Obamacare Court Victory Could Backfire On Republicans
Republicans scored a win in Court last week, but it seems likely to lead to a political loss in the long-term.
The ruling late last week by Texas-based Federal District Court Judge Reed O’Connor striking down the Affordable Care Act as unconstitutional has brought the health care debate back to the center stage and has seemingly given Republicans what they’ve been working toward for the past eight and a half years. Realistically speaking, though, this ruling puts them in a virtually impossible political position just when they are beginning to deal with the political reality of Democrats taking control of the House of Representatives:
Congress was ready to move on from Obamacare.
The midterm elections took repeal off the table, and Democrats were gearing up for a party-defining fight over “Medicare for all.” But Friday night’s ruling by a federal judge in Texas that the Affordable Care Act must be scrapped once again puts the law front and center as Democrats prepare to take back the House just weeks from now.
The ruling is sure to be appealed, and the Trump administration says it’s business as usualin the meantime. But the decision spells bad news for Republicans, by allowing Democrats to replay a potent health care message that helped them flip40 House seats: that the GOP remains hellbent on gutting Obamacare and rolling back protections for pre-existing conditions.
“Republicans are never going to give up on trying to take away health care,” Sen. Chris Murphy (D-Conn.) told POLITICO. “And it’s hard to figure out how Trump and Mitch McConnell would come up with any strategy to put the pieces back together.”
Republicans have been on the defensive since the failure of their repeated efforts to dismantle Obamacare while having control of Congress and the White House. While President Donald Trump and lawmakers such as incoming House Minority Whip Steve Scalise (R-La.) cheered the development, some in the party called for bipartisanship to address the failings of the country’s health care system.
“We have a rare opportunity for truly bipartisan health care reform that protects those with pre-existing conditions, increases transparency and choice, and lowers costs,” Rep. Greg Walden of Oregon, chairman of the Energy and Commerce Committee, said in a statement.
But that doesn’t appear likely if Friday’s ruling is working its way through the courts during the 2020 election cycle. House Democrats had long planned to intervene in the lawsuit on behalf of the ACA and will likely introduce a resolution directing the House counsel to defend the law during the first days of the new Congress. People familiar with the conversations say the Democrats will quickly put it to a floor vote that will force GOP lawmakers to either signal support for Obamacare or endorse its elimination — along with the law’s most popular patient protections.
Trump and other key Republicans’ hailing of the ruling as vindication of their belief that the law is unworkable and needs to be jettisoned also doesn’t set a constructive tone, said Rodney Whitlock, a former top Republican Senate health care staffer.
“He’s got to lead,” Whitlock said of the president. “I don’t think you’ll see congressional Republicans wanting to go that route when it’s far from clear that they’d have support from 1600 Pennsylvania Ave.”
The result is likely to be a split GOP caucus that draws flakfrom both the right and the left. Republicans who survived the midterm elections by vowing to protect people with pre-existing conditions will find themselves in a particularly tough spot, feeling intense pressure to make good on that pledge.
“It’s all the downsides,” a House GOP aide said. “Politically, I don’t think that it helps us at all.”
The recent midterm elections already showed the extent to which the health care issue was resonating with the public in a way that helped Republicans and hurt Democrats. For one thing, even before the election, polling has shown that public opinion on the PPACA as a whole has been positive for some time now and that support for repeal of the law has essentially disappeared. More specifically, even when the PPACA as a whole was unpopular and polling was showing that most Americans favored repealing the law, the provisions regarding protections for people with pre-existing conditions were almost universally popular, even among Republicans and conservatives who were opposed to the law and said they were in favor of repeal.
Because of this, the recently concluded elections demonstrated quite clearly that Republicans were on the wrong side of the issue from the public’s point of view. This is why that most Republicans had abandoned the “repeal and replace” rhetoric that marked their rhetoric from 2010 through the first year of the Trump Presidency during which they engaged in a failed effort to, well, repeal and replace the Affordable Care Act. After that, the consensus among Republican leaders in Washington was that the health care debate was basically over, and their focus moved on to issues where they knew they could get easy legislative wins such as tax reform. Now, with this one ruling, the health care debate is back at center stage and Republicans find themselves largely unprepared for how to respond. And it all started because of a lawsuit brought by a group of Republican Attorneys General who were apparently too smart for their own good.
