Might anti-Obamacare zealots live to regret throwing every tool they could think of at the ACA?

If the Supreme Court gives the wingnuts their way in the King v. Burell challenge to the ACA, it will mean a mess, yes, says James Surowiecki, but not the end of Obamacare.

"Obamacare’s opponents may win when the Supreme Court finally decides King, sometime next year. But it could turn out to be a fight they’d have been better off losing."

-- The New Yorker's James Surwiecki, in
"On Obamacare, the G.O.P. Lays a Trap for Itself"

by Ken

It's not as hard as you might think to be a jerkwad incompetent right-wing scumbag, because as you maraud your way through life, destroying everything you can get your grubby mitts on, you can always fall back on Rule No. 1 in the Jerkwad Incompetent Right-Wing Scumbag Handbook:

(1) It's always somebody else's fault.

Until it isn't. And even then, it still is.

It's only if you really, absolutely can't even pretend to find someone else you can point a finger at that you discreetly slip down to Rule No. 2 in the JIRWSH:

(2) Quick, ferchrissakes change the subject.

Could the jerkwad incompetent right-wing scumbags who've invested their entire beings in the proposition that Obamacare is the root of all evil be headed for a moment like this -- and of their own cock-brained doing?

New Yorker financial columnist James Surowiecki has taken an interesting look at the structural impact on the system of health-care law set up by the ACA in the event that the idiotic, hooligan challenge based on one tiny bit of sloppy text-drafting in the law gets the blessing, or rather curse, of right-wing thug-justices who are positioned to do, well, the sort of thing they do. The general assumption is that with the Supreme Court's recent announcement that it will hear the appeal in King v. Burwell, the right-wing thug contingent has not just the four votes needed to put a case on the docket but a likely and perhaps even in-the-bag fifth vote.

The problem, you'll recall, and I really hate to have to go into this again, is in a section of the ACA dealing with federal-government subsidies available to certain insurance buyers. The challenge is based on a misreading of admittedly careless language, by which "the State," clearly meant to refer to the government, is taken to mean any one of the 50 states. Never mind that the sentence in question, and the section in which it appears, can't be made to make any sense if read this way, or that it's clearly contradicted by everything else in the law, not to mention everyone involved in the frame and passing of the law. And never mind that there's an entire body of court precedent (yes, including the Supreme Court's) governing ambiguous legislative language, all of which leads to the obvious conclusion.

Never mind all of that, if you can twist this passage into meaning what it cannot possibly have been meant to mean, then you can twist your way to the conclusion that the indicated federal-government subsidies are available only to purchasers in states that have set up their own insurance exchanges, in accordance with the framework intended by the law. In states that have only the federal exchnges set up to provide coverage to people who live in states whose governments are controlled by jerkwad incompetent right-wing scumbags would, if you accept this idiotic misreading, purchasers would be ineligible for subsidies.

Again, this is a misreading that is impossible for anyone who is (a) reading in good faith, and (b) reading at or above, say, a fourth-grade reading level. Alas, the elite group that satisfies both conditions does not necessarily include a majority of the current U.S. Supreme Court.

As James S says in "On Obamacare, the G.O.P. Lays a Trap for Itself":

Republican politicians are, as of now, gleeful at the prospect of the Court delivering a blow to Obamacare. But, once the economic and political consequences of those disappearing subsidies kick in, Republicans could well end up wishing King v. Burwell had never seen the light of day.

Say what?

Let's back up a step. In a general way I think we all understand that a Supreme Court ruling for the mischief-making plaintiffs in King v. Burwell would be a devastating blow to the system set up by the ACA to bring as many people as possible into the insurance system, including especially the previously uninsured younger, healthier individuals, so that the whole shebang is workable from an actuarial standpoint, the way any system of insurance has to be. In order to pay out claims, enough people have to be paying in. Insurance 101.

