At the Atlantic, Ron Brownstein writes a simple truth about the Trump and Republican health care plans:
There’s a reason Donald Trump has never produced a health-care plan that protects consumers with preexisting medical conditions: Ending protections for the sick is the central mechanism that all GOP health-care proposals use to try to lower costs for the healthy.
Protection against pre-existing conditions and more geekily speaking, protection against re-classification risk, is popular. Very few people have the financial capability to absorb both the short term costs of a massive complex diagnosis like pediatric leukemia nor the ability to self-insure against life long incremental costs after a diagnosis like that. The AHCA and BCRA during Repeal and Replace Spring and Summer 2017 through single digit billions at this problem as massive waivers against risk pooling would be allowed. The Farm Bureau “shhh this is only an insurance like product in the same manner that Velveeta is cheese-like” plans and short term limited duration plan proliferation are also attempts to split risk pools.
The fundamental philosophical underpinning of these concepts is that people are on their own and responsible for their good health and their bad luck with no expectation that society has a responsibility.
That is an ethos.
It is also one that flipped the House in 2018.
This is why the ACA is back in the Supreme Court. If it can be knifed there, perhaps the splatters won’t be politically trace-able.
Another Scott
“through” -> “threw” perhaps?
Yup.
Thanks.
Cheers,
Scott.
rikyrah
It’s traceable.
It’s so directly traceable.
Not one judge appointed by a Democratic President is going to vote to end the ACA.
Will be nothing but Republicans.
And, in case folks don’t get it.
SEVEN MILLION PEOPLE in America just got another Pre-existing condition called COVID-19.
SEVEN MILLION AND COUNTING.
JPL
If Amy votes against the ACA, it will be trace-able. Donald seemed surprise at the number of those with preexisting conditions.
gene108
Republicans stacked the courts. so the courts will knife any and all progressive New Deal, and post-New Deal laws, without any political splatter.
Geminid
Protecting the ACA was one of the Democratics’ strongest issues in 2018. Senator Bob Casey (D-PA) said it was easily his strongest. Circumstances this year only make it more critical, and I look for Democrats to pound it hard.
Eunicecycle
@rikyrah: I am not a lawyer, but I have seen lawyers say that the decision the original federal judge made was based on a very tenuous legal argument that most felt was invalid. I hope Roberts and Gorsuch at least, and maybe Amy herself will live up to their vaunted intellects and vote to uphold the law.
p.a.
Safely say the 40% (and dropping??) can’t, won’t make the political connection between courts and rethug attacks on ACA. Will the EC and suppression/cheating counteract the popular understanding that led to the 2018 Dem wave?
ThresherK
“If governance were easy, Republicans could do it” is something I’ve been saying for most of my adult life.
Governance is difficult even when you’re good at it and you want it to succeed.
narya
So many folks (likely those who’ve only ever had employer-sponsored coverage) seem to file “pre-existing conditions” under the big ones–cancer, for example, or a genetic disorder. But when I was on the market for individual insurance, back in 2006, I could not get insurance that would cover the thing that was most likely to cause me issues but that affects a zillion people my age. It’s not JUST the big things, it’s things that people just accumulate by virtue of living their lives or having their genetic background.
Goku (Amerikan Baka)
@gene108:
How do you figure that? As others have noted, only Republican appointed justices will vote to destroy the ACA for example. That’s politically traceable
hells littlest angel
So the Republican health care plan is an insurance company’s dream: only provide coverage to those least likely to need it.
gene108
@Goku (Amerikan Baka):
IANAL and do not follow court rulings and how they establish precedent or binding rules.
My understanding is there are a lot of issues lower courts have control over, which never make it to the Supreme Court, like the Flores settlement regarding detaining immigrant children.
There’s going to be a death by a thousand cuts as conservative justices chip away at labor rights, women’s rights, etc.
This way Republicans get the deregulated corporate driven “utopia” their donors crave, while elected official has to get their hands dirty by actually having to govern and vote on legislation to change things.
Kropacetic
And not even all of them.
RaflW
@JPL: Donald seemed surprised that Joe Biden had a second son named Beau, so really, we’re just dealing with an idiot narcissist.
That said, the way in which the GOP is conducting the seat-filling is pretty damn traceable. Yes our supplicant press struggles to explain things that it is clear from town hall events the general public understands better than big city editors do, so Democrats have to hammer this (as they have been).
