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Yesterday the Supreme Court declined to fast track the Virginia challenge to the Affordable Care Act, which has Greta Van Susteren in a tizzy over those lazy Supreme Court justices who dare to take their three-month break while the health of America teeters in the balance.

Ken Cuccinelli was happy to oblige her, jumping right in with his assessment that states will spend "millions before taxpayers even see a band-aid or any health care", due to the cost of setting up exchanges in advance of implementation of the Affordable Care Act.

If their estimate is correct and June 2012 would be the earliest a Supreme Court decision would be made on the constitutionality of the Affordable Care Act, that throws it right into the middle of the 2012 general election, which could really be a political neutron bomb. If the Supreme Court decision were a 5-4 ruling it unconstitutional, for example, it could play right into the hands of conservatives who will then begin touting their market-based reforms, a la Ken Cuccinelli at the end of this clip.

Maybe I'm just being cynical here, but I don't see the decision to delay it as particularly good news. It feels just as political as a decision to fast-track it would have been, delaying the outcome until we're right in the thick of the 2012 general election.

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Credit: Commonwealth Fund

Just in the time for this week's one year anniversary of the passage of the Affordable Care Act, a new study by the Commonwealth Fund revealed that the new health care reform law's full implementation can't come soon enough. Since the start of the recession, almost 60% of Americans who lost a job and their health insurance- 9 million people - could not afford to regain coverage. Medical costs pushed four million more into bankruptcy. Mercifully, as the analysis also showed, "When fully implemented in 2014, the Affordable Care Act will bring relief: nearly all of the 52 million working-age adults who were without health insurance for a time in 2010 will be covered."

The Commonwealth Fund report ("Help on the Horizon: How the Recession Has Left Millions of Workers Without Health Insurance, and How Health Reform Will Bring Relief") sums up the bleak present and hopeful future of the American health care system.

Its 2010 Biennial Health Insurance Survey of over 3,000 adults ages 19-64 highlighted the devastating toll of the Bush recession which started in December 2007.

The survey finds that both insured adults--who are facing higher premiums and out-of-pocket costs--and uninsured adults cannot afford adequate health care. Seventy-five million adults did not get needed health care in 2010, skipping doctor visits, prescriptions, specialist care, and recommended tests and treatments because of costs. This represents a 60 percent increase from 2001, when 47 million people reported skipping needed care because of costs. Uninsured adults were the most likely to forgo care because of costs, with 66 percent reporting they did so. However, many insured adults were also less insulated from high health care costs--31 percent of adults who were insured all year went without the health care they needed because of costs, up from 21 percent in 2001.

Likewise, 73 million people reported problems paying their medical bills or were paying off medical debt, up from 58 million in 2005. The survey finds that because of medical bills, an estimated 29 million people spent all of their savings, 17 million incurred credit card debt, 22 million were unable to pay for basic necessities like food, heat, and rent, and 4 million declared bankruptcy.

All told, "Nearly three of 10 (28%) working-age adults, an estimated 52 million people, were uninsured for at least some time during 2010, up from 38 million or 24 percent in 2001." Those with incomes below the Federal Poverty Line (FPL) fared much worse, with 54% going without coverage at some point last year, compared to 13% among families living at twice the poverty level.

But as the Commonwealth Fund President Karen Davis explained last week, the new consumer protections, insurance requirements and government subsidies contained in the health care reform law signed by President Obama last March will help ensure that nearly everyone, including the jobless, has access to comprehensive coverage by 2014:

"The silver lining is that the Patient Protection and Affordable Care Act has already begun to bring relief to families," she said. "Once the new law is fully implemented, we can be confident that no future recession will have the power to strip so many Americans of their health security."

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Perpetual presidential candidate Mitt Romney has performed more flips than an X Games champion. The pro-choice Senate candidate (and Planned Parenthood donor) of 1994 did a hard right turn on abortion for the approaching 2008 GOP primaries, prompting adviser Michael Murphy to acknowledge "he's been a pro-life Mormon faking it as a pro-choice friendly." On immigration, disinvestment from Iran, the significance of Osama Bin Laden and even his state of residence, Romney's gymnastic contortions are the stuff of legend. But in his embarrassing effort to whitewash his support for a Massachusetts health care law virtually identical to the federal Affordable Care Act, Mitt Romney has literally rewritten his own book - and history.

