the merits of the argument itself, that strikes me as a much tougher call. Unlike the original round of PPACA litigation, these cases don’t raise Constitutional issues per se, and they don’t raise the same kind of questions that the birth control cases do. Instead we’re talking about an issue of statutory construction and the question of whether or not the Executive Branch, or the Judiciary, can substitute its judgment for what appears to be the plain language of the statute. In this case, it’s obvious that the law that Congress passed authorized tax subsidizes for exchanges established by the states. However, since the Federal Government cannot directly order the states to establish exchanges, there is also language in the statute that authorizes the Federal Government to establish an exchange for states that decline to establish an exchange. What the statute does not explicitly state is that subsidies are also authorized for an exchange established by the Federal Government. Despite that fact, both the IRS and HHS have interpreted the statute to authorize subsidies for policies through the Federal Exchange. The question before the Courts is whether that interpretation is permissible.

The rules regarding Judicial interpretations of statues, statutory intent, and the like can get fairly complicated and I won’t go through them in detail here. However, the basic rules include the idea that the plain language of the statute ought to be the starting point for any case involving how to interpret a statute and that Courts should not substitute their judgment for that plain language absent some compelling reason. Additionally, courts generally presume that words used in a statute are used a the legislature intended them, and that the statute is deemed to be both internally and externally consistent, meaning that it doesn’t contradict itself or other laws passed by Congress. Finally, the intent of Congress as set forth in official documents can also be relevant to the process of interpretation, but it’s the actual text of the law that controls, not some expression of intent in the Congressional Record or elsewhere, These are the basic principles upon which the evaluation of the cases that have been filed will be evaluated, along with a whole host of case law on the issue that is likely to make the opinions issued in these cases quite long and somewhat dry reading from the perspective of the lay person.

Not having reviewed the pleadings or the law at issue here in depth, I am not going to even try to make a prediction about which way these cases might go even in their initial round at the District Court level. However, I don’t think that Cannon and Adler are understating the impact of what could happen to the PPACA if their argument ultimately wins the day. Most of the states in the country are covered by the Federal Exchange, as is the majority of the population of the country, and if it turns out to be the case that these people are not eligible for the PPACA’s tax subsidies because of what may or may not be a drafting error in the law, then it will have a series impact on the viability of the entire system going forward. We may not know the ultimate answer to the questions raised her until 2015 or 2016, but it could end up doing more damage to the survival of ObamaCare than the website problems that have afflicted the law for the past three months.

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About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May, 2010 and also writes at Below The Beltway. Follow Doug on Twitter | Facebook

Comments

  1. Heisenberg says:

    If the case wins, then all Congress has to do is extend subsidies to Federal exchange customers by law.

    Which will put Republicans in a tough spot, because it’s by and large red states that don’t have exchanges, making the GOP very vulnerable in the general to “X voted to make your health insurance more expensive” ads if they vote no, but also vulnerable to primary challenges if they vote yes.

    Could end up with a few unexpected Dem pickups that way, if the Democrats play their cards right.

    Highly-rated. Helpful or Unhelpful: Thumb up 25 Thumb down 2

  2. JKB says:

    @Heisenberg:

    Without subsidies, health care on the individual market becomes unaffordable. Without an affordable option, the individual and employer mandates disappear.

    No subsidies, no mandate to buy

    Pressure goes to scrapping the expensive government requirements

    Once the law is opened up, all sorts of “fixes” are possible.

    In any case, by next November, the only indication will be that the law is a mess. The law passed solely by Democrats

    Poorly-rated. Helpful or Unhelpful: Thumb up 6 Thumb down 26

  3. Todd says:

    Why would this necessarily put the overall law in jeopardy? People think of Obamacare as “national”, when in reality, isn’t it 51 separate markets? It seems to me if this lawsuit is successful, the pressure won’t be on the Obama administration, so much as it will be on the governments of the states that have chosen not to set up and exchange.

    In other words, the law still applies in those 17 states that did set up exchanges. Would all the people who have gained coverage because of the law suddenly have it snatched back? That could be problematic for a Congress that tried to use this lawsuit as an excuse to repeal the whole law.

    Like or Dislike: Thumb up 11 Thumb down 1

  4. Ron Beasley says:

    Well if it does go down that just brings the inevitable single payer that much closer. My guess is it will happen on a state level. Red states will resist until the find they are no longer competitive with states that have it..

