Obamacare: On the ropes?

The second open enrollment period for the Affordable Care Act began on November 15, but it seems like Obamacare has been under attack forever. Republican lawsuits make their way through the courts, Democratic candidates run from President Obama's signature achievement, and Democratic Senators openly question it.  Here are 10 things to know about the current state of the Patient Protection and Affordable Care Act and the threats facing it.

1. As of April 2014 (after the first open enrollment period), approximately 15.2 million previously uninsured had gained health care insurance as a result of the ACA - either through the Marketplace or through the Medicaid and CHIP expansions. Daily Kos notes that a) the uninsured rate dropped more than 30 percent from September 2013 to September 2014; b) healthcare spending in the U.S. grew at a slower rate in 2013 than it had in 53 years; c) an estimated 50,000 lives were saved between 2010 (when ACA was passed) and 2013 because hospitals have been made safer.

2. The original ACA provided for an expansion of state Medicaid systems that would have made health care affordable for an additional 21.3 million Americans by 2022. The Supreme Court made that provision voluntary and, as of October 2014, 23 states had chosen not to expand Medicaid coverage. Nearly 4 million poor uninsured adults fell into the“coverage gap” that resulted from state decisions not to expand Medicaid, meaning their income is above current Medicaid eligibility but below the lower limit for Marketplace premium tax credits.  With Republican victories at the state level in the midterms, this denial of affordable medical care will continue.

3. SCOTUS will hear King vs. Burwell this term. This case, as well as its related brethren (Halbig vs. Burwell, Pruitt vs. Burwell, and Indiana vs. IRS), would deny subsidies to people who obtained their healthcare plan through the Federal exchange rather than through a state exchange. If successful, as many as 13 million people in 37 states could be affected, For many of these, healthcare would once again become unaffordable.

4. King vs. Burwell rests on what Think Progress calls a "glorified typo." If read in isolation, one line of the Affordable Care Act suggests that only “an Exchange established by the State” can offer subsidies to help people pay for health insurance in the exchange. Previous Supreme Court decisions have noted that “a reviewing court should not confine itself to examining a particular statutory provision in isolation” as the “meaning—or ambiguity—of certain words or phrases may only become evident when placed in context.”

5.  With today's politicized Supreme Court, the outcome of King vs. Burwell will depend on Chief Justice Roberts. Once before, Roberts bucked conservative pressure when he sided with the court's liberals in determining the ACA to be constitutional. Will Roberts' concern for his legacy (or perhaps his conscience) let him do the right thing for the American people or will he cave to this political stunt and ignore previous Supreme Court rulings on the importance of context?

6.  Sen. Charles Schumer blamed the loss of the Senate and the general thumping of Democrats in the midterms on the timing of Obamare.  Perhaps the best response to Schumer came from Michael Hiltzik at the Los Angeles Times: "It's a startling admission of political spinelessness. Schumer gets the positive impact of the legislation wrong, he gets the politics of it wrong, and he displays a shocking ignorance of the problems facing the American middle class. The only good thing about his remarks is that they confirm how bad today's Democrats are at messaging."

7. The House GOP filed suit against President Obama on November 21. The lawsuit focuses on two points: (1) the administration's decision to delay the law's mandate that businesses with 50 or more workers provide comprehensive health benefits and (2) the requirement that insurers reduce the out-of-pocket expenses for lower-income customers with the government making "periodic and timely payments" to insurers to cover their costs. This suit is even more blatantly political than King vs. Burwell and stands less of a chance of success.  Still, as the LA Times opines in a November 24 editorial: "...it's worth noting how Republicans have sought to undermine and destabilize the Affordable Care Act by attacking the benefits it provides to Americans on the lowest economic rungs."

8. Retiring Sen. Tom Harkin, co-author of the ACA, now says that Democrats should have passed single payer healthcare when they had the chance in 2009.  By trying to address the concerns of three centrist Senators (Democrats Lincoln and Nelson and Independent Lieberman), the country ended up with a more complicated healthcare system. I agree with Sen. Harkin.  Single payer or public option healthcare would have been a better choice. Compromising did no good. The ACA passed the Senate without a single Republican vote and the complexity of the system has opened it to, as we have seen, unending lawsuits.

9. A GOP Senate can be counted on to try to dismantle the ACA in stages should both King vs. Burwell and the House GOP suit against Obama fail. The idea would be to gather enough Democratic votes to avoid a filibuster, or better, to override a Presidential veto. Based on discussions with health care experts and lobbyists, the New Republic lists these possible Republican actions:

(a) Repeal the individual mandate

(b) Repeal or modify the employer mandate

(c) Eliminate "risk corridors" (government reimbursement to insurers for some losses)

(d) Repeal the 2.3 percent medical device tax. Its primary purpose is to generate revenue to help subsidize healthcare costs for lower income people.