On Friday, the former Massachusetts governor delivered a blistering assault on President Obama at the CPAC conference. But 24 hours before a speech in which Romney omitted any mention of his signature health care law, the Boston Phoenix explained that he carefully rewrote critical sections of the paperback edition of his year old book, No Apology.

In a book otherwise unchanged, the Phoenix and later ThinkProgress reported, Romney added new criticism of the Obama stimulus program and performed major surgery on the section about the "Massachusetts Model:"

In the original hardcover, Romney tried to carefully distinguish between the Massachusetts law and the national version that was nearing passage as he wrote.

But the Massachusetts model has become Romney's bête noire among conservatives, who loathe the national reform they call "Obamacare." The rewritten paperback swings much harder, proclaiming that "Obamacare will not work and should be repealed," and "Obamacare is an unconstitutional federal incursion into the rights of states."

Just as important as what Romney put in is what he took out. The 2010 hardcover edition included an explanation of the major difference between his RomneyCare and ObamaCare: a public option. Sadly for Mitt (and the American people), the Affordable Care Act did not include a public option. Which may explain why the following paragraph was amputated from the paperback version of No Apology:

In 2009, the national health-care policy supported by Barack Obama was often and erroneously reported as being based on the plan we enacted in Massachusetts. There were some big differences -- in particular, our plan did not include a public insurance option. The notion of getting the federal government into the health-insurance business is a very bad idea. Government-supplied insurance would inevitably be subsidized at great cost to the taxpayers and, combined with Medicare and Medicaid, it would give government the kind of monopoly we would never allow a private entity to claim. Clearly, the public insurance option is simply a transitional step toward the president's stated goal of creating a single-payer system, one in which the nation's sole health insurer would be the federal government.

It's no wonder Romney altered his conclusion from "We can accomplish the same thing for everyone in the country, and it can be done without letting government take over health care" to "And it was done without government taking over health care."

It also comes as no surprise that the once and future GOP White House hopeful added seven paragraphs in the vain hope of explaining his Massachusetts health care plan now gone national. Vain, that is, because of past statements like these:

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Senate Republicans have attached an amendment to the FAA funding bill currently pending to repeal the Affordable Care Act. It appears that Harry Reid is willing to allow the vote to go forward, in order to "get it out of their systems quickly".

"We want to get this out of their system quickly," said Senate Majority Leader Harry Reid at a press conference with his top deputies Tuesday afternoon, who said the vote could come up "sometime today," depending on how long the floor debate drags on. Aides suggest the vote's more likely to come Wednesday.

"A budget point of order lies against it. It breaks the budget by a trillion dollars, they don't show any way of making up that trillion dollars." said Sen. Chuck Schumer (D-NY) told reporters. "I for one was hoping that Senator McConnell would not do this on this bill... but he did, its his right."

To waive the point of order, Republicans will need 60 votes. They won't come close.

Meanwhile, they are at least (finally) admitting that the goal of their tweaks isn't "repeal and replace", but rather to kill the whole thing and allow the status quo to remain for everyone.

I caught a few minutes of Senator Tom Coburn bloviating on the Senate floor this afternoon with the same old mantra about free-market health care, and how government will interfere with the doctor-patient relationship, etc. etc. ad infinitum. I could only wonder how he can stand there with a straight face and do that. The man is an OB/GYN who wants the government to execute doctors who perform legal procedures on women, robbing them of choices rightfully made with the advice of a doctor and without the US government in the examining room.

Finally, in what could be the ultimate irony of the day, Forbes wonders aloud why the uninsured aren't protesting in the streets like Egyptians.

Put plainly, the political and legal peril in which health reform finds itself is directly attributable to the failure of the uninsured to visibly advocate on their own behalf. Those without health insurance have allowed a civil rights issue of guaranteed access to medical care to become a referendum on Big Government rather than a test of basic human compassion for brain-damaged husbands. And, even more ironically, have left the heavy lifting on lobbying against repeal to the big insurance companies of the world such as Aetna, Humana, UnitedHealth Group and WellPoint

Worse, while the prestigious Institute of Medicine characterizes the consequences of a lack of access to care as “needless illness, suffering, and even death,” it is Republican physicians in Congress brazenly lead the effort to repeal care coverage.