    Like or Dislike: Thumb up 13 Thumb down 2

  5. stonetools says:

    Whatever the merits of the case, its politically too late. By the time it gets to the USSC in 2016, tens of millions of people will have signed up for plans on the Federal Exchange and for subsidies. Will there be 5 votes on the Supreme Court to tell those tens of millions that the subsidies will be taken away and that they have to pay for their hospitalizations and their cancer treatments out of pocket? I’m betting no. Scalito and Thomas, sure, but Roberts and Kennedy aren’t the blind ideologues they are.
    Going to the merits, you’d have to accept a type of statutory interpretation opposite to that normally done. I expect this claim to fail.

    Highly-rated. Helpful or Unhelpful: Thumb up 21 Thumb down 2

  6. JKB says:

    @Ron Beasley:

    Why have the Blue States gone single payer up till now? I do believe VT went single payer with the Obamacare system so there is test case that seems to be having a bit of a rough go….even for a small homogenous state.

    Like or Dislike: Thumb up 1 Thumb down 8

  7. anjin-san says:

    I do believe VT went single payer with the Obamacare system so there is test case that seems to be having a bit of a rough go….even for a small homogenous state.

    I believe VT approved single payer in late November, and is not expected to be fully implemented until 2017 (by design). What exactly do you mean by “rough go”?

    Highly-rated. Helpful or Unhelpful: Thumb up 18 Thumb down 0

  8. Rich LaRocco says:

    There is nothing in the law that Obama can’t change by executive order. And since the Senate is led by a liberal who will refuse to let anything take down Obama’s health insurance mandate law, even if the House impeaches the president for taking unconstitutional steps to protect his pet legislation, the Senate will not even hold a trial, let alone convict the president. Thus, Obama will continue to rule like a tyrant until 2016. The thousands of people who fell for Obama’s rhetoric have got us into this mess, and there’s precious little we can do about it (except for refusing to vote for a single Democrat until this economy-busting law is removed from memory).

    Poorly-rated. Helpful or Unhelpful: Thumb up 5 Thumb down 38

  9. Dave Schuler says:

    The law encourages states to create health-insurance exchanges, but it permits Washington to create them if states decline. So far, only 17 states have passed legislation to create an exchange.

    The 33 states that haven’t set up their own exchanges aren’t restricted to Red States. Illinois, for example, declined to set up its own exchange, preferring to rely on the federal government’s portal. The reason given was that setting up such an exchange was outside the state government’s core competency (if such a phrase can be used with a straight face to describe Illinois’s state government).

    Like or Dislike: Thumb up 9 Thumb down 0

  10. JKB says:

    @anjin-san:

    It was a single article I read and perhaps speculative. I’ve not heard of VT having Oregon or Federal level of troubles so they might make a go of it.

    Like or Dislike: Thumb up 0 Thumb down 7

  11. stonetools says:

    @JKB:

    On the contrary, Vermont is well under way to achieving single payer. Their timeline can be found here. They should achieve single payer by 2017.
    In the meantime, Vermont is on track to signing up everyone in the state for health insurance by the end of 2014.

    Like or Dislike: Thumb up 12 Thumb down 0

  12. michael reynolds says:

    @Dave Schuler:

    Hah! That was my first good laugh of the day. I so hope they actually used the phrase “core competency,” because that brings up the question of whether they were laughing as they said it.

    Like or Dislike: Thumb up 6 Thumb down 0

  13. Tyrell says:

    So, some people are finally getting around to finding out what is in the bill.

    Like or Dislike: Thumb up 3 Thumb down 13

  14. michael reynolds says:

    @Tyrell:

    Yes. And they consistently like eliminating pre-conditions, eliminating lifetime caps, requiring equal coverage for women’s health and mental health, eliminating recissions, etc…

    Oh, and I like the lower rates.

    Highly-rated. Helpful or Unhelpful: Thumb up 23 Thumb down 2

  15. Gustopher says:

    @Dave Schuler: that can be solved by offering the federal governments exchange to willing states for a nominal fee, so we then get back to the red states being the holdouts.

    And I say… Screw the red states. Let them subsidize the blue states for once. Once the people in those states realize that their taxes are going off to Washington and not coming back, they will either pressure their state governments to set up an exchange, or they will gather in empty fields with their walkers, waving “Don’t Tread On Me” flags. Up to them.

