Chait on the political dynamics of the ACA:
In Kentucky, Mitch McConnell — who had vowed publicly and privately to “repeal this monstrosity” — was asked whether he would repeal the insurance exchange in his own state, and replied with word salad (“I think that’s unconnected to my comments about the overall question here”). When asked about repealing his state’s Medicaid expansion, he replied, “I don’t know that it will be taken away from them.”
Unpopular Pennsylvania Republican Governor Tom Corbett recently agreed to accept Medicaid expansion. Four more Republican governors — in Tennessee, Utah, Indiana, and Wyoming — have taken steps toward following suit. In Washington, the river of attacks against Obamacare issuing from Republicans has slowed to a trickle. (The number of Congressional news releases attacking the law has fallen by 75 percent this summer from last.) The Weekly Standard’s Jeffrey Anderson is warning darkly of an “anti-repeal wing” within the party. “Root and branch repeal is starting to look more like twig and leaf,” concedes Reason’s Peter Suderman.
The Republican crusade against Obamacare is not ending; rather, it is shrinking and mutating. The party base will demand a presidential nominee who promises to repeal the hated law, just as it did in 2012. But the next Republican candidate will be running in an environment where repealing the law would create millions and millions of now-identifiable victims. Since the start of the year, Obamacare has gone from a weakness Republicans were salivating at the chance to exploit to an issue they no longer want to talk about. Two years from now, matters could be worse still.
The desperation of the Halbig troofers is, in this sense, rational; the more the ACA is entrenched, and the more beneficiaries it has, the harder it is to get rid off.
Which makes it a good time to make clear what the troofers — not to mention the Republicans who won’t take the Medicaid expansion — are trying to accomplish:
In a five month span, however, two things changed that offered Jenn a new chance at life. The first was a double lung transplant. On August 29, 2013, Jenn received two new lungs that were free of cystic fibrosis. Not long thereafter, she drew her first breath as an adult from lungs that were not constantly filling up with choking mucus. Although Jenn will be on anti-rejection drugs for the rest of her life, she can now speak on the phone again. Her husband Eder can touch her face again or kiss her cheek again without triggering a fit of coughing. Jenn is not confined to a hospital anymore. She lifts kettlebells instead.
The second change came on the first day of 2014 when the most important provisions of the Affordable Care Act took full effect. That meant that, for the first time in her life, Jenn knew that, no matter what happened, she would have health insurance. For Jenn, Obamacare means that insurers must cover her, despite her expensive preexisting condition. And it means that she is not facing a death sentence if she is unable to obtain health insurance through her own job or her husband’s.
Except for the fact that a group of lawyers are trying to take this certainty away from her. Last July, two Republican judges on the United States Court of Appeals for the District of Columbia Circuit voted to defund much of the Affordable Care Act, including provisions which ensure that Jenn’s insurance is affordable. Moreover, although the full DC Circuit recently withdrew this decision and announced that it would rehear the case before a much larger panel of 13 judges, the plaintiffs in this lawsuit have not exactly hidden their desire to get this case before the conservative Roberts Court where four justices already voted once to repeal Obamacare. If the justices ultimately take this case, which is known as Halbig v. Burwell, and if one more of them agrees that Obamacare should be defunded, that could trigger a death spiral that could collapse the law’s health insurance marketplace in much of the country.
Five men in Washington could sentence Jenn to the same uncertainty she endured before the Affordable Care Act. They could potentially sentence her to die.
On January 1, 2014, Jennifer Causor woke for the first time knowing that, no matter what direction her health turned, she would at least live without fear that she would not be able to afford treatment. She shared that certainty with millions of Americans who once feared that each trip to the doctor would bring a choice between death and bankruptcy.
Eight days before next Christmas, a lawyer will walk into a courtroom, approach a podium, and stand before 13 judges of the United States Court of Appeals for the District of Columbia Circuit. He will then open his mouth, and in a calm, lawyerly manner, ask those judges to take from Jenn the certainty Obamacare has given her.
Freedom! And for that matter, the same thing applies to people who would have forgone the passage of health care reform until it was possible to pass the Single Payer and a Pony Act of 4545.