And here to stay.

Yesterday, in a 7-2 opinion, the U.S. Supreme Court upheld the Affordable Care Act.

…For these reasons, we conclude that the plaintiffs in this suit failed to show a concrete, particularized injury fairly traceable to the defendants’ conduct in enforcing the specific statutory provision they attack as unconstitutional. They have failed to show that they have standing to attack as unconstitutional the Act’s minimum essential coverage provision. Therefore, we reverse the Fifth Circuit’s judgment in respect to standing, vacate the judgment, and remand the case with instructions to dismiss.

It is so ordered.

Missouri Attorney General Eric Schmitt (r) whiffs yet again.

From the White House:

FOR IMMEDIATE RELEASE
June 17, 2021

Statement by President Joe Biden on the U.S. Supreme Court Decision Upholding the Affordable Care Act

The Affordable Care Act remains the law of the land.

Today’s U.S. Supreme Court decision is a major victory for all Americans benefitting from this groundbreaking and life-changing law. It is a victory for more than 130 million Americans with pre-existing conditions and millions more who were in immediate danger of losing their health care in the midst of a once-in-a-century pandemic.

It is a victory for every American who, prior to the Affordable Care Act, stayed up at night staring at the ceiling, wondering whether they would lose everything if they or a loved one got sick. Because of this law, they don’t have to worry about being denied coverage due to a pre-existing condition like diabetes or watching their coverage being capped during a cancer treatment. Because of the law, they are able to get free preventive screenings that can save their lives and improve their health. Today’s victory is also for all the young people who can stay on their parents’ insurance plan until they turn 26 years old, and for the millions of low-income families and people with disabilities receiving health care because their states expanded Medicaid under this law.

After more than a decade of attacks on the Affordable Care Act through the Congress and the courts, today’s decision – the third major challenge to the law that the U.S. Supreme Court has rejected – it is time move forward and keep building on this landmark law.

That is what we are doing thanks to the American Rescue Plan, which has lowered health care costs and expanded coverage for millions of Americans through the Affordable Care Act. More than 1.2 million Americans signed up for coverage under the law through a special enrollment period I established during this pandemic, which people can still sign up for through August 15th. And I look forward to working with the Congress to build on this law so that the American people will continue to have access to quality and affordable health care.

Today’s decision affirms that the Affordable Care Act is stronger than ever, delivers for the American people, and gets us closer to fulfilling our moral obligation to ensure that, here in America, health care is a right and not a privilege.

###

A big @&%#ing deal.

Joe Biden (D) [2014 file photo].

So how do we know that Obamacare is a success? There’s all the standard measures: enrollment numbers, decreases in uninsured, stable or dropping medical costs, deficit savings, etc. – which are all looking great, by the way. And then there’s Kit Bond’s recent Op-Ed in the St. Louis Post-Dispatch.

An editorial note at the end of the post, notes that Bond’s lobbying firm has taken on the thankless task of promoting the Obamacare Medicare expansion – an expansion that the obdurate, anti-Obama, ideologically-blindered State Legislature just won’t countenance (if you listen carefully you just might hear the sound of tiny stamping feet and spluttering screams of “no, no, we won’t, you can’t make us” echoing off in the distance). The Op-Ed reveals Bond’s strategy for dealing with the ferocious anti-Obama-on-funny-but-misguided-principle crowd in and out of the legislature: pretend that Medicaid expansion has nothing to do with the loathsome program.

The first thing you will note about the Op-Ed is it’s evasiveness. It only mentions the Medicaid expansion once, near the end of the piece, and only equates it with the Obamacare legislation obliquely. Instead, Bond, cleverly cries a few tears over the problem of hospital closings in Missouri, problems he attributes mostly to “Obamacare-mandated cuts in funds hospitals receive for uncompensated care – the care hospitals are required by law to provide regardless of folks’ ability to pay.”

Since Bond knows his audience very well, he fails to point out that these hospital closings could far more honestly be attributed to the failure of the legislature to accept the Medicaid expansion funds offered through Obamacare, funds for care which was intended to take the place of the emergency room as the main mechanism for care of the uninsured and so offset the loss of federal emergency care dollars – and emergency room care is, incidentally, a far more costly and inefficient way of dealing with the uninsured than granting insurance through Medicaid. Aren’t Republicans supposed to be the financially responsible ones?

