FeaturedOn March 9, 2015, Illinois Senate President John Cullerton addressed the City Club of Chicago. His remarks concern the cuts proposed by Governor Bruce Rauner in his budget. The highlights of Cullerton’s speech are posted by the City Club of Chicago here.
By Mark Rosenberg, M.D.
Not content with serial votes to repeal the Affordable Care Act (ACA, aka Obamacare)—we count 67 votes to date—Republicans also have launched court cases intended to invalidate all or part of this landmark legislation. King v. Burwell, the latest of these legal assaults on Obamacare, is scheduled for oral argument in the U.S. Supreme Court on March 4.
One of the ACA’s primary tools for making healthcare affordable is to share the burden of premiums, and even deductibles and coinsurance, with income-qualified consumers. These advance premium tax credits are available to households earning up to four times the federally-defined poverty level, which comes to about $92,000 a year for a family of four.
The plaintiffs in King challenge the legality of the ACA’s premium tax credits and cost-sharing subsidies being made available to all income-qualified consumers who purchase health insurance through the Marketplace. They contend that the language in the statute makes these federal subsidies legally available only when a consumer literally purchases health insurance through a state-run exchange. They argue that, conversely, subsidies are unavailable to anyone living in a state that has opted to use the federal exchange rather than create its own.
According to rules of statutory interpretation, a law’s language should be read in the context of the legislation as a whole. The purpose of the ACA is to provide affordable health insurance to as many as possible, and the availability of subsidies furthers this goal. Reading the statute as extending subsidies to all income-qualified consumers, without regard to whether the exchange they go through happens to be operated by their state, is thus rational. Federal courts generally uphold the Executive Branch’s interpretation of a statute, as long as that reading is rational.
For this reason, every one of the United States Circuit Courts of Appeals that has considered lawsuits challenging the availability of federal subsidies for insurance purchased on exchanges not established by a state has ruled against the plaintiffs. Yet the Supreme Court has agreed to hear King v. Burwell. Based on voting in previous cases heard by the Supreme Court, including the 2012 decision upholding the constitutionality of the ACA, many assume that four justices will agree with the plaintiffs in King, leaving the decision primarily in the hands of Chief Justice Roberts. The question then becomes whether Roberts would concur in a legal analysis, rejected nearly unanimously by the lower federal courts, that deprives millions of people of affordable healthcare.
A Supreme Court decision invalidating federal subsidies for health insurance purchased on federally-run exchanges would deprive more than eight million people in some 34 states of the financial help they need in order to afford health insurance, unless their states create their own insurance exchanges. Ironically, some 80 percent of those eight million individuals who stand to lose health insurance are white working poor who live in the South, a region that votes reliably Republican in most elections. The ruling would not affect those earning less than 138 percent of the federally-defined poverty level as these people qualify for Medicaid, as long as they live in one of the 28 states or the District of Columbia that have accepted the federally-funded Medicaid expansion available under the ACA. (The Supreme Court’s 2012 decision held that the federal government could not mandate states’ participation in expanded Medicaid). A decision for the King v. Burwell plaintiffs also would have the consequence of increasing premiums for health insurance since the pool of insured individuals would be vastly decreased, thus increasing insurers’ risk per insured.
There is no question that a Supreme Court decision that would seriously undermine Obamacare and deprive millions of health insurance would be viewed widely as a partisan political act and not a legal pronouncement based on the merits of the case. But the Court may have an “out.” Recent reporting in The Wall Street Journal has questioned whether the King plaintiffs have the legal standing required to pursue the case. According to the Journal, it is possible that none of the named plaintiffs is subject to the ACA’s individual mandate that requires individuals to purchase health insurance. Two of the plaintiffs may be entitled to veterans’ healthcare; one, who may be homeless, may earn so little as to be exempt; and the fourth will become eligible for Medicare in June. This could give the Supreme Court a procedural basis for rejecting the lawsuit.
Tenth Dems March Newsletter
Please follow the link to view our March newsletter as a pdf file:
https://tenthdems.org/wp/wp-content/uploads/2015/02/201503NL.pdf
In this issue of Tenth News:
If Marriage Equality Can Happen In Alabama, the Writing Is Clearly On the Wall
by Steven Gan
Even the infamous Judge Roy Moore couldn’t stop same-sex marriage in Alabama.
A Morning at the Job Interview Workshop
by Dave DuBordieu
A personal account of a morning in the life of a volunteer facilitator at the Tenth Dems Community Connection monthly job interview/job retention workshop.
Tenth Dems Enjoys Political Satire by the Capitol Steps
by Mark Levy
Tenth Dems members have made it their annual comic duty to see the Capitol Steps perform cutting-edge political satire, and this year’s performance did not disappoint.
Stand United in the Pursuit of Peace
by Karim Pakravan
Negotiations with Iran to prevent its becoming a nuclear power stand at a crossroads, and the stakes could not be higher. The perspective of one Iranian-American living in the 10th Congressional District..
The Affordable Care Act Five Years After Enactment
by Mark Rosenberg, M.D.
This landmark legislation is now five years old, and the second open enrollment season has just closed, so now is a good time to take a look at just how well the law known as Obamacare has worked.
Medicaid Expansion In Illinois Should Be Praised
by Julie Hamos
The decision to expand Medicaid in Illinois in 2013 has made much-needed healthcare available to more than a half-million Illinoisans. The benefits far outweigh the modest costs to the state, as the federal government is responsible for 100 percent of those costs through 2016.