(e) Abolish the Individual Payment Advisory Board. IPAB is a board with the power to ratchet down what Medicare pays for goods and services.

(f) Introduce "copper plans" which would cover less (50%) of an individual's health care expenses than the current plan levels.

10. I'll close with commentary from a source I don't often cite. Forbes magazine, the self-proclaimed "capitalist tool," has some bad news for Obamacare bashers. A McKinsey Center report found that a) competition and choice are increasing among insurance companies; b) the median increase in premiums for 2015 will be 4% (Forbes' comment: "When was the last time we saw insurance premiums experience an annual increase of less than 5 percent? I cannot remember such a time and doubt that you can either."); c) premiums for those being subsidized will vary - with some likely to pay more and others likely to pay considerably less.  The author's closing advice is priceless: "Even if you are committed to bashing the ACA at all costs, do yourself a favor and go check out the policies available to you come November 15th. You are likely to find something to your liking at either a lower price or at a very small increase. Should you find such a policy, buy it and be secure in the knowledge that the next time you trash Obamacare nobody will have to know that you benefited personally from the program."

  

Sunday Roundup - June 15, 2014

This is the weekly selection of news and opinion from sources outside the US mainstream media. Today we look at Syria, pro-gun antics, the State Senator sellout and the Tea Party victory in Virginia, and Iraq.

Syria
According to the UN, more than 160,000 people have been killed in Syria's civil war.  Nearly three million refugees have sought sanctuary abroad and six million people have been displaced inside the country.  Syrian President Bashar al-Assad was re-elected to his third seven-year term on June 3 in an election held in government controlled areas.  On June 9, Assad announced a wide-ranging amnesty.  As reported by the Reuters news agency: In a decree published by state media, Assad commuted some death sentences to life imprisonment, reduced jail terms for many offences and canceled some others altogether.  Foreigners who entered the country "to join a terrorist group or perpetrate a terrorist act" would receive an amnesty if they surrender to authorities within a month, the decree said. Kidnappers who free their hostages and army deserters would also be covered.   On June 10, Reuters reported on the  internecine fighting among Assad's mainly Sunni Muslim opponents.  A six-week offensive by the Islamic State in Iraq and the Levant (ISIL) against rival Islamists in eastern Syria has killed 600 fighters and driven 130,000 people from their homes...The group follows al Qaeda's jihadist ideology but its leader Abu Bakr al-Baghdadi has defied orders by al Qaeda leader Ayman al-Zawahri to stop fighting in Syria and focus on Iraq. The UK-based Observatory said 241 fighters from ISIL and 354 from Nusra and other Islamic brigades had been killed in fighting since ISIL launched its offensive in Syria's Deir al-Zor province, seizing four oilfields from its rivals. Civilian deaths are estimated at 39.

Gun Violence
Mass shootings continue in the US with no Congressional action to even establish standards for universal background checks anywhere in sight.  Among other shootings in the past several weeks, a couple allegedly at the Cliven Bundy ranch shot to death two Las Vegas police officers and a bystander.  In a June 10 post, The Daily Kos analyzes the disappearance of the Tea Party terrorist story from Fox News reports after just one day.  Ordinarily, Fox, or any news operation, would grasp dearly to a story that had the emotional punch of police officers murdered in an ambush. It has the drama of a horrific crime and the sympathy reserved for a community's fallen heroes. For Fox to forgo all of that makes it clear that they are afraid of their own audience. They are not going to risk upsetting them with a story that indicts their most closely held principles. And Fox is surely not going to indulge in a story that contradicts everything they have stood for over the last seventeen years.

Meanwhile just when you thought the anti-gun-control fanatics couldn't get any nuttier, we are treated to the spectacle of packs of Open Carry Texas members carrying their rifles into commercial establishments and hounding gun control advocates, the NRA criticizing OCT actions and then retracting its criticism, "Joe the Plumber" insisting to parents of children killed at UC-Santa Barbara that the deaths of innocent people "don't trump" his constitutional rights, and a loaded gun being found in the toy aisle of a Target in South Carolina. Perhaps some of these pro-gun activists are afraid of universal background checks because they act so bat-shit crazy that, in any civilized society, they would be deemed unsuited to carry weapons.  President Obama asked for us as a nation to do some soul-searching and that may be all that happens for the foreseeable future on a Federal level.  With NRA money backing so many in Congress and with Republicans in control of the House of Representatives, don't expect too much by way of courageous action to stop the American gun slaughter.  