The conventional wisdom is that as people became dependent on Obamacare, they grew to like it and therefore it went from a net negative to a net positive. I think this is a simplistic analysis given that it only affects a relatively small percentage of people, that about a third of them don’t even understand they have Obamacare and instead they think they have a local alternative like KentuckyCare, and that those that do have it are amongst the least likely to vote: the young and the poor. In reality, there are several reasons for the shift but I think they can be lumped together under the umbrella of people learned more and more as the debate went on. And since the majority of the population is not under government medical (Medicare, Medicaid and the VA plan) they were able to check what the Republicans said against actual reality. Healthcare in America means constantly dealing with insurance policies, the yearly changes, the increasing copays and employee contributions, the forms, the approvals, the pre-approvals, the ever more arcane rules governing who is in plan and who is out of plan, what drugs are covered and what are not, and on and on and on and on, ad nauseam.
Remember, when this started out the Republican mantra, repeated over and over, was “We have the best health care in the world!” But how many people in the intervening decade met up with someone formerly covered by a Canadian or European health system who now deals with the US system? I’ve discussed this with dozens, if not hundreds of people (OK, I’m an anomaly because of what I do for a living) and not one single one has ever preferred the US system. Not one. Not even those who use Britain’s National Health, generally considered the worst of the western countries’ systems. And sure, we have good outcomes for many things here in the US, but we are not the best. And in a few things we are more like third world countries.
Remember how the Republicans went all in on how Obamacare meant death panels? The germ of truth in that was that it would allow coverage if a patient wanted to discuss end of life decisions with their physician. And in that 10 years how many of us, directly or indirectly, had to deal with aging parents or grandparents and wish they had made it clear early on, when they were fully cognizant, just how much life saving intervention they wanted.
And the ultimate reality check: the Republican claim they had a better plan in the wings that would provide better coverage for more people at cheaper rates. And then they got total control of government and they had nothing. Not a thing. It was all lies.
Obamacare has faults but it is a sincere effort to address a lot of our system’s serious problems. And the Republicans offered nothing but lies. Lies from every single Presidential candidate, through three elections. Lies from Mitch McConnell and Paul Ryan and Sean Hannity and the Heritage Foundation and the National Review and every single entity connected in any way to the Republican Party. Nothing. But. Lies.
And when you lie about something for ten years, something that is a constant unpleasant burden on people’s lives, even the average Joes eventually notice that you are lying.
@MarkedMan:
It was pretty obvious long before then. for one thing, when the Obamacare debate began, the GOP had no competing plan to offer, only rhetorical criticism employing scare tactics.
One could also think back to the period between 2000 and 2006, when the GOP held the Congress and White House and offered no comprehensive health care plan at all.
And the thing is there are plenty of things that could be done to improve insurance and lower the price of health care. It wouldn’t be easy, it would take a lot of study, and a lot of effort. Above all, it’s way to late to start now. it was too late to start in 2008, but at least then the Democrats were also just getting started.
“_____________” victory could backfire on Republicans.
As an opposition party, the GOP could have any insane claims it wanted to rile people up. Many believed the insane claims and though: Yeah, the GOP can do “_________” better! They SAY they can, and I believe them, because after all I watch “____________” and I believe them!
Governing is not the same. Austerity for most and flowing money up doesn’t sell in real life.
It goes back to what the Republican staffer, presumably Rove, said about faith based beating reality based. Eventually detachment from reality is going to bite you on the butt. The Rs and their sponsors had decided to attack Obama no matter what he did. So when Obama passed the Heritage/Romney plan they launched a torrent of ‘gubmit takeover’ ‘death panel’, ‘socialism’ nonsense. Being conservatives they actually believe their own BS, so now they’re surprised the public eventually noticed the disconnect between GOP rhetoric and reality.
In a democratic society no citizen should be required by the government to buy anything. Once that starts, where does it end? The government could require certain medications, dictate end of life procedures, certain tests, and procedures.
That Justice Roberts infamous decision on the “Obama Care”, Affordable Health Care mandate was probably ghost written or partially written by someone else.
One solution for the health insurance is to get as many companies as possible involved. We used to have a lot of HMO’s to choose from. What happened?
See: “Want to reduce health insurance premiums? Repeal Obama Care’s premium tax” (Avik Roy, The Apothecary)
“How about them Cowboys?”
@Tyrell:
The Second Militia Act of 1792 required that all white citizens over 18 years old and less than 45 be enrolled in the militia and
Also I’m required to buy car insurance.
One of the few things essentially all (non hired gun) economists agree on is that health care cannot work on a free market basis. (Massachusetts General? I’m having a heart attack, what are you charging today?)
Having lived in Dallas for two years I found Dallas fans so obnoxious I came to root for whoever’s playing the Cowboys.