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  16. Tillman says:

    The health law’s authors in Congress deliberately chose to pass the bill with known imperfections and to use the reconciliation process to make only limited amendments. Writing a perfect bill would have required too many votes and risked failure.

    Yeah, they would’ve been better off not making all those concessions to Republicans in exchange for their zero votes of support.

    Highly-rated. Helpful or Unhelpful: Thumb up 22 Thumb down 1

  17. Jenos Idanian #13 says:

    As with other flaws discovered so far, the probable solution is Obama simply and unilaterally rewriting the law while threatening to veto any attempts to actually change the law. And that veto threat will be redundant, because Harry Reid will keep any changes from being voted on.

    I’m just hoping Republicans are keeping track of all these moves, because they’re setting a very powerful precedent for a future Republican president to just arbitrarily rewrite laws at his or her whim.

    Boy, wouldn’t it be cool if that president were to postpone funding for Planned Parenthood, or tax hikes, or say that Affirmative Action laws won’t be enforced while a very thorough review is completed…

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  18. Just 'nutha' ig'rant cracker says:

    @Tillman: Well said!

    Like or Dislike: Thumb up 3 Thumb down 0

  19. Tony W says:

    I wouldn’t be so confident that Red State constituents will ever vote in their own interest. They have proven time and again that they are far more interested in maintaining their ridiculous victim mentality.

    Like or Dislike: Thumb up 10 Thumb down 1

  20. Obama has agreed that Obamacare must be repealed.

    Like or Dislike: Thumb up 4 Thumb down 3

  21. Tillman says:

    @Jenos Idanian #13:

    I’m just hoping Republicans are keeping track of all these moves, because they’re setting a very powerful precedent for a future Republican president to just arbitrarily rewrite laws at his or her whim.

    And, much like the Democratic filibustering of judicial and executive branch nominees under Bush II set the stage for the nuclear option, I’m sure the Republicans will overplay their hand once they have the reins of the White House again.

    Unless superdestroyer is actually right about the whole one-party state thing.

    Like or Dislike: Thumb up 11 Thumb down 0

  22. PD Shaw says:

    @Heisenberg: If the insurance is too expensive because of the loss of subsidies, they would be entitled to a hardship waiver. (Or more accurately, people would have to apply for a hardship waiver and the Obama Administration would have to decide whether to grant them)

    Like or Dislike: Thumb up 1 Thumb down 0

  23. al-Ameda says:

    @Rich LaRocco:

    Thus, Obama will continue to rule like a tyrant until 2016.

    Yes, thanks for reminding us all that America is very similar to North Korea. Well, I’ve got to go, I have an appointment with my Obama-designated Death Panel, wish me well.

    Like or Dislike: Thumb up 12 Thumb down 0

  24. al-Ameda says:

    @Jenos Idanian #13:

    I’m just hoping Republicans are keeping track of all these moves, because they’re setting a very powerful precedent for a future Republican president to just arbitrarily rewrite laws at his or her whim.

    Drama Queen Alert. In recent years Republicans have been okay with hundreds of Signing Statements issued by Bush 41 and Bush 4. As you know, Signing Statements are an indication that a president is challenging certain or various provisions of legislation.

    Highly-rated. Helpful or Unhelpful: Thumb up 15 Thumb down 0

  25. PD Shaw says:

    “I think it’s a case without merit,” said Sara Rosenbaum, a health care expert at George Washington University.

    Well, the D.C. district court judge found that the case did have merit. Specifically, the judge said both sides had presented good arguments that withstood preliminary motions, and he set a briefing schedule for a final decision sometime early next year. I think its reasonable for outsiders to take it as a 50/50 proposition at this point.

    Like or Dislike: Thumb up 3 Thumb down 1

  26. Jenos Idanian #13 says:

    @al-Ameda: In recent years Republicans have been okay with hundreds of Signing Statements issued by Bush 41 and Bush 4. As you know, Signing Statements are an indication that a president is challenging certain or various provisions of legislation.

    Lying scumbag alert: A signing statement is an indication that a president is considering challenging certain or various provisions of legislation. It’s laying groundwork for a challenge, not a challenge itself.