Virginia Doings
Referring to what appears to have been the bribery of a Democratic state senator by Virginia Republicans, Zoe Carpenter writing in The Nation wonders "What won't the GOP do to keep the poor uninsured?" Phillip Puckett, who served as a Democratic state senator for one of Virginia's poorest districts, resigned suddenly on Monday. His decision to step down appears to have been the result of a bribe offered by Republican colleagues bent on stopping the expansion of Medicaid. Puckett’s resignation gave Republicans the one seat they needed to take control of the Senate; it also put him in the running for a paid post on a state tobacco commission that is controlled by some of the very same Republicans. And it cleared the way for the chamber to appoint his daughter to a state judgeship. Turns out Puckett, in view of the uproar, may not be taking the post at the state tobacco commission.  But the damage was done.  By stepping down, Puckett effectively ended a months-long battle over the fate of the 400,000 Virginians who are too poor to buy insurance but don’t meet the state’s restrictive eligibility requirements for Medicaid. The state Senate had been on course to vote to expand the program under the Affordable Care Act, setting up a budget showdown with the Republican-controlled House. But with the GOP now in control of the Senate, both chambers are expected to pass a spending plan on Thursday that does not include the expansion.  Virginia is not the only state where Republicans have gone to insane lengths to keep millions uninsured, or to justify doing so.  Carpenter cites Missouri, Louisiana, Utah and Arkansas as examples of these Republican efforts.

In other Virginia political news, House Majority Leader Eric Cantor was deemed too moderate (wow, Cantor pressured Boehner from the right!) for the likes of his constituents.  David Brat, an obscure right-wing professor of economics, supported by the Tea Party but outspent 25 to 1 by Cantor, defeated Cantor by 11 percentage points.  How did this happen? New York Magazine assessed it this way:  Brat ... benefited from the constant undercurrent of discontent emanating from the base that House Republicans had accommodated President Obama by failing to force him to accept their agenda — the still-extant pangs of anger that drove the party to shut down the government last fall.  But the biggest issue by far was immigration reform. Cantor was no reformer, really. He rejected the bipartisan immigration reform deal ...but he did hope to salvage some partial compromise, perhaps allowing some illegal immigrants who had been brought over the border as children.... Brat rejected even that. Any token of conciliation was too much. He still uses the old lingo, calling undocumented immigrants “illegals.” The chortling on the Democratic side has begun.  They are glad that Cantor has been defeated.  I wonder what they can possibly be thinking.  He was replaced on the 2014 Republican ticket in a secure Republican district by someone even further to the right than he is. Albeit this was one of the few Tea Party victories against the Republican establishment candidates in this primary season.

Map is from uniraq.org

Iraq

Iraq is facing its gravest test since the US-led invasion more than a decade ago, after its army capitulated to Islamist insurgents who have seized four cities and pillaged military bases and banks, in a lightning campaign which seems poised to fuel a cross-border insurgency endangering the entire region.  [The Guardian, June 11]  Al-Qaeda-linked extremists seized control of Nineveh province and Mosul, Iraq’s third-largest city.  It puts terrorists in control of an enormous part of Iraq’s north and west.   As Bob Dreyfuss in a June 10 article in The Nation so correctly puts it: The crisis now engulfing Iraq provides the ultimate condemnation of the decision by George W. Bush, Dick Cheney and their cohorts—backed, of course, by Hillary Clinton and John Kerry—to invade Iraq in 2003. That action, which destroyed virtually all of Iraq’s institutions and created a power vacuum that led directly to an ethnic and sectarian civil war, is now playing out all of its terrible consequences.  The ongoing sectarian violence has taken a staggering toll in Iraq - with more than 8,000 killed in 2013 and monthly totals that suggest an even higher number of deaths this year; in May, 799 Iraqis died as the result of suicide bombings, car bombs, targeted assassinations, tit-for-tat killings and other civil war–like violence, according to the United Nations—and that data doesn’t even include Anbar province. 

Mother Jones, June 13 post: "What the Hell is Happening in Iraq Right Now?"

Sunday Roundup - April 27, 2014

This is the weekly selection of news and opinion from outside the US mainstream media.  Today we look at the collapse of the Israeli-Palestinian peace talks, and, in brief, the ongoing Republican efforts to deny affordable health insurance to Americans, Jon Stewart's take on the Cliven Bundy ranch showdown, the states-led effort to decide the Presidency on the basis of the national popular vote, and the giant Antarctic iceberg that is now entering the open seas.

