“Last week, the House of Representatives voted to authorize Speaker John Boehner to file a lawsuit challenging President Obama’s failure to fully implement Obamacare. Specifically, the lawsuit will challenge the administration’s delay of the employer mandate—requiring many employers to provide health insurance or pay a fine—that was supposed to go into effect Jan. 1. It’s clear President Obama repeatedly has abused executive power to circumvent Congress and essentially rewrite the law, but this lawsuit still raises a host of questions.”
“Most voters agree with Republicans in Congress that the president does not have the right to change laws without Congress’ approval, but they doubt a House lawsuit will stop him from acting on his own.
The House voted last week to sue President Obama for exceeding his constitutional authority by making changes in the new national health care law after it had been passed by Congress. A new Rasmussen Reports national telephone survey finds that only 22% of Likely U.S. Voters believe the president should be able to change a law passed by Congress if he thinks the change will make the law work better.
Sixty-three percent (63%) think any changes in a law should be approved first by Congress. Fifteen percent (15%) are not sure. (To see survey question wording, click here.)
Forty-five percent (45%) favor the House’s decision to sue the president to stop some of his executive actions on the grounds that they exceed the powers given him by the Constitution. But just as many (44%) oppose the lawsuit. Eleven percent (11%) are undecided.
However, only 30% think it is at least somewhat likely that the lawsuit, even if it is successful, will stop the president from taking executive actions on initiatives he has proposed that Congress refuses to go along with. Fifty-six percent (56%) consider this unlikely. This includes 11% who say the lawsuit is Very Likely to stop the president from acting alone and 21% who say it is Not At All Likely to work.”
“Six months ago, a House Republican campaign official listed the top three issues that would propel the party’s candidates to victory in the midterm election: “Obamacare, Obamacare, Obamacare.”.
It was a strategy that worked well in 2010, when GOP electoral gains were fueled primarily by a high-profile campaign to repeal the newly passed Affordable Care Act.
But now, months removed from the political storm that resulted from the botched rollout of the law and as more Americans begin receiving healthcare under the program, many Republicans have a more nuanced view of its importance.
House Republicans are broadening their once-singular focus on the healthcare law and headed into an extended summer break without delivering on their promise to advance an alternative.”
“Court decisions can have huge policy implications. Because judges are not policy experts, statistical modelers or economists, and because these are inexact sciences anyway, the policy implications of judicial rulings may not be fully appreciated when they are made.
A good example is the 2012 U.S. Supreme Court ruling that made Medicaid expansion optional for states. It’s hard to imagine that the justices had any idea that their decision would leave 4.8 million low-income people in a coverage gap without insurance in states that chose not to expand, or that 10 million slightly higher-income people would get tax credits to help them buy coverage in those same states. (Not that those things may, or should have, changed the justices’ conclusion.)
Now let’s consider Halbig v. Burwell, a case in which recent appeals court rulings made headlines. Halbig, which raises questions about whether the U.S. government can provide tax credits to people in federal- as well as state-run insurance exchanges, is still churning through the courts.
What if the plaintiffs prevail in Halbig, denying tax credits to moderate-income people in states with federal health insurance exchanges? The map below shows the potential combined effect of the 2012 Supreme Court decision and a plaintiffs’ victory in Halbig. (To be clear, the courts are not considering the earlier Medicaid ruling as part of Halbig, but the combined effect would be real.)”
“The recent decision of a three-judge panel in the Halbig case, if it prevails, would have a direct effect on the availability of subsidies under the Affordable Care Act (ACA). People buying coverage on their own in insurance exchanges run by the federal government would be ineligible for income-based subsidies. Depending on how you count, that would take premium subsidies away from 4.6 million people in 34 states, or 4.7 million people in 36 states if you count New Mexico and Idaho (which have signaled their intention to operate their own exchanges but are still using the federal marketplace).
Many more people are eligible for subsidies but haven’t yet signed up. We estimate (using the approach described here that a total of 9.5 million uninsured people are eligible for subsidies in federal marketplace states (or, 9.7 million people if you include New Mexico and Idaho).
Since many low and moderate income people would have difficulty affording insurance without the subsidies, this would no doubt alter the extent to which the ACA is reducing the number of Americans who are uninsured, which recent surveys peg at about 8 to 10 million.
But, there would also be two important side effects of the Halbig case.”
“When Sen. Mark R. Warner faces his Republican challenger Ed Gillespie in their first debate today at The Greenbrier resort in West Virginia, the two are likely to clash over the Democrat’s support for the Affordable Care Act, which Gillespie wants to see repealed.
But seven months after entering the race, seven weeks after his nomination as the GOP candidate and three months before the November election, Gillespie, who has repeatedly attacked his opponent for “casting the deciding vote” for the health care law, has yet to roll out his own ideas for policies that would replace the measure.
