As The New York Times suggested last week, the fate of President Obama's Affordable Care Act in general, and its mandate that Americans obtain health insurance in particular, may hinge on Justice Anthony Kennedy's notion of "liberty." While Solicitor General Donald Verilli posited "a profound connection" between health care and liberty, his opponent Paul Clement argued, "that it's a very funny conception of liberty that forces somebody to purchase an insurance policy whether they want it or not."

Of course, that very conception of liberty has been the law of the land for decades. Today, tens of millions of Americans must purchase health insurance and a pension plan for their golden years. And as it turns out, the Medicare and Social Security mandates for individuals and employers dwarf anything required by the dreaded Obamacare.

As we learned during the recent debate over the extension of the payroll tax cut, 160 million Americans pay taxes to fund the Medicare and Social Security trusts for today and tomorrow's retirees. Since 1935, workers and their employers have each paid into the Social Security trust fund, a figure which next year will return to its 6.2 percent rate on the first $106,000 of income. In addition, employer and employee alike are on the hook for another 1.45 percent for Medicare, the insurance program for the elderly established in 1965.

In comparison, the Affordable Care Act's individual mandate impacts just a small fraction of Americans. For starters, over 80 percent already have health insurance, compared to roughly 17 percent who do not. The Economic Policy Institute estimates that 59 percent of those under age 65 receive employer-sponsored insurance, while another 22 percent are covered by public programs including Medicaid and SCHIP. Of the 50 million people who are currently uninsured, about 20 million (including undocumented immigrants and those with religious objections or claiming economic hardship), are not covered or are otherwise exempt from the health insurance mandate. As a recent Urban Institute analysis concluded:

What may be surprising, however, is that if the ACA were in effect today, 94 percent of the total population (93 percent of the nonelderly population) or 250.3 million people out of 268.8 million nonelderly people would not face a requirement to newly purchase insurance or pay a fine.

As Ryan Grim noted, that's because "98 percent of Americans would either be exempt from the mandate — because of employer coverage, public health insurance or low income — or given subsidies to comply." The Urban Institute estimated that 8.1 million Americans would have their insurance paid for by the expansion of Medicaid to 133 percent of the federal poverty level. Another 10.9 million people would receive subsidies to buy private insurance in the new state exchanges, while only 7.3 million (2 percent of the total U.S. population) would be required to purchase a health plan using their own resources alone. As for those Americans choosing to instead to pay the penalty for failing to obtain insurance at all, the CBO estimated that number at 4 million. (That forecast is almost double the rate in Massachusetts, where only 48,000 in a state of 6.6 million people opted to pay the penalty rather than acquire health insurance under Mitt Romney's version of the individual mandate.)

But if far more Americans pay the Social Security and Medicare mandates, the number of direct beneficiaries of "Obamacare" is much lower.

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Part One of today's arguments before the Supreme Court concern the question of what happens if the individual mandate is struck down by the Court. Because the Affordable Care Act was constructed from many pieces and no severability clause was included in the Act itself, the Court has been asked to determine whether striking the individual mandate kills the whole thing, only that part of it, or all of the patient protections contained in it.

Here's Justice Scalia's answer from page 73 of the transcript:

JUSTICE SCALIA: No, I -- that wouldn't be my approach. My approach would say if you take the heart out of the statute, the statute's gone. That enables Congress to -- to do what it wants in -- in the usual fashion. And it doesn't inject us into the process of saying: This is good, this is bad, this is good, this is bad. It seems to me it reduces our options the most and increases Congress's the most.

Throughout the arguments, this question was asked over and over again:

JUSTICE BREYER: But the -- the question here is, you've read all these cases or dozens. Have you ever found a severability case where the Court ever said: Well, the heart of the thing is gone and therefore we strike down these other provisions that have nothing to do with it which could stand on their feet independently and can be funded separately or don't require money at all.

The answer from all three lawyers is no, there is no other case.

Paul Clement, arguing for the NFIB (a Koch Industries-funded group, by the way), wants the mandate stricken, and argues that if it is stricken, the entire law should be stricken:

Now, in getting back to the -- an inquiry that I think this Court actually can approach, is to look at what Congress was trying to do, you need look no further than look than the title of this statute: Patient Protection and Affordable Care. I agree with Mr. Farr that community rating and guaranteed-issue were the crown jewels of this Act. They were what was trying to provide patient protection. And what made it affordable? The individual mandate. If you strike down guaranteed-issue, community rating and the individual mandate, there is nothing left to the heart of the Act.