@Tyrell:
You don’t have to get in an ambulance after getting shot. The federal government arranges the system of dispatchers and defines the singular ambulance which is sent to you. Yes, that’s right — you don’t have a choice. How, precisely, is that different from the single fire truck saving your house when it catches on fire from a neighbor’s cigarette?
You don’t have to purchase a house on a coastline. But if you do, you are mandated to purchase and pay premiums on private flood insurance.. and this has been going on for decades. Where were you when this was initiated?
You don’t have to drive a car. But if you do, you’re mandated to purchase private car insurance. Why is this not a complaint you’re making every day on this website?
Either be consistent and be equally outraged by each of these items – or calmly admit to yourself that you’ve had your ire drawn to the health care issue simply because you’ve been watching Fox.
You don’t actually care about “things the .gov forces you to buy” — you care about Owning The Libz.
If we just believe hard enough, surely Paul Ryan’s 13th tax cut for the rich will Solve Health Care and put a chicken in every pot — because trickle down works if we say it three times!
@Tyrell:
What proof do you have for that assertion? Share, please.
Normally, I ignore @Tyrell, but his mention
Reminded me that the government does require certain vaccinations – for the “common good”
In a democratic society, the citizens are the government. If the citizens decide that the common good requires that people must buy certain things, then the government has an obligation to require that those things be bought or good reason be shown why not. (“I don’t wanna” is not a good reason.)
Your argument isn’t with “the government”; your argument is with the adults who have decided you have an obligation to be responsible about paying for your healthcare.
@dennis:
While I doubt @Tyrell was serious when he wrote that, the reality is that many federal court decisions are collaboratively written with clerks.
Again not the bullshit he was peddling, but the reality remains that most decisions are collaborative…
Though please note that theoretically, Supreme Court decisions are typically supposed to be drafted by the Justices.
It’s going to backfire more on the judge who made this bad decision than the GOP.
@gVOR08: Many people do not buy auto liability insurance. They don’t own a car.
Lowering health care prices is the key to lowering insurance costs. Look at how low lasik eye surgery is now. Why?
When the Cowpokes lose, it is a cause for celebration in many places around here. This area has a huge Washington Redskin fan base.
“It’s going to backfire more on the judge who made this bad decision than the GOP.”
Eh…. Is that because…
…he’s going to be subject to recall?
…”2nd Amendment solutions” squads from the NRA will try to carry out the fatwa declared on him by Islamic clerics in the US?
…he’s going to be kicked out of the Heritage Society?
…Donald Trump is going to blame him for the loss in the 2018 election?
…WorldNetDaily and NewsMax are going to demand Trump recall him?
I’m not seeing how the dots connect on that.
“Look at how low lasik eye surgery is now. Why?”
Because you have stumbled across the one elective procedure in all of healthcare (and not actually a health related issue at that) eta:that is actually market sensitive because you don’t need it “now”? Because advertisements have been telling us to call to see how low lasik eye surgery is (and most of us really don’t have a comparison point from which to compare)? Because large numbers of medi-businesses are hiring marginally trained “lasik eye surgery specialists” to create a market for the product? Because lasik eye surgery done by a competent certified opthamologist hasn’t actually gone down in price? Which answer do you like best?
You can buy eyeglasses (even variable focus bi and trifocals) now on line for very low prices. So far the major complaint about them is that they often don’t work because the focal center of the lens doesn’t match that of the eye, so you can’t see out of them. But they are low cost!
ETA: “Many people do not buy auto liability insurance. They don’t own a car.” And, interestingly enough, the government doesn’t require those people to buy auto liability insurance, either.
The individual mandate simply keeps insurance companies from imploding, and it’s necessary so long as they cannot deny coverage for pre-existing conditions.
It’s very simple. People buy things and services when they need them, or soon before they’ll need them. If you’re not sick, do you need health insurance? If your car hasn’t been in an accident, do you need car insurance?
The answer to both is no. But no insurer will cover damage to your car unless it was insured before it was involved in an accident. That is, it won’t pay for pre-existing conditions. That’s why you buy insurance before you need it, and not knowing when, or if, you’ll need it.
So if insurers have to cover pre-existing conditions for medical insurance, the rational course of action is to buy insurance only when you’re sick or have been injured, and to stop paying for it once you recover. But then if most people did this, insurers would all go broke, or would charge enormous sums for premiums. Or they may sell only multi-year plans.