Israelis Walk Away from the Table

From the antiwar.com website

The Israeli walk-out comes as no surprise but is still something of a disappointment.  The Kerry-driven peace talks were going nowhere and were scheduled to end later this month.  The incredible "reason" the Israelis gave for abandoning the talks a few days early was the reconciliation agreement between Hamas and Palestinian Authority.  After continuing to build illegal settlements on Palestinian land in the midst of the peace talks, after demanding that the Palestinian authority abandon the Palestinian right of return and acknowledge Israel as a "Jewish state", after reneging on the fourth and final round of freeing Palestinian prisoners, the Israelis decided that they had had enough.  So the Kerry talks are dead and Palestinians may need to turn to international organizations such as the International Criminal Court for justice and statehood.

Juan Cole, in an Informed Comment post on April 24, writes of the move that prompted the Israeli withdrawal from the talks:  This week the Fateh Party (secular Arab nationalist) of Palestine President Mahmoud Abbas met in Gaza with members of the Hamas Party (fundamentalist Muslim), seeking a reconciliation and a government of national unity.  The two sides agreed that in 5 weeks a government of national unity will be appointed by Mahmoud Abbas. There will then be new elections for a president and parliament, to be held no later than 6 months after the new government is sworn in.  Cole reminds us of something seldom mentioned in the Western press - the reason the two sections of Palestine are politically separated: In January 2006, the fundamentalist Hamas Party won the parliamentary elections. This outcome was not acceptable to Israel and the Bush administration, and they connived with the secular Palestine Liberation Organization to overthrow the Hamas government in the West Bank, in which they succeeded. A similar attempt at a coup in the Gaza Strip failed, however. Gradually journalists and politicians have forgotten who was elected and who made the coup, so that you often see the Hamas government in Gaza described as the one that came to power by force. Rather, it is the remnant of the decision the electorate made in 2006.  In 2007 Israel put Gaza under a severe blockade, including its civilian population, which has destroyed the economy, created massive unemployment, and caused a majority of families to be food insecure. It is illegal for an Occupying power to impose collective punishment on a civilian population for which it has responsibility.

Water shortage in the Gaza Strip -  PressTV file photo

Zvi Bar'el writing in the Israeli newspaper Haaretz asks why the Palestinian reconciliation is driving the Israeli government into a panic, pointing out the contradictions inherent in Israel's refusal to engage in dialogue with Hamas.  The discussions with the PLO that led to the Oslo Accords were begun when the PLO was defined as a terrorist organization and had not recognized Israel.   Another contradiction in Israeli policy is that they objected to talks with Hamas "because it was a terror group and served as an Iranian agent in the region. But when Hamas cut itself off from Iran and moved to join the PLO, Israel used it as an excuse to stop the peace negotiations with the Palestinians and blame Abbas for the talks’ collapse."  Bar'el sums up the situation: The reconciliation will lead Hamas and Islamic Jihad into coalition with the PLO, making them an inseparable part of the formal framework that signed the Oslo agreements. It is possible of course that the new PLO will move to revoke these agreements unilaterally. But so far no inclination has been reported on Hamas’ part to condition its joining the PLO on revoking the agreements.  On the contrary, Palestinian Authority President Mahmoud Abbas has stated that there is no contradiction between the peace talks and the reconciliation agreement. This could indicate an agreement between Fatah and Hamas to maintain the peace talks, as [Hamas po;itical leader] Meshal made clear already in 2012, when the basic reconciliation agreement between the two movements was ratified.  The dilemma that Abbas has laid at the US and Israeli doorstep is this: If they want to advance a peace agreement between Israel and the Palestinians, they cannot demand to neutralize Hamas and at the same time claim that Abbas does not represent all of the Palestinians.  Israel is expected to cut ties with the unity government and the US will likely turn a cold shoulder towards it.  Bar'el concludes: the European Union and Arab states, most of which support the reconciliation, will have to make a decision. Will they allow some 5 million Palestinians to be left with no services, no funds and no hope of a political horizon, or will they take this opportunity to shape reality in the Middle East, rather than merely observe from the side?

Who knows?  Perhaps a break in the talks will lead each side to reconsider its position and maybe peace and justice will eventually come to all in that troubled land.  The makings of an agreement are clear. Palestinians, including Hamas, recognize Israel and renounce the use of violence in their pursuit of statehood.  Israel stops taking land from the Palestinians, removes the blockade on Gaza, and drops the demand that it be recognized as Jewish state (or somehow guarantee the Palestinian right of return in a Jewish state).  Until an agreement on the final borders of a viable Palestinian state can be reached, the Arab League and Europe step up and support the Palestinians.  They have been stateless since 1948.  It's long past the time when they are due some justice.