H. Bartow Farr was appointed by the Court to submit an amicus curiae brief to argue that the mandate could be stricken and the balance of the Act kept without additional action by the Court. The most attractive argument he made (and I don't think it was all that attractive), was this:

Congress included at least half a dozen other provisions to deal with adverse selection caused by bringing in people who are less healthy into the Act.

There are -- to begin with, the Act authorizes annual enrollment periods, so people can't just show up at the hospital. If they don't show up and sign up at the right time, they at least have to wait until the time next year. That's authorized by the Act.

There -- with respect to the subsidies, there are three different things that make this important. First of all, the subsidies are very generous. For people below 200 percent of the federal poverty line, the subsidy will cover 80 percent, on average, of the premium which makes it attractive to them to join.

The structure of the subsidies, because their income -- they create a floor for -- based on the income of the person getting the insurance, and then the government covers everything over that. And this is important in adverse selection because if you do have a change in the mix of people, and average premiums start to rise, the government picks up the increase in the premium. The amount that the person who is getting insured contributes remains constant at a percentage of his or her income.

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The video above excerpts some of the excellent discussions on CSPAN surrounding the arguments taking place this week. I highly recommend it for an overview. The second part will be at the end of the post.

Today's arguments will center around the individual mandate, and Justice Roberts may have tipped his hat on a back-door reason to uphold the mandate. In Monday's argument, this exchange occurred:

MR. KATSAS: What the amicus effectively seeks to do is extend the Anti-Injunction Act, not just to taxes which is how the statute is written, but to free-standing nontax legal duties. And it's just -­

CHIEF JUSTICE ROBERTS: The whole point -­the whole point of the suit is to prevent the collection of penalties.

MR. KATSAS: Of taxes, Mr. Chief Justice.

CHIEF JUSTICE ROBERTS: Well prevent of the collection of taxes. But the idea that the mandate is something separate from whether you want to call it a penalty or tax just doesn't seem to make much sense.

MR. KATSAS: It's entirely separate, and let me explain to you why.

CHIEF JUSTICE ROBERTS: It's a command. A mandate is a command. If there is nothing behind the command. It's sort of well what happens if you don't file the mandate? And the answer is nothing. It seems very artificial to separate the punishment from the crime.

[...]

Why would you have a requirement that is completely toothless? You know, buy insurance or else. Or else what? Or else nothing.

As Brian Beutler noted, these remarks appeared to signal an alternative way to uphold the mandate:

That wasn’t what the challengers wanted to hear. A key feature of their argument is that the individual mandate is distinct from the fine the government will assess on people who fail to purchase insurance. They say the case isn’t about Congress’ power to tax or penalize people but rather about its power to force people to take actions they may not want to take. Roberts dismissed this distinction.

The question now is how far-reaching the implications of that dismissal are. It’s possible that Roberts was linking the mandate and its enforcement mechanism for the purpose of answeringa much narrower question — that it wasn’t a tip-of-the-hand at all. But if the two measures are linked, then the court could easily conclude they both stem from the same power, and give them the green light.

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Day One of the arguments before the Supreme Court over the constitutionality of the Affordable Care Act are wonky, but probably some of the most critical of the three-day stretch.

In a nutshell, they concern whether or not the parties have the right to sue over taxes not yet levied.

Via SCOTUSblog:

Section 7421 is actually a section within the Anti-Injunction Act that traces its origins to 1867; that law is often referred to as the Tax Anti-Injunction Act to distinguish it from another congressional enactment that is similar. Both have to do with defining the powers of the federal courts. The tax version is a part of Title 26 of the code of federal laws, and Title 26 deals only with tax issues. The section’s most important words are these: “no suit for the purpose of restraining the assessment or collection of any tax shall be maintained in any court by any person, whether or not such a person is the person against whom such tax was assessed.”

Before the words “no suit,” the section lists 12 exceptions to the ban that follows. None of those exceptions is involved in the health care cases, so they can be omitted from the discussion. Congress could, if it wished, eliminate the section as a potential barrier to the insurance mandate challenges, simply by passing a law to create a new exception just for that purpose; it has not done so yet, so the ban as written remains intact. It is important to note that when the section refers to “any tax” it only means any federal law, not any state law.