In the next two weeks, two months, two years, and two generations.
Enhanced Voting Techniques
Answering that is easy
Redshift
The other important thing to remember is that when Republicans say they’ll protect pre-existing conditions, there’s always an unspoken “as long as you can pay whatever the price is.” Some of them probably aren’t even consciously lying when they say it, because of the ingrained ideology that things only have value if someone is making a profit.
Market worship is as ingrained as “tax cuts raise revenue,” the the free market always produces the best outcome, not just the most profitable, must never be questioned.
Kent
I’ve never really been much of a health care policy wonk. And as someone who has always had access to employer-based health care through both my and my wife’s employer, this stuff has never really hit that close to home. As a science teacher and former science agency bureaucrat, education and the environment have always been more in my wheelhouse.
But I gotta say, over the years, the more I grow to understand the ACA, the more impressed I am with the policy chops that it took to put the whole thing together. It really is a truly impressive piece of legislation. And if we actually had people with good intentions running the executive branch and courts, rather than sociopaths, it would be working quite well. Far from perfect, yes. But really quite well.
As for SCOTUS tanking the the ACA. Honestly that would just be the new Fort Sumpter and if Dems control the Senate it would be more than enough argument to finally toss the filibuster to restore health care to millions. Just re-implement the individual mandate, for example, if that is the argument they want to use to tank it.
Kent
@Redshift:
The ones who have actually worked with health care policy are lying. They know better. The problem with the GOP is that they have dismantled their entire policy apparatus. It’s not just health care. It’s everything from the environment to education to infrastructure. Even taxes. They just make up shit and lie about EVERYTHING and have intentionally become the party of stupid. Not one of their policies in any area of government makes actual sense at a policy level. They don’t care. They just lie.
Health care isn’t even the worst area of policy for the GOP. That would be climate change and the environment
Matt McIrvin
@gene108: Bear in mind, a thing that currently magnifies the power of these court decisions is the nearly complete inability of Democrats to pass legislation. That means courts can do things like strike down or hobble the entire ACA on arcane statutory-interpretation grounds by a close parsing of one sentence, and there won’t be any fix from Congress that just consists of patching the wording of that sentence.
SCOTUS can then pretend in the written opinions that all it’s doing is telling Congress to do its job, knowing that Congress won’t do its job because a majority or obstructing minority actively wants the law to die.
If there’s a Democratic majority + Democratic President, and the Senate drops the filibuster, all that changes. Technicalities won’t stick for long–SCOTUS can only knock down something like the ACA with a sweeping, ideologically-based ruling. That provides less of an appearance of calling balls and strikes.
RaflW
@narya: Pre-ACA my partner was initially denied a plan (by one of the major non-profit insurers chartered in MN) because he had plantar fasciitis and acid reflux. Like, that was it.
He got his doctor to write a letter as part of his appeal and he won coverage, but it was frightening. The ACA has meant we could relax — somewhat — but as I hit 55 later this year as an early retiree, I’m really worried. We can afford stupid-expensive premiums if we absolutely had to, but it’s the flat out denial of coverage, or huge carve-outs around routine issues that freak me out.
eg. Would having controlled high blood pressure mean the insurance could deny coverage of stroke? Devastating if something happened later.
narya
@RaflW: Exactly. And if they discover something that you’ve had for awhile but didn’t know you had, BOOM!, you’re done. Now you have to prove you didn’t know you had it. It was terrifying, and expensive, to eventually get coverage. And, as many have rightly noted, we now have at least 7 million people who’ve had Covid-19 infection, with no real understanding of the long-term effects of that. Even in 2005, I was paying $400/month, out of pocket, for coverage that wouldn’t have covered the thing that was most likely to need medical intervention (but didn’t, so I was lucky for those two years, and since).
Snarki, child of Loki
Oh, I’m sure the RWNJ’s will reach back into their playbook, and gin up some loud bitching about “tyrants in black robes”, just like they did a couple of decades ago.
In spite of having a majority on the supreme court, of course. (then and now)
Then use it as an excuse to replace even more D appointed judges.
Now, explain it to me again, is there ANY problem in modern American that can’t be solved or made better by “slaughter all Republicans”? Drawing a blank.