Links
A new comprehensive UN report on the situation in the Gaza Strip says the besieged territory will not be “livable” in 2020 unless immediate action is taken to improve the humanitarian situation there. [PressTV, April 25]

Americans for Peace Now statement on the pause in discussions [APN website, April 25]

In Brief
Back in February, news broke of Georgia Gov. Nathan Deal's efforts to make sure that no governor of Georgia could ever decide to take Medicaid expansion, giving the legislature veto power over any future governor's decision to do so. But it's not just Deal. Kansas's Gov. Sam Brownback (R) is doing it too.  Georgia and Kansas have left a combined 487,000 residents uncovered under Obamacare because they refused to expand Medicaid. And, though the law remains unpopular, a recent poll found that majorities of Georgians (54 percent) and Kansans (55 percent) support Medicaid expansion. [Daily Kos, April 22]

New York has become the latest state to join an agreement that would transform the U.S. presidential election. Under the compact for a National Popular Vote, states across the country have pledged to award their electoral votes to the presidential candidate who wins the popular vote. [Democracy Now, April 17]

Jon Stewart's hilarious take on the Cliven Bundy ranch showdown [Daily Kos, April 22]

And our climate change article of the week comes from Reuters: Scientists are monitoring an iceberg roughly six times the size of Manhattan - one of the largest now in existence - that broke off from an Antarctic glacier and is heading into the open seas.  [Reuters, April 23]

Obamacare Done Good!

The open enrollment deadline has passed and it looks like about 7 million people have enrolled through the healthcare exchanges set up by the Affordable Care Act.  There was a huge surge in the last days and, in spite of a couple of system shutdowns yesterday, Obamacare appears to have reached it's original (i.e., before the website problems of last October) goal of 7 million signups.

It's bound to be a major topic in the midterm elections.  Up to the end, Republicans have tried to deny the real good that it has done and, in November, they will run on a platform whose centerpiece is to repeal it.  They have nothing else to show for their most recent term.  Well I guess they can say "Hey, we only shutdown the government once!" 

It being April Fool's Day, I thought I'd present a few of the egregious and ridiculous comments recently emitted from the mouths of politicians and political commentators on the subject and then give some facts. 


With 7 million people signed up for Obamacare, Republicans are hard pressed to continue to call it a disastrous failure.   That doesn't stop them from continuing the assault against the Affordable Care Act.  On Sunday, "Sen. John Barrasso (R-Wyo.)...dismissed the White House's recent announcement that Obamacare enrollment had reached more than 6 million people, calling it a meaningless figure. 'I don't think it means anything. ... I think they're cooking the books on this,' said Barrasso on  Fox News Sunday."[Huffington Post, March 30]

Fox News “Medical A-Team” contributor Dr. Manny Alvarez, “explaining” the purpose of the Affordable Care Act: “We did it for nothing. We did it to confuse America. We did it to create a false tax. We did it to create an environment of punitive damages to people that don’t follow what the federal government tells them to do.”
Read more at http://www.newshounds.us/fox_news_outrageous_quote_of_the_week_poll_3_16_14_3_22_14_03242014#7E0Jh72SwkT5Uyq1.99

Fox News “Medical A-Team” contributor Dr. Manny Alvarez, “explaining” the purpose of the Affordable Care Act: “We did it for nothing. We did it to confuse America. We did it to create a false tax. We did it to create an environment of punitive damages to people that don’t follow what the federal government tells them to do.” [Newshounds website, March 24]

No discussion of Republican blathering would be complete without an entry from Michelle Bachmann.  Here's her take on the Administration decision to extend the deadline for people who started but did not complete their applications before midnight March 31.  "Unfortunately, it is the continuation of lawlessness from the administration,” Bachmann told Fox News’s Neil Cavuto on Wednesday. [Daily Kos, March 27]

I guess you notice a theme here.  These inane comments are all from commentary on Fox "News" shows.

Now for some facts.

In addition to the 7 million sign-ups, the ACA provided numerous improvements to health care insurance in our country- including provisions that

• Let young adults stay on their plan until 26
• Stop insurance companies from dropping you when you are sick or if you make an honest mistake on your application
• Prevent against gender discrimination
• Stop insurance companies from making unjustified rate hikes
• Do away with life-time and annual limits
• Give you the right to a rapid appeal of insurance company decisions
• Require all insurers to cover people with pre-existing conditions  
• Require that all non-grandfathered health insurance plans cover preventive services (including yearly check-ups, immunizations, counseling, and screenings) at no out-of-pocket costs 
• Essential health benefits (including emergency care, hospitalization, prescription drugs, maternity, and newborn care) must be included on all non-grandfathered plans with no annual or lifetime dollar limits.

For more information on the Affordable Care Act, see the Obamacare Facts website.

