Tuesday, May 12, 2015

Another chance to whack Obamacare

The Supreme Court now has another chance to kill deeply maim Obamacare. This time it's a technical question about whether subsidies can be given in states that don't have their own exchanges, which is a lot of states.

If the court rules that ACA can't give subsidies in those states, that probably throws a few million people off their health insurance. Congress could restore the subsidies, but I don't think that will happen with the GOP in control. They won't care about the suffering of a few million people, who are perhaps mostly Dem voters anyway.

However, the GOP may want to avoid looking hard-hearted, so they'll probably figure out how to blame this on the ACA law, and its complexity, and how it was rammed through without being well-constructed, so it's all the fault of those Dems. They may be able to get away with that story because enough of it sounds true enough.

The GOP may even get extra lucky, and the loss of the subsidies will send Obamacare into a death spiral of massively higher premiums and fewer people covered. Again, they may be able to cause this death spiral without receiving the blame. It's hard for me not to believe that many Republicans are hoping for exactly this outcome.

But at the end of that death spiral will be some very big problems, and ultimately the GOP won't be able to ignore them. There will be a massive number of uninsured people, which will include plenty in the middle class or former middle class, and they won't be forgiving the GOP for the end of readily available health insurance. The GOP will have to come up with an answer, or a partial answer--enough to keep them in office. Maybe they'll cobble something together, but that would be several years down the road. In the meantime, the road will be littered with people bankrupted by healthcare costs or dead from lack of coverage. I doubt the GOP will pay a high enough price for what they wrought--if it plays out this way. I hope we don't get to see if it plays out this way. It's too big a risk for too many innocent people.

Image: bet.com

Extras. Bernstein is much more optimistic than me. This WaPo column is more realistic in the dangers.

1 comment:

Dangerous said...

While we can't know for sure how the Supreme will rule, if they decide to be political and make subsidies only available in states that set up their own exchanges, those states can do so and, except for deep red states, they will lest the voters in those states blame their governors and legislators for taking away their coverage or subsidies. Congressional Republicans can shrug their shoulders, as you accurately point out, but voters will not tolerate lack of action in GOP-controlled states such as Florida, Georgia, Wisconsin and so on.

Further, the law does not say what the parties which sued says it does. They got one of three circuits to agree with them and that split led to the Supremes taking the case. The phrase "... established by" in the law, which is the subject of the controversy, is not clearly defined, so the IRS applied its authority to make a rule which, essentially, said a state could run an exchange or defer to the feds to run it. Either would be a "state-established" exchange.

If not for the political environment and consequences, this case would have been thrown out of court as the suit-bringers argue for a completely novel approach to statutory interpretation. They argue that there's ambiguity, then demand their explicit interpretation, and, despite the consequences, a result which would undermine the entire statute. This approach is expressly contradictory of judicial principles of statutory interpretation and the courts would only side with the Obamacare-killers for political reasons.