By coincidence, there are about the same number of elderly on Medicare as there are uninsured. Egyptians understand the power of an aroused populace. Do the uninsured? In Red States and Blue States in 2012, there will be Congressional districts and senatorial races up for grabs and a contest for the presidency featuring a man who made a historic effort on their behalf. Will Republicans whose party has never put forth a serious proposal to provide access to care for all suffer any consequences at the ballot box from turning to the sick, the scared and the suffering with a curt, “Government is not the answer.”

It's a good question, though. We should be in the streets. Every damn day.

I see our elected representatives are hard at work, representing their constituencies. Not that those constituencies even vaguely represent voters, you understand. No, they would like to repeal the Patient Protection and Affordable Care Act 28 times. In 11 days, no less. What busy little beavers they are!

Here's a list as of today, divided by House and Senate.

House
H.R. 105 Dan Burton, GOP – Indiana : To repeal the Patient Protection Act & enact in its place incentives for people to buy health insurance.
H.R. 118 John Fleming, GOP – Louisiana : To permit a state to elect not to have an American Health Care Exchange.
H.R. 119 John Fleming, GOP – Louisiana : To prohibit hiring of irs agent to implement or enforce health insurance reform.
H.R. 127 John Graves, GOP – Georgia : To de-authorize funding of Patient Protection Act.
H.R. 141 Steve King, GOP – Iowa : To repeal the Patient Protection Act.
H.R. 145 Connie Mack, GOP – Florida : To repeal the Patient Protection Act.
H.R. 154 Ted Poe, GOP Texas : To prohibit any federal funds to be used to enforce Patient Protection Act.
H.R. 171 Cliff Stearns, GOP – Florida :
H.R. 2 Eric Cantor, GOP – Virginia : Repeal of Patient Protection Act.
H.R. 38 John Fleming, GOP – Louisiana : Rescind funds authorized for Patient Protection Act.
H.R. 9 David Drier, GOP – California : Requires Committees to look into Patient Protection Act.
H.R. 26 David Drier, GOP – California : Repeal Patient Protection Act.
H.R. 215 Don Young, GOP – Alaksa : Repeal Patient Protection Act.
H.R. 19 John Carter, GOP – Texas : Disapprove rules on MLR in Patient Protection Act.
H.R. 299 John Carter, GOP – Texas : Repeal Patient Protection Act.
H.R. 358 Joe Pitts, GOP – Penn : Remove abortion funding from Patient Protection Act (there is none)
H.R. 360 Michael Burgess – Texas : Amend Patient Protection Act to include President in Health Care Exchanges.
H.R. 364 Tom Latham, GOP – Iowa : To Repeal Patient Protection Act
H.R. 371 Marsha Blackburn, GOP – Tennessee : Repeal Title I of Patient Protection Act.
H.R. 5 Phil Gingrey, GOP – Georgia : Repeal Patient Protection Act.
H.R. 397 Wally Herger, GOP – California :Repeal Patient Protection Act.
H.R. 429 Darrell Issa, GOP, California – Repeal Patient Protection Act.
H.R. 452 Phil Roe, GOP, Tennessee – A bill to repeal Patient Protection Act.
H.R. 450 Dave Reichert, GOP, Washington – A bill to repeal Patient Protection Act.

Senate

S. 19 Orrin Hatch, GOP – Repeal Health Mandate & therefore repeal patient protections.
S. 17 Orrin Hatch, GOP – Repeal Tax on Medical Devices
S. 16 David Vitter, GOP – Repeal Patient Protection Act
S. 196 Chuck Grassley, GOP, Iowa – A bill to to provide congressional staff gets to participate in Exchange.
S. 192 Jim DeMint, GOP, South Carolina – A bill to repeal health care.

I thought it might be interesting to see what Democrats did in their first 11 days after assuming control of the House in 2006. Well, lookee there. All sorts of interesting bills in those first days. Everything from gun show loophole closures (David Dreier's baby) to First Amendment protections, to small business assistance to alternative energy.

But for Republicans and their keepers, this Congress is all about sticking it to Obama. Nothing more, nothing less.

Both sides have now laid out strategy roadmaps for the upcoming repeal battle in the Senate. Or not. Right now it feels like a fist-shaking session with a big pissing contest for the finale.

It will go something like this: Senate Democrats will force Republicans to debate and take votes on provisions like closing the doughnut hole, ending exclusions for pre-existing conditions, barring exclusion of children with pre-existing conditions and allowing young adults to remain on their parents' policies until age 26.