Brachiator
@Kent:
The GOP do not see any of this as appropriate areas of policy.
Except for taxes.
Eisenhower was the exception when it came to some infrastructure projects, but the modern GOP defer to the plutocrats on most issues, and plutocrats don’t want anyone standing in their way.
On taxes the GOP spent time re-writing every aspect of the tax code to benefit the wealthy. For some reason, this fact and its implications never really is understood by some liberals.
RaflW
@Kent: “They just make up shit and lie about EVERYTHING and have intentionally become the party of stupid.”
GOP didn’t just get the nihilists in golf pants monicker outta no where, they earned it.
laura
Funny, not funny, that some republican candidates are shitting their pants about the ACA and desperately attempting to convince their voters that the upcoming supreme court case to overturn the ACA is unlikely to overturn the ACA.
waspuppet
They will never, ever stop thinking there are “sick people” and “well people” and thinking you never cross over from one to the other and/or back in your lifetime.
Its a corollary to the way they think there are “law-abiding citizens” and “criminals” and that what you actually do in your life has no bearing on which one of them you are.
Brachiator
Funny thing about ethos. It is sometimes based on mythology.
One of the reasons that the GOP and their conservative base hate the ACA is that they think that health insurance is something only hard working people deserve. If you don’t have a job, you don’t deserve health insurance. You see this amplified in the weird rules tying work requirements to Medicaid expansion.
And yet, employer-based insurance largely arose during World War 2 as an enticement to get workers into the labor force. Wages were frozen, so employers competed by offering more benefits. Unions had previously fought for health benefits for their members. But health insurance had not been a general consequence of getting a job.
And then the deal was sealed via a court ruling on tax policy.
In 1943, 943, the Internal Revenue Service decided that employer–based health insurance should be exempt from taxation. This made it cheaper to get health insurance through a job than by other means.
None of this had anything to do with the current right wing fantasy of a strong and deserving worker being worthy of health insurance because he or she has a strong and well-deserved job.
Dan B
Velveeta was originally a true cultured cheese. Now it’s processed whey protein. Here’s a detail: most true cheeses have a processed version. Swiss slices are based upon Swiss cheese. Where did American slices get their name? It’s a cheap processed version of Velveeta which was the only cheese originating in the US for many decades. Velveeta is still better than American. Shudder!
...now I try to be amused
@Kent:
Yeah, I think the Dems could do whatever it takes to restore the ACA and it would be popular.
It’s becoming clear why the Republicans were so frantic to repeal the ACA. The longer it’s in effect, the more popular it becomes. It might already be the third third rail of US politics, along with Social Security and Medicare.
Matt McIrvin
@waspuppet:
I’ve never been able to understand how a party whose base consists so heavily of elderly people could not get this.
Bill Arnold
Is that snark?
If somebody and/or a family member is denied health insurance due to Republicans, they won’t have to fork over money for insurance premiums, and after a few months, if they’re so inclined[1], they’ll be able to buy one of these:
20 of the Best Sniper Rifles For Sale in 2020 (USA Gun Shop, April 4, 2020)
Seriously, do Republicans think that every single one 10s of millions who lose health care will just meakly accept their fate? Some small non-zero-sized fraction of them will be Second Amendment solution types. As a country, we do not want to encourage our fellow citizens to go down those dark paths..
[1] To be clear (to lurking MiB), I’m not a gun person, am philosophically non-violent, and have other skills. (Though my father, rifleman in WW2 in Europe who killed fascists at respectably long range, taught his kids rifle skills. Not uncommon.)
burnspbesq
@gene108:
True as far as it goes, BUT …
The lower Federal courts are severely understaffed, and have been for a long time. That’s a problem that I would expect a Democratic Congress to have near the top of its to-do list.
Chris T.
This is a dead thread but I’ll make a “bold” (?) prediction: it’s way higher than 7M. We’re going to find out that somewhere around 20 to 60 percent of symptomless young folks who got Covid19 in 2020 have knock-on effects that show up in their later years (40s, 50s, on up)—similar to shingles as a post-chicken-pox problem, but probably worse than merely causing debilitating pain. Since we’re mainly testing those who have symptoms, and we’re opening schools in some big but R-governed states (FL, GA), we’ll find out later that it was roughly 15 million at this point.