    Besides, they can’t be so bad. Obama’s using signing statements, too. Why are you going back to Bush on this, when Obama’s a much more recent example? Here’s a list — by my count, two dozen.

    Poorly-rated. Helpful or Unhelpful: Thumb up 1 Thumb down 17

  27. al-Ameda says:

    @Jenos Idanian #13:

    Why are you going back to Bush on this, when Obama’s a much more recent example? Here’s a list — by my count, two dozen.

    Still Trying Unsuccessfully To Ignore Bush Alert:
    Two dozen? Bush 43 had over 150.

    Highly-rated. Helpful or Unhelpful: Thumb up 15 Thumb down 0

  28. Stonetools says:

    Obama needs to fill those slots on the DC court of appeals stat.

    Like or Dislike: Thumb up 3 Thumb down 0

  29. Jenos Idanian #13 says:

    @al-Ameda: A dead skunk just came up to me to complain about how much your hypocrisy reeks.

    So, Bush issues 150 signing statements, and that’s some horrible offense against Democracy. But Obama’s 24 signing statements are no big deal. Just what is the magic number, anyway? You’ve established it’s somewhere between 24 and 150, but I’d like to narrow it down some.

    Anyway, a signing statement is a declaration of consideration. It’s a prelude to a president challenging a law. How the hell is that more bothersome to you than a president simply declaring that the law doesn’t apply, without even the courtesy of a signing statement to back up his declaration?

    Because that’s become a hallmark of the Obama administration — simply refusing to apply a law because they don’t want to.

    1) The War Powers Resolution — didn’t apply to Libya because Obama said it didn’t.
    2) The WARN Act — not only did Obama urge companies to not comply with legal requirements regarding possible layoffs over the sequester, but offered to pay the legal bills of any company that ignored the law.
    3) Immigration laws — Obama has said that he won’t enforce the laws that govern the deportation of illegal aliens.
    4) ObamaCare (or, if you prefer, the PPACA): Deadlines written into the law are postponed because they’re not politically feasible — they might get people pissed off at Democrats before the 2014 elections.
    5) Congressional recesses — he declared the Senate to be in recess when the Senate itself didn’t agree.

    And that’s just five examples off the top of my head. I could probably find more if I took a couple of minutes.

    In Obama’s defense, the first three laws predated his administration, so he had no opportunity for issuing a signing statement. But in the fourth case, he could have said “I reserve the right to change the dates spelled out in this law for my own political convenience.” Instead, he just did that.

    I never understood the furor over signing statements. They weren’t a direct challenge to the law, they were preparatory groundwork for a future challenge. If anything, it’s nice of a president to give everyone a heads-up about his potential future plans, and allows those who might oppose such a move time to prepare their own arguments.

    As opposed to Obama, who just decides what the law means and what it doesn’t, depending on his political needs of the moment.

    One final thought: here’s Article II, Section 3 of the United States Constitution:

    “he shall from time to time give to the Congress Information of the State of the Union, and recommend to their Consideration such Measures as he shall judge necessary and expedient; he may, on extraordinary Occasions, convene both Houses, or either of them, and in Case of Disagreement between them, with Respect to the Time of Adjournment, he may adjourn them to such Time as he shall think proper; he shall receive Ambassadors and other public Ministers; he shall take Care that the Laws be faithfully executed, and shall Commission all the Officers of the United States.”

    See that part I bolded? In Joe Biden’s words, that’s a big effing deal.

    Like or Dislike: Thumb up 2 Thumb down 11

  30. Stan says:

    @Jenos Idanian #13: Re the Affordable Care Act, I gather you don’t support it. If it’s repealed, we revert to the status quo. That means no insurance if you have a pre-existing condition, the possibility that your insurance company will end your coverage if your medical expenses are too high, and the possibility of annual and lifetime caps on your coverage. In addition, about one sixth of legal residents don’t have medical insurance, and the number has been increasing by one percent per year.

    If your side wins big in the next few elections and repeals the Affordable Care Act, what do you think should replace it? Or should we just revert to the policy before the ACA was passed?

    Like or Dislike: Thumb up 10 Thumb down 0

  31. Tony W says:

    @Stan: I take it you’re new here? Jenos is just whining – he doesn’t have any ideas, just complaints about others trying to do something. You kinda get used to it after a while.