Conservative groups spent millions trying to dissuade people, especially young and healthy people,  from signing up.  The Republican-controlled House of Representatives voted 50 times to repeal it or change it.  Misleading Obamacare horror stories filled the airwaves.  States refused to help people understand the law.  For nearly a month at startup, the healthcare.gov site was basically non-functional.  Still 7 million people cut through the crap thrown at them and applied.  In addition to the health exchange signups, there are millions of working poor who will now qualify for Medicaid thanks to the Medicaid expansion provision of the law.

But still the work for health care coverage is not done.

The main driving force for the ACA was to provide health care coverage for those who could not afford it.  An important provision in achieving this was the Medicaid expansion.  The intent was to cover the gap between Medicaid recipients and those who could still not afford health care insurance even with a subsidy.  State expansion of Medicaid was made voluntary by the Supreme Court in its decision on the constitutionality of the Affordable Care Act.  This decision was a game-changer

Republican governors and state legislatures, for the most part, prevented Medicaid expansion from taking effect in their state.  They did this despite the fact that the Federal government would cover about 93% of the costs for the first nine years of the expansion (2014-2022).  The CBO estimated that if all states expanded Medicaid coverage under the provisions of the ACA, 17 million people would be eligible.  

With many red states refusing to expand Medicaid at this time, between 7 and 8 million people will still not be able to afford health insurance.  States can decide to expand Medicaid at a later date.  Let's hope they do so and that public pressuring such as MoveOn.org's billboard campaign will help bring this about.  For the cost to expansion-denying states will be more than lost Federal dollars.  It will be lives. 

If the Republicans bring up their "death panel" lies again, I suggest we direct them to the January 2014 Harvard Medical School researcher's study: "Opting Out Of Medicaid Expansion: The Health And Financial Impacts."  The study estimates from 7,000 to 17,000 needless deaths per year because of these state decision to keep the working poor uninsured. [Daily Kos, March 30]

So to those GOPer's who want to make Obamacare "the issue" in the mid-terms, I say "Bring it on!"

Obstructing the Judiciary

Justice too long delayed is justice denied.

- Martin Luther King, Jr., Letter from Birmingham Jail

The President of the United States is responsible for nominating judges to the Federal judiciary.  It is the Senate's responsibility to confirm or deny these nominations.  With just 7 months remaining before the 2014 midterm elections, there are 86 vacancies in the Federal courts - roughly 10% of the total Federal judgeships.  Nearly all vacancies have resulted from Republicans blocking Obama nominees in an attempt  to deny the Democratic President his choices and ensure continued Republican control of the judicial branch.  The obstructionism on presidential nominees to Federal judgeships is unprecedented in recent history.


Harry Reid was able to change the Senate rules to prevent filibustering of these nominees to the federal courts.  Should the Republicans gain control of the Senate in 2014, this will no longer matter.  You can rest assured that any Obama nominee sent to a Republican Senate will not be confirmed.  Just look at the decisions of the currently composed Supreme Court to see what the future holds.  Democracy-challenged supporters of the corporations and the wealthy, appointed by Republican Presidents, fill most of the seats on the Court and they've brought us such decisions as Citizens United and the gutting of the Voting Rights Act.  Who can ever forget the Republican majority Supreme Court stopping the vote recount in Florida and handing Bush the Presidency even though Gore had garnered more than a half-million more popular votes nationally?


The Court's favorable ruling on the constitutionality of the Affordable Care Act was still detrimental to the "non-ruling" class.  By making the expansion of Medicaid optional, they effectively eliminated this option for low-wage-earners in most Republican-controlled states.  There has been some movement but as of now, there are still 25 states not moving forward with the ACA's provision for Medicaid expansion.  In the end, those finally denied affordable medical insurance will be in the millions.




The Roberts' corporate court sided with the Chamber of Commerce in 13 of 16 cases during the 2009-2010 term.  Then, in the 2010-2011 term, "the Roberts Court cut down an exemplary Arizona statute that leveled the financial playing field, rejected a [gender discrimination] suit by 1.6 million women against...Wal-Mart, shielded the makers of drugs from lawsuits by patients who had been harmed, smothered lawsuits against mutual fund cheaters and liars, and disallowed a suit by a death row inmate even though the prosecution failed to turn over exculpating evidence." [Reno News & Review, "Top 10 Worst Supreme Court Decisions", March 2012]



Currently there are 49 nominees pending for the 86 vacant judgeships.  Mr. President, please wake up and bring forward nominations for the remaining 37 vacancies before the mid-terms. Senator Reid, please put these nominations on a fast track.