Instead Bond argues that the answer to the loss of these funds is to enable hospital mergers as a way to keep the hospitals pinched by the loss of emergency room funds functioning in underserved communities. And then he decries the fact that the Federal Trade Commisison (FTC) review process, which has the power to okay or deep-six a proposed merger, is, guess what, thorough. Or, the short version, the FTC does what it’s supposed to do and Bond knows that that gets his intended audience hot under the collar because, you know, big government:

Despite helping to create the problem for hospitals with expensive new mandates and cuts to reimbursements, the federal government is now making it difficult for these hospitals to deploy this private-sector solution. Currently, the Federal Trade Commission is moving painfully slow to evaluate any proposed merger or system expansion. Reviewing applications through the narrow lens of a century-old anti-trust law, the FTC is taking months or even years of bureaucratic analysis to approve these hospital partnerships – often too late for a community on the brink of losing its only hospital and largest employer.

Despite Bond’s anti-Obamacare, anti-FTC song-and-dance, Obamacare has actually been fueling hospital consolidation. But, Bond’s encomium to the merged entity that became  BJC HealthCare in the St. Louis area offers only one view of the possible outcomes of such mergers. Ill-considered consolidations have the potential to raise consumer prices, create physical access problems, as well as barriers to access to reproductive health services. As an article in Becker’s Hospital Review points out, there are a number of factors that determine whether a merger will be benign or harmful. Hence the FTC review process. It’s there to protects us, the consumers of health services – something Republicans don’t seem to understand or care about.

But of course, this whole, lengthy argument is not the real point of Bond’s Op-Ed, and is stealthily followed by this little tidbit:

Inaction by legislators in Jefferson City is also putting our health care safety net in Missouri at risk. State Sen. Ryan Silvey, R-Kansas City, has proposed a solution to reform our state’s Medicaid program that would increase access to care for hardworking Missourians, protect our health care safety net in rural and urban communities, and safeguard the state’s budget.

Unfortunately, anger over Obamacare has confused the issue, and right now, legislators are refusing to consider this common-sense solution … .

Senator Silvey’s proposal? Simply a way to try to make Obamacare Medicaid expansion somewhat palatable to the GOP heads-up-their-backsides contingent of the state lege. Such expansion, all by itself, could take care of the squeeze that the loss of federal emergency room dollars creates for hospitals. But – and here’s the magic of Bond’s rhetoric – in this article, it’s been aligned with “common-sense,” GOP-acceptable solutions to healthcare problems that Bond alleges to have been caused by that big winger bogey, big government, including – wait for it – Obamacare itself. One could read this article and leave persuaded that Silvey’s proposals have nothing to do with Obamacare and are only exciting opposition because the tentacles of evil Obamacare have confused the thinking of the poor souls in the Missouri capital.

Wow! Talk about tangled logic. Kit Bond, I salute you.

What this tells us is that conservatives who are capable of distinguishing their front from their backsides, know that Obamacare is a success and that now is the time to get Missouri in on it and let Missourians share that success. The deviousness of this piece of casuistry also reaffirms that reasonable conservatives also understand the real reason that Missourians don’t have this benefit – unbalanced, hysterical hatred of Barack Obama on the part of GOPers who can’t accept the failure of the dream of the conservative Reich that took root during the Bush years, and on the part of constituents who either fear and hate the black man in the white house, mostly because of that black-white dichotomy, or who credulously swallow all the nonsense their Foxified leaders have been spewing in their war against the godless, socialist Kenyan and his Nazi hordes.

And the funny thing? Politicians like Bond were more than willing to fan this hysterical fervor; they thought it was their ticket back into power. Now they have to serve it – or, as Bond is trying to do in his Op-Ed, trick the true believers and give GOPers in the lege a way to save face. Because Obamacare is a success and now we know they know it too – they just can’t say it out loud.