“I do believe there are reforms that would be helpful,” the former GOP strategist and chairman of the Republican National Committee said in an interview last month. “(But) I haven’t finalized or settled on these in terms of the policy moving forward.””
“The decision in the Halbig v. Burwell case this week was an unexpected legal boon to opponents of Obamacare. Spearheaded by the Cato Institute’s Michael Cannon and law professor Jonathan Adler, the case will almost certainly lead this debate about the text of the Affordable Care Act back to the Supreme Court. My colleague Sean Davis has written a comprehensive piece on the case, particularly on the nature of the supposed “drafting error” at its core.
But whatever the ultimate outcome for Halbig, the case serves as a reminder of the uneven ground on which Obama’s health care law is likely to be standing over the next two years. Whether facing challenges in the courts, or in implementation, as we saw in the GAO’s security report this week, or simply as a matter of political approval, Obamacare is going to be a subject of uncertainty in 2016, and its survival will depend on who wins the election, as I wrote here last month.
This raises an interesting question about how the presidential candidates will interact with the law. The law’s continued instability and problems will have to be answered – but the odd circumstance likely to result from the political frame of the issue is that Republicans will put forward a plan to replace Obamacare, but Democrats won’t.
One of the lazier memes of Democratic politicians and a few too many members of the media over the past several years has been the myth that Republicans have no alternative to Obamacare. This is the sort of thing that doesn’t pass even the most basic assessment of accuracy in reporting – here is a list of the health care reforms introduced by Republican House members in 2012, and here’s one for 2013. While their plans vary in scope, there are eight things Republicans generally agree about when it comes to health care reform:
•They want to end the tax bias in favor of employer-sponsored health insurance to create full portability, either through a tax credit, deductibility, or another method;
•They want to incentivize the reform of medical malpractice laws, likely through carrot incentives to the states;
•They want to allow for insurance purchases across state lines;
•They want to support state-level pre-existing condition pools;
•They want to fully block grant Medicaid;
•They want to shift Medicare to premium support;
•They want to speed up the FDA device and drug approval process; and
•They want to maximize the consumer driven health insurance model, making high deductible + health savings account plans larger and more attractive.”
“A lot of attention is being paid to the dueling decisions in two U.S. appeals courts about whether the U.S. government can provide tax credits to people in federal- as well as state-run insurance exchanges. In human terms, the stakes are high: Millions of moderate-income people will not be able to afford health coverage without a subsidy, and a court ruling could gut coverage expansion in the 36 states with federally run insurance exchanges, unless states decide to set up their own exchanges. One of the cases, Halbig v. Burwell, also adds uncertainty to the enrollment process set to begin this fall, when millions more people are expecting to get tax credits–and wondering if they may be taken away.
Amid the reaction, little attention has been paid to whether Americans will perceive Halbig as a legitimate legal question or as more inside-Washington politics. The plaintiffs paint this as a case about statutory language and intent. The health-care law said that tax credits would be provided only in state-run exchanges, they argue, and it is executive overreach to provide credits in federal exchanges. Proponents of the Affordable Care Act see this as a thinly veiled game of gotcha being played over imperfect legislative language despite clear legislative intent. They believe that providing tax credits in the exchanges was always a central element of the Affordable Care Act’s strategy to expand coverage whether in state or federal exchanges–and that everybody knows it.”
“This week, an unprecedented circuit split emerged in Halbig v. Burwell and King v. Burwell over whether health insurance premium assistance is available in states that didn’t set up health insurance exchanges. Many commentators have since claimed that there’s no way Congress intended to deny premium assistance to residents of the 36 so-called “refusenik” states that have not set up their own health insurance exchanges.
But in January 2012, Jonathan Gruber—an MIT economics professor whom the The New York Times has called “Mr. Mandate” for his pivotal role in helping the Obama administration and Congress draft the Affordable Care Act—told an audience at Noblis that:
What’s important to remember politically about this is if you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits—but your citizens still pay the taxes that support this bill. So you’re essentially saying [to] your citizens you’re going to pay all the taxes to help all the other states in the country. I hope that that’s a blatant enough political reality that states will get their act together and realize there are billions of dollars at stake here in setting up these exchanges. But, you know, once again the politics can get ugly around this.”
“Most working people in the U.S. sign up for health insurance in a very straightforward way: a few forms, a few questions for human resources, a few choices of plans.
Signing up for Affordable Care Act insurance was nothing like that. It involved questions about income, taxes, family size and immigration status. And in most places in the country, there were myriad choices of plans with subtle differences between them.
Guess what? People looked for help on the decision.
During the Affordable Care Act’s first open enrollment period, about 10.6 million people received personal help from navigators and other enrollment assisters, according to an online survey of the programs released Tuesday by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)
And the assistance was time consuming: 64 percent of the programs reported that they spent an hour to two hours with each consumer on average. The assisters and navigators included 28,000 full-time-equivalent workers across the country, funded by federal and state governments as well as outside sources, the survey found.”