December 15, 2018

Killing the Affordable Care Act

A federal judge in Texas ruled yesterday that the Affordable Care Act is unconstitutional, since the Republicans removed the penalty associated with the 'individual mandate' requiring people to have insurance. Since the penalty is now $0, that means the 'tax' for not having insurance is no longer in effect, and that 'right to tax' was the lynchpin that held the whole thing together in previous court cases.

Clearly, this will go back to the Supreme Court for decision, and for now, nothing will happen to people who are now on the last day to sign up for ACA policies on healthcare.gov.  Nothing, that is, except for mass confusion (will there be a policy for me?) and fear (will I lose my coverage?).  It will be interesting to see what the Justice Department does when it goes to the Supremes, since
The Justice Department's response to the case was highly unusual: thought it disagreed with the plaintiffs that the entire law should be struck down, it declined this year to defend not just the individual mandate, but the law's provisions that protect people with pre-existing conditions. 
The thing that's so important about pre-existing conditions, of course, is that over 100 million Americans have one or more of the darn things, and also that, most of the time, it seems that's the only provision anyone in Congress knows is in the ACA. Seriously:
  • when was the last time you heard a elected official talking about annual and lifetime benefit maximums, which can bankrupt their constituents?  
  • when was the last time you heard them talking about maintaining coverage for kids 26 years old on their parents' policy?
  • or, when was the last time they talked to you about fully-covered preventative care, free of deductibles and coinsurance?
  • or may favorite one, the part of the ACA that requires insurance carriers to spend a specific percentage of the premiums they collect on paying benefits, otherwise they have to refund the money to their subscribers? 
See, while those dreaded Republican death panels we heard so much about are NOT in the ACA, the items above, and many others, above ARE in the ACA. Think about that, especially that last one, and think about all of your free-market proponents in Congress and statehouses across the country, and all of their large, for-profit donors, and think about what's not going to make it into a Republican replacement plan.

And while you're at it, think about 'Medicare for all' - that wacky, socialist universal health care, widely derided by Republicans - and remember that, as a candidate, Donald Trump proposed free healthcare for Americans.

What, you didn't remember that?  Back when his cabal was issuing position papers, the two provisions below were among the ones that were included in his plan for fixing healthcare:
  • allowing tax free contributions to a health savings account (HSA); the HSA would become part of the person's estate with no 'death tax' and could be used by anyone in the family, without penalty, and
  • allowing people to fully deduct health insurance premiums from their tax returns
As I noted when I looked at his position back in 2016,
Translated: government-sponsored health care. Free health care. Say it either way, doesn't much matter. I mean, say your income tax responsibility is $5,000, and say you pay $6,000 in health insurance premiums. That means that the $5,000 Uncle Sam is counting on getting from you is now $1,000 that Uncle Sam owes you. Which means that someone else is going to be picking up the costs, right? And if someone else is paying for your insurance, it kind of makes your health insurance free, doesn't it?
Now, we know that the Republicans wasted millions of dollars on attempts to repeal the ACA, and they had the fiasco of failure the first time they attempted to get a replacement plan on the table , and they came close to passing a repeal until that "one guy, in the middle of the night, went like this and killed the whole thing," as the president likes to say.  And that was when they had the majority in both the House and the Senate.

I've said many times that the ACA was not perfect, but that repeal and replace was not the answer, anymore than it would have been the answer to completely throw away the entire tax code in order to pass last year's tax cut bill, or throwing away the entire defense budget and starting over (well, maybe that one would...).

In any event, we will have to see whether incoming Speaker Nancy Pelosi will prioritize fixing the ACA, or if she's going to go after other legislative priorities. Of course, that sort of assumes she'll have time for legislative priorities, given the full slate of investigations into Trump that we've been told to expect.  And, we'll have to see what the Trump Justice Department decides is worth fighting for.

Fun times, folks. We've got fun times ahead.

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