    Like or Dislike: Thumb up 9 Thumb down 1

  32. Tyrell says:

    Interesting articles came out recently about “sticker shock” of the AFA. See Huffington Post and other news outlets . It seems that many people are signing up for the cheapest plan (“Bronze”) and don’t realize the high deductibles and co pays. Most people can’t afford the other plans, even with subsidies. One example was a family of four paying $1400 a month and winding up with a $12, 000 deductible, which would be $6,000 for an individual because it would be unlikely for all to wind up in the hospital at once.
    Sticker price it is, just like on a new car. Most people don’t realize that price the hospital gives you when you check out is just a starting point and you negotiate. I know people who work in the business office of a hospital and they tell that those prices are highly inflated to start with – like about 600 % or more. Most hospitals will cut the bill down by 50% if you stay after them. Then you offer to pay so much a month. Then, like in my case, after three years many of them will wipe the remainder off.

    Like or Dislike: Thumb up 1 Thumb down 2

  33. Stan says:

    @Tony W: I’m not new here and I know where Jenos stands. But I’m curious about his views on policy, and I hope he’ll respond to my post.

    Like or Dislike: Thumb up 2 Thumb down 0

  34. bill says:

    i hope it doesn’t work- Americans need to see just how bad a deal this thing is so they can vote it’s supporters out next term.

    Like or Dislike: Thumb up 1 Thumb down 1

  35. Stan says:

    @bill: And then we’ll go back to the status quo? Is that your policy recommendation? Or what?

    Like or Dislike: Thumb up 1 Thumb down 0

  36. Nikki says:

    @Stan: Uh…why exactly?

    Like or Dislike: Thumb up 2 Thumb down 0

  37. beth says:

    @Nikki: None of the naysayers have put forth any intelligent alternatives to Obamacare. They got nothing except some vague “market based health care”. Isn’t that just another name for the crappy system we’ve always had?

    Like or Dislike: Thumb up 4 Thumb down 0

  38. al-Ameda says:

    @Jenos Idanian #13:

    @al-Ameda: A dead skunk just came up to me to complain about how much your hypocrisy reeks.

    That dead skunk was Donald Trump’s hairpiece.

    Again, why do you have no problem with, say, 150 signing statements by a Republican president, however 24 by a Democratic president really bothers you? Also, you’ll be pleased to know that Sam Donaldson’s hairpiece is upset about Benghazi.

    Like or Dislike: Thumb up 2 Thumb down 0

  39. Jenos Idanian #13 says:

    @Stan: Re the Affordable Care Act, I gather you don’t support it. If it’s repealed, we revert to the status quo.

    First up, Obama’s doing just fine repealing it piecemeal, by executive fiat. Second, I don’t know if we can go back to the status quo — part of ObamaCare is the wholesale gutting of the old systems.

    A new system? I’m no expert, but it seems to me one of the strengths of our political system is we have 50 separate laboratories where we can try and see what works. The notion of finding a one-size-fits-all national solution right out of the box struck me as the kind of incredible idiocy that can only be produced by the overeducated. A couple of states were already trying out various solutions; I’d have encouraged more states to give it a whirl.

    However, I think there’s been so much damage done already that the only remaining solution is single-payer, which will be a complete and total disaster. Fortunately, Obama repeatedly declared, over and over, that he was staunchly opposed to single-payer, and would never support it.

    Kind of like his position on gay marriage.

    Like or Dislike: Thumb up 2 Thumb down 4

  40. Jenos Idanian #13 says:

    @al-Ameda: Again, why do you have no problem with, say, 150 signing statements by a Republican president, however 24 by a Democratic president really bothers you?

    You brought up the signing statements, not me. I never said I had a problem with them — I was asking why you had a problem with Bush’s, but not Obama’s. Since you won’t answer, I’ll supply my own — “because you’re a hypocritical lying crap-bag” seems to sum it up.

    I said why I think they’re useful — they lay groundwork for a future possible dispute, giving both sides time to prepare their arguments. I don’t understand your beef with them, apart from they were used by Bush, and therefore you have to automatically hate them. Funny how that changed after Obama started doing the same…

    Like or Dislike: Thumb up 0 Thumb down 2

  41. Rick DeMent says:

    Can you imagine how awesome this law would be if they put one tenth as much effort into fixing it as they have into destroying it?