King v. Burwell: The Latest Legal Assault on the Affordable Care Act
by Mark Rosenberg, M.D.
The latest Republican effort to undo the Affordable Care Act is being played out in the Supreme Court. What are the issues the Court has to decide, and what would be the consequences if the challenge succeeded?
Tenth Dems Community Connection 5th Annual Poetry and Prose Contest and Awards Night
This highly anticipated annual event is now set for Tuesday evening, April 14. Save the date.
All You Need Is Love…and Tenth Dems
by Lisa Radin
Last fall’s elections may be over, but there’s much to be done as the next cycle gets underway. Beatles song titles proliferate in this description of what it means to be a part of Tenth Dems.
After Mark Kirk took heat for his inflammatory remarks that Republicans “should build a number of coffins outside each Democratic office”if there was a terror attack during a potential DHS shutdown and that “all the dead Americans from [an attack] should be laid at the feet of the Democratic caucus,” it seems he has changed his tune after seeing some brutal poll numbers.
A new poll yesterday showed that voters in Illinois and several other key Senate battleground states were inclined to vote against Kirk and others who are driving the government towards a potential DHS shutdown. 47% of Illinois voters said they’d be less likely to vote for Kirk for tying DHS funding to immigration policy.
After seeing the polling, Kirk now “generally agrees with the Democratic position.”
Is he serious?
“After despicably remarking just yesterday that Republicans should build fake coffins in the event of a terrorist attack to score political points, Mark Kirk is clearly floundering as he attempts to change his tune on a clean DHS funding bill,” said Sadie Weiner, National Press Secretary at the DSCC. “Apparently it takes a day of bad headlines and some brutal poll numbers to convince Mark Kirk to stop being irresponsible, but the fact remains that Kirk has been along for the ride as the GOP majority has plowed ahead with absolutely no plan to fund DHS. Illinois families deserve better than a Senator like Mark Kirk who callously lobs political attacks in the face of a DHS shutdown then changes his tune the moment he fears for his reelection.”
By Mark Rosenberg, M.D.
While most of us have resolved in the New Year to lose weight, exercise more, and promote peace on earth, the Republican majority in the 114th Congress has resolved to try to repeal the Affordable Care Act (ACA, or “Obamacare”) for the 50th time. Not terribly surprising or even very original. What is original is what Sen. John Barrasso (R-WY), Chair of the Senate Policy Committee, said on Meet the Press recently—that Republicans were trying to build consensus around one plan to replace Obamacare. After five years of attempts to repeal without offering a constructive replacement, the Republicans may actually come up with an alternative? Given the success of the ACA in lowering the rate of uninsured to under 13 percent (according to Gallup, a more than four percent drop since enactment) and thereby providing needed affordable health care to millions, I do not recommend you hold your breath waiting for an alternative that would actually pass Congress.
What the Republican Congress does plan to pass this session includes the following changes to the Affordable Care Act:
1. With the support of a number of Democrats, repeal the medical devices tax that is expected to generate about $30 billion over the next 10 years.
2. Revise the ACA’s definition of full-time employment from 30 hours per week to 40 hours per week. This measure already has passed the House.
3. Abolish the Independent Payment Advisory Board, whose mission is to recommend savings in Medicare without affecting coverage or quality of care. This is the entity that opponents of the ACA wrongly labeled a “death panel.” Note that the Board’s recommendations are already subject to Congress’ overruling them by a supermajority vote.
4. Abolish the Patient Centered Outcomes Effectiveness Institute, which examines disease treatment regimens for results and recommends effective treatments to medical providers.
Since President Obama holds a veto pen, the only way these proposals could become law is if enough Democrats vote with Republicans to override the veto. This appears highly unlikely, except perhaps in the case of repeal of the medical devices tax.
However, there are two other significant threats to the ongoing viability of the Affordable Care Act: the pending lawsuit, King v. Burwell [Secretary of Health and Human Services], and the number of states with Republican governors and Republican control of the legislature. Relying on some unartfully drafted legislative language, plaintiffs in the Burwell case contend that unless a state actually operates a Marketplace website of its own, the ACA doesn’t allow the federal government to provide financial assistance to citizens of that state who purchase health insurance on that exchange. If the Supreme Court upholds the plaintiffs’ case in court, low- and middle-income citizens of any state that opted to use the Federal exchange would lose the tax credits that lower their premiums, as well as any cost sharing that lowers their deductibles and out-of-pocket maximums. Bottom line: millions of citizens no longer would be able to afford health insurance.
The second threat relates to those earning less than 137 percent of the federally-defined poverty level. Under the Affordable Care Act, these people are newly eligible for Medicaid, a state-federal partnership program; however, in the very 2013 decision that found the ACA to be constitutional, the Supreme Court also said that the federal government could not force a state to offer Medicaid to the newly-eligible poor, even if there was no cost to the state. After the states that had chosen to adopt this federally-funded Medicaid expansion last year showed such good results in lowering the number of uninsured, more states had been expected to opt into this federally-financed Medicaid expansion, but the election of more Republican governors and Republican legislatures may reduce the number of states willing to allow low-income families to obtain health care through Medicaid.
From all reports, as was the case last year, ACA enrollments this year will exceed expectations. Yet it appears that 2015 could be a crucial year for the continued success of this landmark legislation. Watch this space as Congress, the Supreme Court, and the states act.