It looks like one more year will come and go with no Obamacare Medicaid expansion. Why won’t the Republican fools in Jefferson City do what’s right when it comes to Medicaid? Temper tantrums because the GOP doesn’t like the scary black man in the white house and want to scuttle his legacy? Sure. Pandering to special interests who don’t want to pay their fair share? Of course. Efforts to insure failure of government run social programs that would otherwise deflect power from the GOP? That too. And there’s certainly plenty of delusional thinking, not to mention the ugly, retrograde political ideologies that have resurfaced in recent years.

Martin Longman speculates that the tantrum over Obamacare has extended so long and has been played out so passionately and so irrationally that there’s no way now for the committed GOP to retreat:

What’s interesting is that the Republicans’ are so dependent on ObamaCare being unpopular that they have to try to convince people it is failing even though it certainly is not. It’s not enough to point at polls about the law because those polls will change over time. They have to try to keep the polls low any way they can. One way to do that is to keep the myth alive among their base. Another way is to misinform as many people outside their circle as possible. Finally, they can work the refs in the media to the best of their ability, but that isn’t going to work anymore for media that aren’t formally or informally working for the Republican Party.

All undoubtedly true. But what this GOP miscalculation means in practical terms for Missouri is that no matter how empty their opposition is shown to be, the hardcore deadenders that populate many of the GOP seats in the Jefferson City will fight until their last breath against Obamacare, so, since Medicaid expansion under the program would be a big win, it can’t be allowed.  

This irrational animus is the sole reason why state Senator John Lamping (R-19), when confronted with efforts from those in his own party to find a way to take a good deal without losing face, insisted no way, “this is done. It’s not happening. Go find something else to do.” It’s why state Senator Kurt Schaefer (R-19) thinks an opportunity to do something to help his constituents is a “problem,” whining about “why is this somehow now our problem, and our immediate problem that has to be solved by us before the end of the session, when we didn’t create this problem?” It’s kind of like  having a meltdown when you win the lottery because you’re too stupid to figure out how to claim the prize.

But reality’s a bitch and, as they say, what goes round comes round, so sooner or later reality will catch up with the particular butt-end of the GOP that is now running the Republican show. Small solace though, since meanwhile, Missouri, currently ranked 39th in the nation for health outcomes, will continue to hover around the bottom, and, what’s even worse, people will actually, needlessly, die just so a few Republican diehards can save face and can continue to insist for a few more years that Obamacare really is a harbringer of Armageddon.  

If Bob Yates hasn’t already most adequately and quite succinctly ridiculed Republican Senator Roy Blunt’s effort to avoid the obviously dishonest position of the Ann Wagners in the GOP, who want to assure the gullible masses that, yes, indeed, the most recent CBO report said that 2.5 million people would lose their jobs, Duane Graham at The Erstwhile Conservative has put finis to the task with a full and detailed takedown of the Fox News Sunday interview with Blunt. Graham and Yates both record the shift in Republican rhetoric from a false story about lost jobs to an ugly story about enabling “moochers” who, Blunt and his fellows imply, just don’t want to work. As Graham puts it:

… notice how Blunt, like all Republicans are now doing and will continue to do until election day this November, focuses on those alleged “2.3 million” people who “don’t want to work” or “don’t have to work.” That is essentially the argument that was made more generally during the 2012 election.

Read both pieces. Roy Blunt deserves everything that Yates and Gaham have to say about his despicable performance.

And when you’re done, read a couple of posts from Paul Krugman’s NYT blog to get a better idea about what is fueling Blunt’s nasty little insinuations and why they’re so bogus. According to Krugman, those who leave the labor force will reduce labor input and decrease GDP somewhat, but the fact that wages and benefits are not being paid to those leaving the labor force would perfectly balance the decrease, rendering the effect neutral, were it not that those individuals would also no longer pay the taxes that correspond to their lost labor. He concludes:

So yes, reduced labor supply adds modestly to the true cost of health reform, although it also adds to the benefits. But the key word is “modestly”.

Why, then, are the usual suspects so incensed? Partly because they don’t understand any of this. Beyond that, there’s a moralistic streak: people should be forced to work, for their own good, you see (are there no poorhouses?). And of course, there’s the underlying rage that a disproportionate share of the beneficiaries (though by no means a preponderance) will be Those People.