    Like or Dislike: Thumb up 4 Thumb down 0

  42. al-Ameda says:

    @Jenos Idanian #13:

    You brought up the signing statements, not me. I never said I had a problem with them — I was asking why you had a problem with Bush’s, but not Obama’s. Since you won’t answer, I’ll supply my own — “because you’re a hypocritical lying crap-bag” seems to sum it up.

    So, you have no problem with Obama’s signing statements? Great, because neither do I, and neither did I have a problem with Bush’s use of them either. The difference between me and the “hypocritical lying crap-bag” greaseballs on the Right is that at least I’m consistent in my acceptance that signing statements are a legal means by which the Executive can express doubts or reservations about certain legislation. Also, I apologize if I offended Donald Trump’s hairpiece.

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  43. Stan says:

    @Jenos Idanian #13: When you talk about having each state set up its own health insurance system you’re begging the question. What type of system would you like for your state? No health insurance, and people pay for medical care out of pocket? Everyone buys their own health insurance? Forced medical savings accounts, Singapore style? The pre-Obama status quo? The ACA on the state level? Single payer, a la Vermont? True socialized medicine, like the British National Health? Which is it? Do you actually have any policy preferences?

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  44. Anonne says:

    @Tyrell:
    Conservatives complain about the inability to just get catastrophic insurance. Well a bronze plan with high deductibles is functionally that. You’ll never satisfy your deductible unless you have a catastrophic incident.

    However, on the flip side, you get certain preventative care and other services at no cost to you, as well as the benefit of the negotiated prices by your insurance company for services.

    The ACA reflects the kludgy compromises to keep this in the private sector. And yeah, we’d have been much better off if all of those weren’t in there to get all zero votes.

    People want to talk all this crap about personal responsibility except when the time comes to put their money where their mouth is. It’s always about other people paying more.

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  45. Jenos Idanian #13 says:

    @al-Ameda: So, your whole diversion on signing statements was nothing but a giant “Squirrel!” moment?

    I’m looking back, and that all started when I said I didn’t like Obama just rewriting the law as it suits him and you compared that with Bush’s signing statements. News flash, chump: they ain’t the same. Bush’s signing statements were “in the future, I might challenge this part of the law.” Obama are “this is what the law means now. Please forget that it used to mean something else.”

    It’s nice to see a leftist actually admit that Bush’s signing statements were a big nothing. It’s sad that it only came up as part of an attempt to distract from Obama’s lawlessness, but I’ll give you a smidgen of credit for honesty anyway.

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  46. Jenos Idanian #13 says:

    @Stan: When you talk about having each state set up its own health insurance system you’re begging the question. What type of system would you like for your state?

    I said I’m no expert. But I think I could come up with a system that’s at least as dysfunctional as ObamaCare.

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  47. al-Ameda says:

    @Jenos Idanian #13:

    It’s sad that it only came up as part of an attempt to distract from Obama’s lawlessness

    Lawlessness? Republicans should initiate impeachment proceedings, right?

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  48. Jenos Idanian #13 says:

    @al-Ameda: Oh, they’ll get right on it. I’m certain that Harry Reid will fast-track it, and the Democrats will put aside partisanship and look at the matter impartially and dispassionately. And we’ll all be so much better off with President Biden.

    Now if you’ll pardon me, I’ll go back to writing my epic ode to the magnificent accomplishments and divine beauty of Hillary Clinton.

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  49. al-Ameda says:

    @Jenos Idanian #13:

    @al-Ameda: Oh, they’ll get right on it. I’m certain that Harry Reid will fast-track it, and the Democrats will put aside partisanship and look at the matter impartially and dispassionately. And we’ll all be so much better off with President Biden.

    LOL – “put aside partisanship?” What, exactly, do Republicans know about that?

    I figured you’d be all in on impeachment of the president. No surprise there. Since 1993, the Republican Party has not accepted an elected Democratic president as legitimate. Bill Clinton? 6 years of investigation, impeachment. Obama? Darrell Issa investigates everything (he’s still tying to turn Benghazi into a scandal), and a group of Republicans met about 2 weeks ago to discuss impeachment.

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  50. wr says:

    @Jenos Idanian #13: In other words, Jenos knows nothing about health care and doesn’t give a damn what happens. When he gets sick, he goes to the emergency room, then runs away without paying the bill. If that system is good enough for him, it should be good enough for America.

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