Senate Republicans will retaliate by forcing Democrats to vote on the tax-related provisions of the law, including the penalty on the individual mandate, the excise tax on medical device manufacturers, etc.

It will continue what is already a contentious, annoying, academic debate, and one that's not likely to be settled in the Congress, anyway. The downside risk to Democrats will be giving Republicans more time to turn people against it. The downside risk to Republicans is reinforcing the perception they don't really want to 'replace' the law with anything else. Ultimately the Supreme Court will have the final say on the individual mandate. If it is nullified, the entire law could be tossed, since no provision was built in to preserve all other provisions if one provision is found to be unconstitutional.

It's still about the pre-existing conditions. Republicans don't want people with pre-existing conditions to have access to health care unless they can pay for it themselves. Democrats understand that health care is one of the fundamental obligations of a government to its people.

Ezra Klein:

The Affordable Care Act doesn't make the government much larger as a share of GDP. Rather, it commits the government to guaranteeing something close to universal health care, even if the relevant transactions occur between individuals and private insurance companies. The reason the GOP talks about "repeal and replace" is that they don't think they can persuade Americans to undo that underlying commitment. If they did, they'd just go for repeal.

Meanwhile, Vermont marches toward single-payer healthcare for residents there. California passed single payer twice and was twice vetoed. The last time they tried to pass it through the legislature, it failed, but they aren't giving up. It will rise again, particularly in light of Gov. Brown's proposed cuts to Medicaid and MediCal coverage.

I believe the only way to move the country toward a national single payer system is via the states, similar to how Canada's came into being. But before that happens, this nation has to embrace the idea that sick people shouldn't be excluded from access to the health care system, which is what this debate should be about, rather than pissing contests over every damn provision in the Affordable Care Act.

Bonus: Joan McCarter at Daily Kos breaks down a recent poll showing zero support for repeal of the whole thing.

When they actually asked about those certain parts, "8% are opposed to everything and 11% are opposed to the individual mandate. And that's about it. Not a single other provision was opposed by more than 1% of the respondents. Not even higher taxes! Hell, a full 14% were supposedly in favor of repeal but couldn't name even a single provision they disliked."

This makes the piece-by-piece strategy the Senate Dems are devising very smart.

Yes, he really said that. He really, truly did, and it's a BFD. digby writes:

Although it sounds ridiculous, Rush is in the process of making his followers believe that the pre-existing condition provision in the health care reforms is something bad and shameful. The reason he's doing this, of course, is because this is the most popular piece of the bill and the one on which the rest of it hinges. If they can divide people on that, the repeal of the plan will be much easier.

Absolutely 100% on the money. The rest of the Affordable Care Act, along with any other proposal for reform like single payer or a public option hinges on one single provision: No exclusion for pre-existing conditions. So the Corpulent One knows that the only way to marshall support for complete repeal is to erode support for covering people with pre-existing conditions.

It drives me crazy now just as it did during the whole debate that there wasn't more focus on effective dates. Waiting until January 1, 2014 for the requirement to cover pre-existing conditions was risky and opens a window for a long, sustained attack. Whether they had passed Medicare for All, a robust public option as part of the overall bill, none of that, or all of that, the heart of the debate is over people who have pre-existing conditions, which are defined by insurers and have been broadened more and more over time. This is only one of many salvos which will be thrown over and over and over again.

digby, again:

People thought it was insane for Rush to say that he wanted the president to fail. But he held the line and made the GOP come crawling for even suggesting that he was wrong. And the party just became more and more radical. They don't see health care reform as sacred and they will feel absolutely no remorse about destroying it.

Here's what concerns me, no matter what side of the Medicare-for-All/SinglePayer/Public Option debate you are on: If they succeed at repealing the requirement to cover people with pre-existing conditions, there will be no possibility of modifying, adding, expanding, or creating a better health care program for this nation. It will all be privatized and Medicare will become a memory we had of our grandparents' day instead of our own.

This is a line they cannot cross.

If you missed any of this, be sure to watch both videos in this post. It's definitely some of the most spontaneous and revealing television I've seen in a very long time. Keith Olbermann brought together Michael Moore and Wendell Potter in a segment about how the health insurance industry mobilized to smear both Moore and "Sicko" ahead of its release, fearing it would get traction and start a "grass roots uprising" for single payer health insurance.