But when you take paternalism and prejudice out of the picture, what you’re left with is some pretty prosaic economics. Should you care how much other people work? Yes, a little – but not so much that it should change anyone’s views about health reform.

As to whether or not this shift in Republian rhetoric will have the desired effect, Krugman’s analysis of the initial strategic misfire suggests why it will not – at least, with anybody other than the true believers:

The thing is, my read […] is that the CBO affair actually ended up hurting Republicans. By the end of the week a barrage of press reports, plus those mighty figures Jon Stewart and Stephen Colbert, had effectively changed the story from “CBO predicts massive job losses” to “Republicans lie about CBO report.” In reality, it’s unlikely that it would have mattered at all even if the first story had stuck. But to the extent that such things matter at all, Republicans ended up losing the week.

It’s hard not to conclude that since everyone who’s paying the slightest attention knows that Republicans have been lying vigorously about the whole CBO business, why should they believe anything that mouthpieces like Blunt now have to say, no matter how much more subtle the latest story happens to be? What is even more interesting, though, is the fact that this exact type of talk, the 47% business, is what helped do Romney in back in 2012. Why does Blunt & Co. think it’ll be more successful now?  

Rep. Ann Wagner’s (R-2) is hopping mad – or, more likely, hopping around, trying to get off the liar’s hot seat (remember the refrain “liar, liar, pants on fire”?). What’s got her hopping? A recent editorial in the St. Louis Post Dispatch that had the temerity to suggest that the deficit was falling, the economic outlook is improving and that the findings of a Congressional Budget Office (CBO) report on Obamacare economic impacts have been grossly misinterpreted by folks like Wagner. So what does she do to relieve the gut-churning evidently induced by the good news? Why, write a letter to the editor, of course, insisting that they take it all back – a letter which she then proudly forwarded to her lucky constituents, a move meant, undoubtedly, to let the Tea Party types among them know what a big, fearsome Obama-hater she really is.

Rep. Wagner attributes her motivation for writing to her tender concern for constituents who, according to her claims, have been telling her about all the ways their lives  have been ruined by Obama administration policies, especially Obamacare:

Every day I hear from hardworking families in the 2nd District who are struggling to make it to the 15th and the 30th of every month in this tough economy. These are real people struggling under the weight of President Obama’s failed agenda.

Wagner added a few details in the constituent email:

Every day I hear from far too many hardworking families in the 2nd District who have seen their premiums skyrocket, their health insurance cancelled, who have been forced to change their doctors, and have seen their hours cut back at work.

I haven’t followed every pronouncement from Rep. Wagner on the topic of Obamacare, but when she starts moaning and groaning about her constituents’ Obamacare-related suffering, concrete details are few and far between. Which is probably intentional given that similar “true” stories promulgated by Wagner’s GOP colleagues have not been able to withstand close scrutiny. Remember, for instance, the subsequently debunked Bette story in Cathy McMorris Rogers response to the SOTU? Of course, it’s also likely that the complaints that she has received in response to her solicitations for Obamacare hardship stories reflect a partisan bias that skews perceptions. A Gallup poll released last week showed that only 19% of Americans said that they had been hurt by Obamcare and, of that 19%, 60% were Republican or Republican-leaning.  Which, in turn suggests that what Steve Benen identifies as political “tribalism” leads people to respond to polls – and requests from politicians for political ammo – in the way they think they should.

The real point is not that Missourians are suffering due to Obamacare, but that Rep. Wagner has invested lots of capital in questionable rhetoric and she’s up in arms  when folks like the Post-Dispatch editorial staff who, after looking carefully at the recent CBO report, point out that she and her GOP cohorts have distorted its contents. Her claims are simple:

The numbers in the CBO report couldn’t be clearer: Due to Obamacare, the equivalent of 2.5 million people will leave the workforce over the next 10 years, and government-run health care will add another trillion dollars to our national debt.

This is where the burning pants really ignite. Wagner is willfully wrong on both counts.

