Mandate or Medicare

The Affordable Care Act (or “Obamacare,” if you prefer) is now in the hands of the Supreme Court. That is, Justice Anthony Kennedy will decide if Congress has the authority to require virtually all Americans to have health insurance or pay a penalty as of 2014.

Barring a sudden attack of integrity among the four hard-right justices, who know very well that the Constitution and court precedents clearly give Congress the authority to regulate health insurance, it looks like the court almost certainly is headed for a 5-4 decision with Kennedy casting the crucial vote. (Some see the possibility that Chief Justice John Roberts will side with Kennedy if he upholds the law.)

After the March 27 arguments, many observers thought Kennedy’s questioning showed his skepticism toward the individual mandate’s constitutionality. But Lyle Denniston, the highly regarded writer for Scotusblog.com, wrote after the arguments that Kennedy ultimately showed an openness to the mandate. And Steve Kornacki of Salon.com noted that we don’t know why Kennedy — or any other justice — asked the questions he asked or whether he found values in the answers.

We don’t especially mind if the Supreme Court throws out the mandate that individuals buy insurance from private corporations, as long as the court lets the rest of the law stand. If you want to see insurance executives panic, let the Supreme Court say the individual mandate is unconstitutional but otherwise insurance companies have to sell insurance to all comers.

The law now requires that insurance policies cover preventive care, which has improved coverage for 54 million Americans; it allows 2.5 million young adults to remain on their parents’ insurance until age 26; it has reduced prescription drug costs by $3.2 billion for 5.1 million seniors; it has made insurance available to 50,000 Americans whose pre-existing conditions previously made them uninsurable; and it gives 20.4 million women with private insurance access to mammograms and other care with no cost sharing. It also has removed lifetime limits on insurance coverage, so that no longer is your gurney wheeled out of the hospital on the orders of your insurance company when the bill passes $1 million.

Lots of people don’t like the health reform law — a recent New York Times/CBS poll found that 47% of Americans disapprove of the health care law while 36% support it, but only 38% want the court to overturn the entire law. When you take out the individual mandate, the rest is pretty popular: 85% support requiring that insurance companies cover preexisting conditions; 77% support lowering prescription drug costs of the elderly; and 68% support allowing parents to keep their children under their own coverage until age 26.

Many of those who object to the mandate don’t realize that it only affects people who don’t already have insurance through their employer — and people earning less than 400% of federal poverty will get subsidies to buy insurance through exchanges that the states are supposed to set up. The opposition to the bill drops dramatically when people are informed that the mandate does not affect people who already have insurance. Research by the Urban Institute for the Robert Wood Johnson Foundation found that, if the insurance mandate were put in place today, only 7% of non-elderly Americans — 18.2 million — would be forced to buy insurance. The other 93% either already have health insurance or fall under various exemptions included in the law.

Of those 18.2 million uninsured people who would be required to buy coverage, Kevin Sack noted at the Economix blog at NYTimes.com (March 27), nearly 11 million would be eligible for subsidized premiums offered through health insurance exchanges. That would leave 7.3 million people — 3% of the non-elderly population — who would be required to buy coverage at full cost or pay a penalty.

While Republicans have been fighting Obamacare in the courts, right-wing state leaders such as Texas Gov. Rick Perry have been cutting health services for low-income women. (Low-income men already were out of luck.) The skinflint Republicans in charge of Texas government have done virtually nothing to make insurance available for the one-quarter of working Texans who don’t get coverage from their jobs. Instead, Republicans have resisted implementation of the federal health care reforms and urged federal regulators to back off on limits on health insurance company profits.

If the Supreme Court tosses the Affordable Care Act, Obama and the Democrats should immediately pivot, advancing a bill to expand Medicare to cover every American. As Robert Reich noted, there’s no question that Medicare is constitutional, as are the payroll taxes to pay for it, and it’s popular.

“If the Supreme Court strikes down the individual mandate in the new health law, private insurers will swarm Capitol Hill demanding that the law be amended to remove the requirement that they cover people with pre-existing conditions,” Reich blogged. “When this happens, Obama and the Democrats should say they’re willing to remove that requirement — but only if Medicare is available to all, financed by payroll taxes.”

In the meantime, Andrew Leonard noted at Salon.com, the Affordable Care Act already has slowed the growth in Medicare costs. Instead of growing faster than overall economic growth, Medicare is now roughly in line with existing growth. The Congressional Budget Office has sharply reduced its estimates for Medicare spending over the next 10 years.

That’s bad news for Republicans who are spreading alarms about Medicare’s long-term viability, in the hopes of dismantling the health program for seniors, but it’s good news for the rest of us who hope to take advantage of Medicare’s guaranteed health benefits when we reach 65. Or perhaps, if Democrats can pull off that pivot, we can get those benefits sooner.

The most depressing thing about the battle over health care reform is the willingness of Republicans to lie about nearly every element of the conflict. During the nearly 10-month legislative battle, and in the two years since then, Republicans characterized the bill as “socialist,” a “government takeover” which would set up “death panels” and destroy lives and American society — by requiring that people buy private insurance — with help for those who couldn’t afford it — but also requiring that insurance companies provide better coverage, with national standards.

As Massachusetts governor, Mitt Romney helped draft that state’s health reform bill in 2005, back when the individual mandate was a Republican idea based on the principle of personal responsibility. Republicans “don’t think the free market ever envisioned an idea that people would be able to do something and make other people pay for it,” he said back then. “People are either going to buy insurance or they’re going to pay for their own care. They’re not going to say, ‘I got care and you Mr. Tax Payer or You Mr. Premium Payer are going to pay for me.”

But when Obama and the Dems adopted the individual mandate developed by the Heritage Foundation and Romney, all of a sudden it was socialism and a threat to the Republic.

Even with all the self-inflicted wounds Romney and other Republican candidates have taken, progressives should not be under the illusion that Obama will breeze to re-election. Right-wing super PACs have been testing their weapons in Republican primaries and statewide referenda but the PACs are banking the checks from anonymous donors that will pay air the lies 24/7 this fall in a test of the nation’s gullibility.

Obama probably won’t put a dent in the states that went for McCain last time, but Republicans have a shot at pulling back several of the states that voted for Obama in 2008 — particularly with the new “voter ID” laws that threaten to disenfranchise millions of low-income and elderly Americans who don’t have driver licenses, in a transparent attempt to make voting more difficult for likely Democrats.

From The Progressive Populist, April 15, 2012


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