But as James points out, one thing is emphatically not true even if the jerkwad incompetent right-wing scumbags actually pull off this judicial coup. This would not means the end of Obamacare -- or the scuttling of it, as James puts it. All the rest of the mammoth law would remain the governing law on health insurance in the U.S. As James puts it:

Even if the Court finds for the plaintiffs, the rules and regulations that Obamacare put in place will remain intact—insurance companies will still have to accept all applicants, without regard for preëxisting conditions, and they’ll still be prohibited from charging people with those conditions higher prices. And the tax increases that fund the subsidies and the cost-saving initiatives in the law won’t go away, either

SO WHAT WOULD IT MEAN?

"What a victory for the plaintiffs in King would do," says James, "is create two classes of citizens when it comes to Obamacare." Let's take this very slowly and methodically.

(1) First, James says, there are "people who live in one of the fourteen states that have set up their own exchanges, like California and New York." For them,

things will remain as they are now. Residents of those states will continue to be eligible for those federal health-insurance subsidies, depending on their income, which means, for most of them, that insurance will be quite affordable. And, because the subsidies make insurance so affordable, lots of healthy people (meaning mainly young people) in these states will continue to buy insurance, with the result that the risk pools in these states will be more balanced and not overloaded with people who are older or who are sick. That will help to hold down price increases in those states in the years ahead.

(2) "By contrast," James says, "life is going to get much harder for people who live in states that have not yet set up their own exchanges."

They’ll no longer be eligible for the subsidies, which means that many of them will have to pay hundreds of dollars more a month if they want to stay insured. Many of them won’t be able to afford that, which means they’ll return to being uninsured.

"And the problems won’t end there," he says.

Plenty of healthy, young people will decide to go without insurance, gambling that they won’t get sick. As a result, the risk pools in these states will be dominated by sick people (who will try, at all costs, to remain insured). Insurance companies will respond by raising the price of insurance to try to cover their costs, and that will drive more healthy people out of the market, leading to more price hikes, and so on.

"What these states may end up facing, in other words, is the insurance "death spiral" that the individual mandate and the subsidies were designed to avert.
Oops!


IN CASE YOU'RE NOT GETTING IT --

You're in good company. The Obamacare demonizers don't seem to be getting it either. As James says, "At first glance, this might all sound good from a Republican perspective."

After all, if Obamacare is an unacceptable imposition on individual freedom and an unworkable intrusion into health care, anything that makes it less effective would seem to be welcome.

This isn't where the story ends, though.

[T]he disappearance of subsidies is going to put governors and legislatures in states that haven’t established their own exchanges (nearly every red state) in a very difficult position. After all, their refusal—mostly politically motivated—to establish those exchanges will be the reason that their citizens lose subsidies, even as people in states like California and New York are reaping all the benefits of the law. The state legislatures will also, in effect, be responsible for insurance suddenly becoming far more expensive for millions of people. Finally, the politicians will also be putting a severe dent in the bottom line of insurance companies in their state, since the absence of subsidies guarantees that insurance companies are going to lose the customers they want (healthy people with low health-care costs) and get stuck with those they don’t (sick people whose health-care costs are sure to dwarf their premium payments).

Even if you're a jerkwad incompetent right-wing scumbag, you may begin to grasp that this could be not-so-good. Because in all likelihood you're also a self-serving opportunist. So let's go on.

The Republican hatred of Obamacare is so powerful, and Republican politicians’ fear of being challenged from the right is so strong, that there will undoubtedly be states where governors and legislatures hold firm and basically tell citizens that they can’t have, and shouldn’t want, the free money that the federal government is offering them. (Something like this already happened, after all, when some states opted out of Obamacare’s expansion of Medicaid, even though the federal government was going to pay almost all the costs.)  But, given that this will wreck the individual market for health insurance in these states, that it will (unlike Medicaid) affect plenty of middle-class voters, and that Democrats will be able to point to states where the subsidies are still intact as obvious success stories, staying true to conservative principles is going to be a very hard political sell—even in truly red states.

AND THE MORAL OF THE STORY IS:

Republican politicians have been able to reap the political rewards of inveighing against Obamacare without actually having to strip benefits from anyone. Now they’re going to have to put up or shut up. Obamacare’s opponents may win when the Supreme Court finally decides King, sometime next year. But it could turn out to be a fight they’d have been better off losing.

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