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Mother Jones
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The Supreme Court will soon hear oral arguments in King v. Burwell, in which conservatives will argue that the text of Obamacare limits federal subsidies only to people who buy insurance from state-run exchanges, not from the federal exchange. Roughly speaking, there are two prongs of the conservative argument:
The argument over #1 revolves around textual interpretation of the statute as a whole, as well as previous Supreme Court precedent that provides federal agencies with broad latitude in how they implement regulations. The argument over #2 relies on trying to find evidence that limiting subsidies really was a topic of discussion at some point during the debate over the bill. That’s been tough: virtually no one who covered the debate (including me) remembers so much as a hint of anything like this popping up. The subsidies were always meant to be universal.
But the recollections of journalists aren’t really very germane to a Supreme Court case. The real-time analyses of the Congressional Budget Office, however, might be. This is an agency of Congress, after all, that responds to questions and requests from all members, both Democrats and Republicans. So did CBO ever model any of its cost or budget projections based on the idea that subsidies might not be available in certain states? Today Sarah Kliff points us to Theda Skocpol, who took a look at every single CBO analysis of Obamacare done in 2009 and early 2010. Here’s what she found:
CBO mostly dealt with overall budgetary issues of spending, costs, and deficits — or looked at the specific impact of health reform proposals on Medicare beneficiaries, health care providers, and citizens at various income levels. The record shows that no one from either party asked CBO to analyze or project subsidies available to people in some states but not others. In a June 2009 analysis of a draft proposal from Democrats in the Senate Health, Education, and Labor Committee, CBO treated subsidies as phased in. But even that proposal, which did not survive in further deliberations, stipulated that subsidies would be available in all states from 2014 — and CBO calculated costs accordingly.
After the Affordable Care Act became law in March 2010, members of Congress, especially Republican critics, continued to raise issues. In its responses, CBO continued to model exchange subsidies as available nationwide. No one in either party objected or asked for alternative estimations assuming partial subsidies at any point in the 111th Congress.
It’s unclear whether this is something the Supreme Court will find germane, but it’s certainly closer to being germane than the recollections of a bunch of reporters.
It’s also possible, of course, that the court will focus solely on argument #1 and never even get to questions about the intent of Congress. Nonetheless, this is an interesting review of the CBO record. The conservative case that Democrats actively intended subsidies to be limited to state exchanges has always been remarkably flimsy. Skocpol’s review exposes it as all but nonexistent.
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No, Congress Never Intended to Limit Obamacare Subsidies to State Exchanges
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Mother Jones
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Via the LA Times from a few months ago, here’s the rise in “personal belief” exemptions from state-mandated vaccinations among kindergartners in California:
And here’s where it’s happening:
In Los Angeles County, the rise in personal belief exemptions is most prominent in wealthy coastal and mountain communities, The Times analysis shows. The more than 150 schools with exemption rates of 8% or higher for at least one vaccine were located in census tracts where the incomes averaged $94,500 — nearly 60% higher than the county median.
….At Santa Cruz Montessori in the small coastal community of Aptos, about 7% of kindergartners in 2007 got belief exemptions. Last fall, that rate was 22.6%. Principal Kathy Rideout said the school has tried different approaches to encourage parents to immunize children. They asked a doctor to talk with fellow parents. They produced handouts emphasizing the importance of immunizations and asked parents seeking belief exemptions to get counseling from a healthcare practitioner. A state law that went into effect this year makes this a requirement. But none of it made much difference, Rideout said.
….“We have schools in California where the percent of children who exercise the personal belief exemption is well above 50%,” said Dr. Gil Chavez, deputy director of the California Department of Public Health’s Center for Infectious Diseases. “That’s going to be a challenge for any disease that is vaccine preventable.”
There are times when it’s appropriate to be skeptical of authority. This really isn’t one of them. “Big Vaccine” is not an issue in American life. Childhood vaccination is just a matter of public health that no one has any real motivation to lie about. Please don’t get sucked into this maelstrom. Get your kids vaccinated.
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By Sam Blisson 8 Jan 2015commentsShare
Well, shoot. Looks like the Department of Agriculture’s new Dietary Guidelines for Americans won’t mention anything about the environment, after all.
USDA nutritionist Eve Essery Stoody told Vice News that the federal food recommendations will be, as always, based on how diet affects human health, not the health of the planet.
In case you haven’t been following: The Dietary Guidelines Advisory Committee, the group charged with writing new eating instructions for the U.S. every five years, wanted to acknowledge that yes, food is produced on Earth and what we choose to eat plays a role in determining what food is produced and how. A few months back, Tufts University professor Miriam Nelson, a member of the committee, said to her colleagues, “In general, a dietary pattern that is higher in plant-based foods and lower in animal-based foods is more health-promoting and is associated with less environmental impact.” That language was included in the draft report that the DGAC voted to submit at its Dec. 15 meeting.