Some people regard insurance as a scam, seeing as how you rarely use it. Some claim it would be better to take whatever money you’d pay for insurance, and invest it. Then you’d have such money plus its gains available in case of disease or accident, essentially you’d self-insure. Me, I see it as a big gamble. after decades of self-insurance, you may accumulate enough to treat a chronic illness for years. But what if it strikes you sooner than that?
I’d rather share my risks with a large pool of other people.
@Just nutha ignint cracker: Public Service Announcement here. LASIK is not nearly as risk free as it is made out to be. From a NYT article earlier this year:
It describes one patient who is listed as a success because he tests for 20-20 vision. But he sees everything in triplicate. Perfectly focused triplicate.
I’ve worn corrective lenses since I was in about the third grade, first glasses, then contact lenses. I don’t need LASIK surgery, nor do I want it; I’ve heard it’s a real crapshoot, and if it doesn’t work, you can never wear contacts again. I wouldn’t want that. I don’t like glasses. I find them uncomfortable, and I only wear them if I have an eye injury and have to take my contacts out while it heals.
Nobody needs LASIK surgery. Someone who needs corrective lenses could choose to wear contact lenses, glasses, or a mixture of both, and both contacts and glasses are sold at multiple price points.
Conversely, when I got a mammogram and was diagnosed with breast cancer, I needed surgery, radiation, and a five-year regimen of an aromatase inhibitor to prevent recurrence. There were no alternatives; I couldn’t choose a less expensive option.
Could I have chosen not to get treated? Sure, but it was a Hobson’s choice: Either get treated or DIE. Same thing with taking the AI. I could choose not to take the AI, but that “choice” means the cancer has far more chance of coming back — and this time, it could be metastatic, which means I DIE. Another Hobson’s choice.
@MarkedMan: Heh. I had LASIK done on me when I was in Japan. It cost a lot, but they went very carefully over the entire procedure and the potential problems (they had me read the LASIK machine’s technical manual since it was in English). I had an actual medical doctor monitoring my recovery (and in fact we had to do some post-op procedures in a hospital). Do I have perfect vision? No. Is it better than what it used to be? Definitely. Would I do it again? Yes.
I tell people LASIK is a bit of a gamble that I wouldn’t take unless you have coke-bottle glasses. That was me! Legally blind without glasses. (Before glasses I used to go back to the wrong mother at the playground.)
Some people regard insurance as a scam, seeing as how you rarely use it. Some claim it would be better to take whatever money you’d pay for insurance, and invest it. Then you’d have such money plus its gains available in case of disease or accident, essentially you’d self-insure. Me, I see it as a big gamble. after decades of self-insurance, you may accumulate enough to treat a chronic illness for years. But what if it strikes you sooner than that?
After I was diagnosed with breast cancer, I joined some online support groups and met many women who were diagnosed in their 30s, even their 20s.
Here’s the cute part: When breast cancer strikes women under 40, it tends to be extremely aggressive. I didn’t need a mastectomy or chemo. These women almost always need both.
How much money can a 26-year-old, or even a 35-year-old, have saved up for cancer treatment? BTW, even though I had a “simple” cancer, my treatment costs were over $200k.
Another thing I learned is that nobody ever thinks they’re going to get cancer. It always happens to other people. My support groups are full of newly diagnosed patients saying, “But I don’t understand how this could have happened. I’m vegan/a gym rat/don’t have any family history/don’t smoke or drink/[insert reason here].”
I was one of them: Non-smoker. Non-drinker. Marathon runner. No family history. Yet here we are.
I tell people LASIK is a bit of a gamble that I wouldn’t take unless you have coke-bottle glasses. That was me! Legally blind without glasses. (Before glasses I used to go back to the wrong mother at the playground.)
That’s the way I’ve always viewed LASIK; it’s not worth the risk unless you’ve got Coke-bottle lenses. I don’t.
@grumpy realist:
Did you receive LASIK or the acid drop procedure (I think it’s called PRK)? I have horrible vision–if I wear glasses, they are coke bottle lenses AFTER opting for the super thin lenses. My doctor informed me my eyes were too weak for LASIK and I could only go the PRK route, which has a much longer recovery time. If Japanese doctors can do LASIK on my eyes, it might be worth a trip to Japan.
@Just nutha ignint cracker: Thank you. The exception that proves the rule. I read somewhere the phrase was originally “proofs the rule”. i.e. tests and certifies the rule. Which is to say the apparent exception which, when examined, demonstrates the truth of the rule.
@MattBernius:
Thanks, MB.
@Nightcrawler:
Thanks for sharing your story. It brings the argument into focus, and cuts through all the b.s.