The CBO report does not say that jobs will be lost, just that some people will voluntarily leave the labor force or reduce their hours of work because they don’t need to keep working in order to secure affordable health insurance. Hours will not be reduced by employers, but by employees. In fact, as the Washington Post points out, “the CBO declares that ‘there is no compelling evidence that part-time employment has increased as a result of the ACA,'” thus  decimating one of Wagner’s talking points about employers cutting employee hours to escape paying for health insurance. There’s lots to be said on this topic, and I think most of it got said last week – and none of it supports Rep. Wagner’s hyperbolic assertions, including a statement from the author of the report she considers so clearly negative, CBO director Doug Elmendorf. In fact, as Elmendorf pointed out, the report indicated that Obamacare would have a positive employment effect:

Elmendorf also noted that the ACA is actually expected to boost the economy in the near-term by making health insurance and medical care affordable for the poorest Americans, giving them the freedom to spend money in other areas of the economy. “On balance, CBO estimates that the ACA will boost overall demand for goods and services over the next few years,” states the report.

As for the business about increasing the deficit:

…the CBO reduced its estimate of the net cost of the ACA by $9 billion through 2024, in part because of the number of states that have refused to implement the law’s Medicaid expansions. And the CBO still maintains that, over the 10-year window of its analysis, the ACA will reduce the federal deficit. In fact, that trend is expected to increase in subsequent years, with the ACA leading to greater deficit reduction.

So what should we think about Rep. Wagner’s whining ways? Paul Krugman’s summary of GOP duplicity could have been tailor-made to her measure:

… .Remember, the campaign against health reform has, at every stage, grabbed hold of any and every argument it could find against insuring the uninsured, with truth and logic never entering into the matter. Think about it. We had the nonexistent death panels. We had false claims that the Affordable Care Act will cause the deficit to balloon. We had supposed horror stories about ordinary Americans facing huge rate increases, stories that collapsed under scrutiny. And now we have a fairly innocuous technical estimate misrepresented as a tale of massive economic damage.

To conclude, sorry Rep. Wagner, but Obamacare is beginning to work out, the economy is getting better despite harmful GOP budget cutting, and lots of things are really getting better for lots and lots of Americans – despite the best GOP efforts to hide the truth.

Today TPM reports that former Florida govenor Charlie Crist, who is running against Medicare-fraud perpetrator Governor Rick Scott to regain the governorship of that state, spoke some home truths to MSNBC’s Chuck Todd about the consequences of failing to take advantage of Obamacare’s Medicaid expansion provisions:

About a million of my fellow Floridians are not getting health care today, and I am told by friends SEIU (sic), that means six people in Florida die every day as a result of that. Every day,” Crist said.

[…]

It’s not hard to figure that out. It’s common sense. Look at it. If people are sick, and they aren’t getting health care, what happens? They usually get sicker,” Crist said. “Or they die. I mean, those are just the facts, Chuck. That’s what happens. In addition to it, it’s economically stupid. As a result, we’re not getting $51 billion over the next 10 years for the health care institutions in Florida. So the people get better health care, so that kids don’t get sick, that we take care of people. That’s what public servants are supposed to do. That’s why I’m running against Rick Scott, because he’s not a good servant.”

The claim that six people will die daily if Medicaid is not expanded likely comes, as TPM noted, from a joint Harvard University and  City University of New York report published last month. You can quibble about the actual number – it’s an estimate after all – but the point is that people will die while ideologues posture and babble incoherently about “government dependency” and the “unsustainable costs” involved in directing federal tax dollars back to the home state.

What does this factoid mean for Missouri? Approximately 2190 yearly deaths that could have been prevented.

But we can take it farther. Most Republicans oppose expanding Medicaid and most Democrats support it. In the Missouri Senate, 24 members are Republicans; in the House, 106 representatives are Republicans, making a total of 130 Republicans running things in Jefferson City. We can do some rough math and conclude that if Medicaid is not expanded, each Republican in the legislature will be responsible for the death of 16.8 Missourians per year, give or take a few.

A crude, tongue-in-cheek exercise perhaps? But no matter, it’s a sure bet that there will be deaths as a result of the action – or rather inaction – of Missouri Republicans. And no matter how you count our dead fellow Missourians, they’ll amount to quite rack of trophies for each Missouri GOPer.