Predictably, Big Meat wasn’t cool with mixing advice on what’s good for eaters with facts about what’s good for ecosystems, since large quantities of animal products are unhealthy for both. So the meat industry’s lobbyists saw to it that congressmembers attached some directives to a spending bill imploring that the new guidelines make clear that food has nothing (nothing!) to do with that thing out there called the environment.
Earlier this week, though, it still seemed possible that the USDA might include some remarks on our food choices’ impact beyond personal nutrition. John Light, who wrote for Grist about how the new guidelines might tell Americans to eat less beef for the sake of the environment, points out that taking earthly issues into account would go against the corporate-influenced history of the federal guidelines:
The beef industry has long held sway over the guidelines the USDA puts out, with unfortunate results for the environment — University of Michigan researchers found last year that if all Americans followed the USDA dietary guidelines, we’d see a 12 percent increase in dietary-related greenhouse gas emissions.
Once again, the ag department appears to have caved under intense political pressure. Now no Americans will ever know that what’s salubrious for them is also generally unhealthy for the climate, since everyone gets all their dietary advice from the government food pyramid!
Maybe they’ll sneak some green talk in the guidelines next time around, in 2020. Unless by then our laboratory-made food really is effectively disconnected from the biosphere.
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Mother Jones
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Last year, as Obamacare finally went into full effect, the ranks of the uninsured began to drop sharply. Despite all the website problems and the repeated predictions of doom from conservatives, it turned out that Obamacare was working well. Then things stabilized as open enrollment ended. Today, Gallup released new results for the final quarter of 2014, which marked the start of Obamacare’s second year of enrollment, and guess what? The ranks of the uninsured are dropping yet again. The percentage of adults without health insurance dropped from 13.4 percent to 12.9 percent:
The Affordable Care Act has accomplished one of its goals: increasing the percentage of Americans who have health insurance coverage. The uninsured rate as measured by Gallup has dropped 4.2 points since the requirement to have health insurance or pay a fine went into effect. It will likely drop further as plans purchased during the current open enrollment period take effect. The Department of Health and Human Services reported that 6.5 million Americans either selected new plans or were automatically re-enrolled into a plan via HealthCare.gov as of Dec. 26, 2014.
….Other signs also point to the uninsured rate falling more after this open enrollment period ends. HHS continues to focus on the financial assistance available to enrollees and increasing the fine for not having health insurance….The uninsured rate could also fall further as more states expand Medicaid.
The uninsurance rate has dropped the most among blacks, Hispanics, the young, and the poor. It’s dropped by only a small amount among the middle classes, since they’re mostly insured already by their employers. But even right smack in the middle, uninsurance rates have dropped by three percentage points. Obamacare just keeps on working, and it’s working for everyone.
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Chart of the Day: Obamacare Just Keeps Working, and Working, and Working….
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Mother Jones
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Greg Sargent notes that the future of Obamacare is one of the big political unknowns of the new year:
One of the big, looming questions of 2015 is this: Will the Supreme Court really gut Obamacare subsidies in the three dozen states on the federal exchange, potentially depriving millions of health coverage at a moment when the law, now heading into its second year, is clearly working as intended?
One thing to watch as we approach the SCOTUS hearings on King v. Burwell this spring is how many people are newly qualifying for subsidies in those states as this year’s enrollment period continues….We could be looking at a lot of people who would lose subsidies in the event of a bad SCOTUS ruling, perhaps more overall than previous estimates of around four million. And the enrollment period still has six weeks to go.
I’ve guesstimated previously that around 6 million would be affected in 2016 if the Supreme Court kills subsidies on the federal exchange later this year. Charles Gaba figures it’s somewhere around 5-6 million this year. That’s a lot of people who would face one of two things: (a) an increase of maybe $2-5,000 in their health care premiums, or (b) an end to health care coverage completely because they flatly can’t afford the unsubsidized premiums.
Will this affect the court’s thinking? It’s hard to think of a comparable case where a ruling would have had such an immediate, devastating effect on millions of ordinary people. If anything, that gives me hope. Will John Roberts and Anthony Kennedy really be willing to inflict that kind of real-world pain, regardless of their ideological convictions? Maybe not. At least, I hope not, because I’ve basically given up on the idea that the Supreme Court is anything other than crudely results-oriented these days. Especially on the conservative side of the aisle, they simply don’t seem to care much about law or precedent or common sense anymore. They like what they like and they hate what they hate, and they shape their opinions to match.
Maybe that’s just the despair of a liberal who’s seen a lot of cases go against him over the past few years. Maybe. But I guess we’re going to find out later this year.
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Supreme Court Set to Devastate Millions of Lives Later This Year. But Will They Pull the Trigger?
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