2014 Senate seat contests -lighter color indicates retiring Senator

Why is this important?  Democrats currently hold a 55-45 edge in the Senate (assuming the two independents continue to vote with the Dems).  If just 6 seats change hands, the Republicans will control the Senate.  I don't want to sound too pessimistic about the Democrats' chances of holding onto the Senate but there are 21 Democratic seats at stake in 2014 compared to just 15 Republican seats.  Four of the 21 Democratic seats are held by retiring Senators - South Dakota, Iowa, Michigan and West Virginia.  Of the 17 remaining Democratic incumbents, 5 are from states that went for Romney in 2012.  So that leaves just 12 seats with a returning Democrat running for office in a "blue state".  By my count, that means 9 Democratic Senate seats are up for grabs.


This year's elections promise to the most expensive mid-terms ever.  The money unleashed by Citizens United is flowing freely into the electoral process.  Fact-free negative ads are bouncing around the airwaves.  Voter suppression measures will be taking full effect in November and "government of the people, by the people and for the people" may become a thing of the past.  With the addition of corporate judges to the Federal courts should the Republicans gain the Senate, the oligarchy will be entrenched for a long, long time.


Image
The 2014 Senate election map is from Wikipedia.
The Medicaid expansion map is from the Kaiser Family Foundation website.

Links
"If you prick a corporation, does it not bleed?..." cartoon [New Yorker, March 14, 2011]

Options for low-income people in states denying Medicaid expansion [AllVoices.com, March 22]

State Of Obamacare

I've been fortunate . I've been covered by health insurance since the day I was born. To me it seems natural and more necessary than almost any other type of insurance. Why anyone would want to deny this to their fellows is beyond my comprehension. Health care is a right, not a privilege. And don't say that we, the richest nation on the planet, can't afford it. With some adjustments to the military budget and the tax laws, we could have universal health care as does every other advanced industrial nation.

The Patient Protection and Affordable Care Act was a step in the right direction. At the time it was signed into law, nearly 50 million Americans were uninsured - many or most because they could not afford it. Single payer or some public-private mix to get truly universal coverage would have clearly been better. But the ACA is perhaps the most we could have hoped for in light of the rabid opposition to the expansion of access to medical insurance.

It's been a hard road so far. Opponents have successfully hampered its implementation (25 Republican-controlled states decided not to expand Medicaid). The startup of the government website was beset with problems. The confusion over health insurance plans that did not meet the new standards was stunning and people were ill informed to deal with the "we're cancelling your insurance" notices sent out by insurance companies.

And it is not going to get any easier. Massive amounts of money are being spent to defeat vulnerable Democrats who supported the ACA in the upcoming 2014 elections. Since September, just one group, the conservative Americans for Prosperity, has spent $20 million on anti-ACA-supporter TV ads. [NY Times, Jan. 15] There are ongoing ad campaigns aimed at convincing younger, healthier Americans not to sign up. Should they be convinced by this onslaught of negativity, premiums will necessarily go up and the rabid opponents of the ACA, who poured millions into these campaigns will say "I told you so."

Here then are some thoughts on the Affordable Care Act at the start of its first fully operational year.

The healthcare.gov rollout was inexcusably botched... The single most important piece of legislation enacted during Obama's first five years relied on a website whose development appears to have been rushed and that lacked adequate pre-startup testing. This one is on Obama and his staff. All IT projects run into problems and, as red state after red state declared their intentions not to set up state health care exchanges, the writing was on the wall. This website would be overwhelmed. Progressives should be angry with Obama for this lack of oversight. The Affordable Care Act is an acid test of the most distinguishing feature between the political philosophies of the two main political parties: Does government have a role in improving the lives of its ordinary citizens? As the title of the History Channel presentation on the NASA space program says "Failure is not an option." The botched rollout was more than what any red blooded Tea Partier or supporter of the corporate oligarchy and the 1% could have hoped for.

...but things are looking up for the healthcare.gov website. After 400 fixes, the downtime was less than 5% by the end of November and it is even better now. "Ping time" (the round-trip delay time for a computer signal) is down to 15- 50 milliseconds. The site can now handle an estimated 800,000 visits per day.

After the fixes, enrollments surged. The LA Times reported on January 13: "More than 2.1 million Americans signed up for health insurance in the last three months of 2013 through new online marketplaces created by President Obama’s health law, as a December surge in enrollment helped the initiative recover from its disastrous launch." Don't forget that one of those last three months was October which saw very few enrollments. So it appears that ACA is enrolling new customers at a rate of about 1 million per month. And there are 3 million more who "have not yet selected a plan but have filled out applications for coverage on the new insurance marketplaces since Oct. 1 and have been deemed eligible for a plan." Finally, in October and November alone approximately 3.9 million people signed up for Medicaid.  If one of the prime purposes of expanding health insurance coverage is to cover those who could not afford it, this surely has to count as a success.