First sentence amended for clarity and a link was added.

By now you’ve probably read lots about State Rep. John Lamping’s (R-24) lame attempt to launch the latest Missouri Republican attack on Obamacare. If you haven’t, you’ll find a good description of the bill and the issues it involves in this write-up by Gloria Bilchik at Occasional Planet, while Blue Girl here at SMP puts Lamping’s legislative chops into perfect perspective – as in “I loathe scum like Lamping with every fiber of my being and can’t imagine what it must feel like to be so empty inside, so bereft of humanity and kindness, so meanspirited, venal and utterly contemptible, so vapid, insipid, petty and trite”. I’m pretty sure she disapproves.

Blue Girl also acknowledges something else we all know which is that this exercise in radical rightwingery hasn’t a ghost of a chance of passing in even our GOP-heavy legislature – there are actually a few constitutional realists among the GOP crazies in Jefferson City – or being signed by our reasonably sane Democratic Governor should the unthinkable occur. And the case against the legislation’s viability was further bolstered by a judicial decision handed down today by the U.S. District Court for the District of Columbia.

Lamping’s bill, SB546 (and companion House legislation introduced by  Rep. Keith Frederick (R-121), HB1314), was inspired by the Cato Institute’s Michael Cannon, who has encouraged lawsuits arguing based on the argument that the subsidies offered to low and middle income Americans on the federal exchange violate the law as it is written. As Ezra Klein notes:

The dispute settles around a single sentence: The Affordable Care Act’s defining a health insurance exchange, in Section 1311, as a “governmental agency or nonprofit entity that is established by a state.” Since the law says subsidies only go to people buying insurance “through an Exchange established by the State under 1311,” Cannon and some others argue that the federal exchanges, though specifically envisioned in the law, can’t receive subsidies.

Today’s verdict is the first to come down and it, tellingly, doesn’t endorse Cannon’s logic:

Judge Paul L. Friedman called that argument “unpersuasive,” saying it didn’t pass legal muster and ran counter to the central purpose of the Affordable Care Act.

“Plaintiffs’ proposed construction in this case – that tax credits are available only for those purchasing insurance from state-run Exchanges – runs counter to this central purpose of the ACA: to provide affordable health care to virtually all Americans,” Friedman wrote in a 39-page decision. “Such an interpretation would violate the basic rule of statutory construction that a court must interpret a statute in light of its history and purpose.”

His reasoning? The federal exchanges — which the Obama administration is constructing for 34 states that declined to build their own — “would have no customers, and no purpose” if the challengers’ logic were adopted.

Of course, this is just the first verdict in one of several lawsuits, but it doesn’t look too good for folks who think they’ve found the perfect, last-ditch, anti-Obamacare wriggle.

What this means in practical terms for Missouri progressives, as far as I’m concerned, is that John Lamping has given the state’s Democrats a big, fat, no-risk gift right before the mid-term elections. While Blue Girl notes that SB546 is “going nowhere, except in our file of stuff to use against the neoconfederates next election cycle,” we shouldn’t underestimate the good we can do with that file or just how potent this particular bit of GOP chicanery could prove to be when it comes to next fall’s elections.

At the end of December 33,138 Missourians or 5.04%  of the estimated eligible population had enrolled in private plans through the federal Website, Healthcare.gov. That number will undoubtedly grow massively in the next three months – in spite of statewide GOP efforts at obstruction – and, as the St. Louis Post-Dispatch noted about earlier numbers, many of these new enrollees will also be eligible for the subsidies that Lamping says he wants to take away.

Lamping must think he’s got a winner here, but if I were one of those folks getting acquainted with Obamacare via my first-time healthcare coverage and finally learning how empty the last three-years of GOP scare-tactics were, I wouldn’t feel too friendly toward jerks who were trying to make sure that I couldn’t afford to pay for it. It could be a relatively short jump from John Lamping to the entire Missouri GOP – particularly in view of their past, desperate anti-Obamacare rhetoric. We’ve just got to get the word out about who it is who doesn’t care if Missourians live or die.

3rd paragraph edited slightly for clarity: (see striken test), and for accuracy: “federal” added before exchange.