@MarkedMan:
I can vouch that dry eyes do cause serious “discomfort.” Your eyes feel itchy, you feel like you’re sleepy but aren’t, and it can hurt a great deal.
I know because I had dry eyes for a spell last year. The eye doctor prescribed artificial tears (lubricant eye drops), administered as needed. the relief when that drop hits the eye is incredible.
He mentioned a laundry list of probable causes, so broad about 95% of all people should be afflicted with dry eyes at some point in their lives. Mine got better on their own after a few weeks, but I still carry vials of artificial tears with me.
I also have mild myopia and astigmatism in the left eye, and astigmatism in the right one. I’ve not considered surgery, as I only need glasses when driving or going to the movies, and even then half the time I forget to wear them I can barely tell the difference.
@Kathy: Good point! When I turned 65 and signed up for Medicare, I had the chance to buy Medigap type insurance that pays everything not paid for by Medicare. I did not do it at the time (the premium–about 500% higher) seemed prohibitive to me. Now, a couple of years later, I recently had a CT scan of my lungs because my doctor had seen something that “might” have been (but wasn’t) a tumor.
My first move was to try to change my policy to a Medigap plan. (Alas, you can’t do that because the insurer in this case can refuse coverage for preexisting conditions. Which I would say is a valid feature in this case because part of the Medigap system is based on frontloading the large premiums to provide the reserve that will pay the part that will be my cost in other programs [YMMV].)
@Kathy: One difference between health insurance and other types is that, it’s possible to spend your entire lifetime and never make a claim against your auto or homeowners’ insurance. With health insurance, you’re virtually guaranteed to need it at some point; certainly if you live long enough, but often even if you’re young.
The only other type of insurance that is certain to be used is life insurance, but unlike health insurance, the former only has a one-time payout.
Tyrell, do you stop at red lights as the government mandates you to? Or do you ignore the light and just barrel through the intersection? Thought so…….
With health insurance, you’re virtually guaranteed to need it at some point; certainly if you live long enough, but often even if you’re young.
If you think about it, the only people who never need expensive healthcare are people who die young and suddenly. Think a child or a young person who dies instantly in an accident, from homicide or suicide, or a catastrophic medical event like a burst aneurysm.
Everyone else will ultimately suffer a serious illness or injury, and as has been pointed out in these comments, this can and does happen to children and young adults quite frequently.
@Neil Hudelson: It was straight LASIK. We discussed the PRK option (which has a longer history IIRC) but decided that LASIK was a good risk considering how bad my eyes were. They in fact managed to correct me to even better than 20/20–which I promptly squandered the next year with a lot of squinting at legal Latin printed in Gothic typeface.
Someone’s gotta specialize in PRK still….
P.S. The LASIK surgery itself seems to be almost automated. It’s the surrounding prep work and follow-up where you really want to have a good eye surgeon on call. (My doc was in fact a professor at one of the medical universities in the area and did LASIK in a clinic as a sideline three days a week.)
@Tyrell:
Here’s where it ends you dumb fuck: At the age of 18, you get to buy into healthcare and start paying for it ahead of time. No more waiting until you have cancer. No more waiting until you get run over by a semi. No more waiting until you have diabetes. Nope, you start paying into it NOW.
Don’t want to buy into it because you feel fine at the moment? OK.
You’re on your own. Good luck.
@dennis: See: “The Inside Story on How Roberts changed his Supreme Court vote on Obama Care” (Avik Roy) There is no definitive proof as such, but various opinions came out about Judge Roberts opinion. I heard one lawyer on the radio say that it definitely appeared to be two differing opinions combined – not written by the same person.
It could be that his opinion was somehow taken and changed before the official release. Or maybe he got “the call”.
I am not some conspiracy person here, but there is something out of ordinary with his opinion and the way it came out.
@Neil Hudelson: I had PRK 13 years ago. I still have 20-20 vision. It was a modern-day miracle for me. I would do it again in a heartbeat. The only adverse affects was that street lights at night have small halos around them…a small price to pay for never needing coke bottle glasses again. As I’ve aged the only thing Ive noticed is a slight delay in focus going from reading to far vision…but that happens to everyone as they age.
Yes, the recovery time is far longer than LASIK…but LASIK has greater risks..especially if you ever get hit in the eye. In 5 minutes….I went from 20/200 to 20/40 post op which resolved over the next 4 months to 20/20. One of the amazing moments of my life was being able to see the clock right after the surgery was over with….that and breaking the habit over the next several months of reaching over to the night stand to grab glasses.