Cancellation of existing policies provided another black eye for the rollout... I don't think the Administration had a clue as to the extent that insurance companies would choose to cancel policies that did not meet Affordable Care Act standards. Rather than enact the necessary provisions (e.g., coverage for prescriptions, hospitalizations and emergency room care), many insurers chose to cancel the policies.  What could have been done to prevent this from bollixing up the works at the eleventh hour as people went to a malfunctioning website after being told they would no longer have health insurance after the end of the year? Several things come to mind: grandfather policies from say January 1, 2013; a notification period of no less than 6 months that your policy was being cancelled; a clear explanation by the President as to what "if you are happy with your existing policy" actually meant (policies in effect as of March 2010 were "grandfathered") ; and, of course, a fully functioning website.

 

...but Obamacare success stories are getting some press.

The Daily Beast, Oct.23 - "The Obamacare Success Stories: From a retired business owner in Arkansas to a young freelance filmmaker in Hollywood, Eleanor Clift highlights a few of the people the media has found who are happy to have Obamacare."

The Daily Kos, Nov. 4 -"Obamacare 'rate shock' victim changes her mind, calls the law a 'blessing in disguise'

TPM,Nov.25 - looks at how "Kentucky Uninsured React To SecuringHealth Care Coverage Under Obamacare"

TheDaily Kos, Dec. 10 -"What Republicans don't want: Florida woman cries tears of joyafter getting $3.19 Obamacare policy"

The Hill, Dec. 29 - "Five states with ObamaCare success"

The most obvious, but surely not the last attempt to defund, repeal or sabotage the Affordable Care Act was the phony debt-ceiling crisis manufactured last year by Republicans. The government was shutdown by the extremists who control the Republican Party. Though it failed miserably, people have a short memory and Republicans' approval ratings are increasing. There's a well-funded campaign in the run-up to the 2014 elections aimed at defeating Democratic legislators who supported the ACA.

There are the advertisements urging young people to opt out. A Yahoo News November 11 headline of an article reporting the shenanigans at the University of Miami read "Anti-Obamacare group entices students with models and a boozy party." What's the reasoning here? As the Yahoo post explains "You see, in order for the health care law to function, lots of healthy, young people must sign up for the exchanges to subsidize older, sicker insurance seekers. So conservative groups are spending a lot of money to convince them not to sign up." Now this logic should outrage any fair-minded person. The absence of a healthier cohort in a health insurance plan raises the rates for everyone. Expect an all-out blitz on this front in the coming months.

Legal challenges may cripple the legislation yet.   It's not over yet in the courts as several legal challenges wend their way towards the Supreme Court.  As reported in the LA Times "The new suits take aim at the parts of the law that offer subsidies to those who are above the poverty level but still may struggle to pay for insurance." 

The most threatening of these lawsuits borders on nit-picking insanity - whether insurance obtained on the Federal health care exchange (as opposed to State exchanges) is eligible for subsidies.  Wording issues such as this one would usually be ironed out between the Administration and Congress.  But in today's hyper-partisan environment, no cooperation can be expected. If this law suit succeeds, then no state without its own exchange would be able to participate in the Federal subsidies. There are 36 states without their own exchanges. Such a ruling would effectively dismantle the Affordable Care Act in these states.

Now for the good news. On January 15, a Federal District Court judge ruled in favor of the Affordable Care Act.  Reuters reports that the judge "upheld subsidies at the heart of President Barack Obama's healthcare overhaul, rejecting one of the main legal challenges to the policy by conservatives opposed to an expansion of the federal government. A ruling in favor of a lawsuit brought by individuals and businesses in Texas, Kansas, Missouri, Tennessee, West Virginia and Virginia would have crippled the implementation of the law by making health insurance unaffordable for many people.  In his ruling, U.S. District Judge Paul Friedman in Washington D.C. wrote that Congress clearly intended to make the subsidies available nationwide under the 2010 Patient Protection and Affordable Care Act. 'There is evidence throughout the statute of Congress's desire to ensure broad access to affordable health coverage,' the judge wrote." 

The respite might be temporary if the plaintiffs take the case to the Supreme Court. But for now, the greatest legal challenge has been overcome.  Stay tuned.  As a great philosopher once said, "It ain't over 'til it's over."

Other Links

Medicaid expansion is going forward in just half of the states.  If every state agreed, more than 20 million Americans could be insured in the next decade.  Here's a link to the Medicaid expansion webpage on the ObamaCare Facts website.