It's not that it's a surprise. We all know this is the standard tactic. But what comes through on these videos is how truly angry and passionate Moore is about this effort to discredit work that he viewed as essential to the debate. If memory serves me, they did succeed at marginalizing it, at least to the extent that it was not as relevant to the general debate as death panels were to become.

Partial transcript follows...

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In what can only be described as a fairly stunning display of hypocrisy, Freshman Rep. Richard Nugent (R-FL) says he will pay $9,000 to keep his health insurance through his "employer", not through the FEHBP plan for members of Congress because he might have an accident and need treatment he couldn't otherwise afford.

NUGENT: I will tell you this, what I will pay for insurance to get through my employer, not through the House, will be almost — will costs me $9,000 more a year. But I wan to remain with that, because I think it’s the right thing to do. Because I think that when you have Americans that are struggling, why should I get a cost saving because I just got elected to the United States House of Representatives?

How nice for Rep. Nugent. He has options, like keeping that insurance through his 'employer'. Only, isn't his employer the House of Representatives now? I paid a visit to his website to see who employed him before he was elected. It seems he was the Sheriff of Hernando County. In fact, in all of the literature I've been able to find about him, I cannot find any evidence that he has ever been employed by a business. He was in the military, and then in law enforcement.

It's possible he worked for the Sheriff's department long enough to have earned the right to keep his health insurance with them until he is Medicare-eligible, in fact, since his bio indicates he began his public safety career in 1972.

If so, then what we have here is a guy who is a career public servant with a public pension and a right to health insurance without fear of being dropped for pre-existing conditions, with a nice fat paycheck from the US government to help pay the premiums. And he would never, ever go without health insurance, right?

Here's another freshman Republican Representative who may be even more of a hypocrite than Nugent -- Rep. Michael Grimm, (R-NY). He's upset because he couldn't get on the Congressional plan fast enough and is quoted in a print article as saying this:

"What am I, not supposed to have health care?" Grimm told the New York Daily News (the article hasn't appeared online, only in print). "It's practicality. I'm not going to become a burden for the state because I don't have health care and, God forbid I get into an accident and I can't afford the operation...That can happen to anyone."

God forbid. Which is why Rep. Grimm thinks it's a great idea to repeal that access for everyone else. Got it.

Between Bill O'Reilly in this clip, CSPAN callers (who I'm convinced are often paid to call and start spewing talking points), and our elected representatives, we are witnessing the Great Revival of the Emergency Room Lie.

It goes like this: Everyone has access to health care because emergency rooms have to treat people who walk through their doors. You can hear the expanded version in the video above, or tune into CSPAN between House votes on the replay of today's shenanigans to hear your 'everyday caller' talk about it. With citations to the law, even.

Ezra Klein would like us to remember young Diamonte Driver, the uninsured 12-year old who died from an abcessed tooth. He had access to emergency services.

In February 2007, Deamonte Driver died of an infected tooth. But he didn't really die of an infected tooth. He died because he didn't have consistent insurance. If he'd had an Aetna card, a dentist would've removed the tooth earlier, and the bacteria that filled the abscess would never have spread to his brain.

Deamonte Driver was 12. His insurance status wasn't his fault.

Because who thinks an abcessed tooth is something one can get treated in an emergency room, after all? Sure, Deamonte Driver had access to the emergency room. He even went to the emergency room, finally. He was there long enough to die.

Washington Post, 2007:

Twelve-year-old Deamonte Driver died of a toothache Sunday.

A routine, $80 tooth extraction might have saved him.

If his mother had been insured.

If his family had not lost its Medicaid.

If Medicaid dentists weren't so hard to find.

If his mother hadn't been focused on getting a dentist for his brother, who had six rotted teeth.

By the time Deamonte's own aching tooth got any attention, the bacteria from the abscess had spread to his brain, doctors said. After two operations and more than six weeks of hospital care, the Prince George's County boy died.

Deamonte's death and the ultimate cost of his care, which could total more than $250,000, underscore an often-overlooked concern in the debate over universal health coverage: dental care.

That's how that 'everyone gets care in an emergency room' thing works. No preventive. No basic services. You go when it's escalated to an emergency, when it costs a fortune for treatment and the chances of death or permanent disability are even higher.

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