The quoted words of Section 7421 serve a basic goal of the federal government. As the Supreme Court put it in a 1984 decision (Bob Jones University v. Simon), “the principal purposes of this language” is “the protection of the government’s need to assess and collect taxes as expeditiously as possible with a minimum of pre-enforcement judicial interference.”

The heart of the question is whether or not a lawsuit can be brought before the tax under the individual mandate has been levied on anyone. If the court finds that this provision applies, then the arguments over the mandate are moot, and the court can move on to the Medicaid expansion in their decision process.

More from SCOTUSblog:

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The Affordable Care Act is working. 2.5 million more young adults ages 19 to 26 now have health insurance. The shrinking of the Medicare "donut hole" allowed 3.6 million seniors to save $2.1 billion on their prescription drugs last year. And the ban on insurers refusing to cover pre-existing conditions is saving lives (even among those who opposed so-called "Obamacare"). And even though most of its provisions don't go into effect until 2014, the data from Oregon and Massachusetts strongly suggest the 30 million people who will gain coverage will be much healthier and more financially secure.

In Massachusetts, the 2006 health care reform Governor Mitt Romney signed into law lowered the uninsured rate from 10 percent to a national low of two percent. Even with its individual mandate, "Romneycare" is extremely popular, enjoying a 3 to 1 margin of support from Bay State residents. Now, a new study by Charles J. Courtemanche and Daniela Zapata published by the National Bureau of Economic Research (NBR) shows that universal coverage in Massachusetts is indeed making people there healthier. As Ezra Klein of the Washington Post summed up their findings:

The answer, which relies on self-reported health data, suggests they did. The authors document improvements in "physical health, mental health, functional limitations, joint disorders, body mass index, and moderate physical activity." The gains were greatest for "women, minorities, near-elderly adults, and those with incomes low enough to qualify for the law's subsidies."

Importantly, the researchers concluded that "the general strategies for obtaining nearly universal coverage in both the Massachusetts and federal laws involved the same three-pronged approach of non-group insurance market reforms, subsidies, and mandates, suggesting that the health effects should be broadly similar." (Or MIT professor and architect of both laws Jonathan Gruber put it bluntly last year, "they're the same f--king bill.") It's no wonder Mitt Romney used to recommend his Massachusetts reform as a model for the nation.

If the individual mandate is one of the highest profile (if contentious) aspects of the 2010 Patient Protection and Affordable Care Act, the expansion of Medicaid is among the most important in enabling 30 million currently uninsured Americans to get coverage. By extending Medicaid coverage to families earning up to 133 percent of the federal poverty level (FPL) and providing subsidies to those up to four times the FPL, starting in 2014 the Affordable Care Act passed by Democrats in Congress will bring insurance to millions more Americans. A March 2011 analysis by the Commonwealth Fund revealed that when fully implemented, the ACA will bring relief to "nearly all of the 52 million working-age adults who were without health insurance for a time in 2010."

As it turns out, America's future is Oregon's present.

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The United States Supreme Court will hear arguments on some challenges to the Affordable Care Act in March, 2012, setting up the possibility of a ruling before the 2012 general election.

Via SCOTUSBlog:

The Court will hold two hours of argument on the constitutionality of the requirement that virtually every American obtain health insurance by 2014, 90 minutes on whether some or all of the overall law must fail if the mandate is struck down, one hour on whether the Anti-Injunction Act bars some or all of the challenges to the insurance mandate, and one hour on the constitutionality of the expansion of the Medicaid program for the poor and disabled. The Court chose those issues from appeals by the federal government, by 26 states, and by a business trade group. It opted not to review the challenges to new health care coverage requirements for public and private employers. It left untouched petitions by a conservative advocacy group, the Thomas More Law Center, and three of its members, and by Liberty University and two of its employees.

As SCOTUSblog notes later in the post, five and a half hours for oral arguments is unprecedented. Arguments on Citizens United were four hours long. It's clear the court realizes the importance of the questions before it, though not all questions are being considered.

Overall, it appears that the court has chosen to consider the Affordable Care Act in the context of the interstate commerce clause and states' rights, which frames not only the arguments over health care, but sharp differences between conservatives and liberals about the role of government in individuals' lives as well as individual states.

SCOTUSBlog:

Beyond the Court, there is a hot political debate going on across the country now on federal vs. state power, and the Court’s coming decision is likely to become an issue in that debate — especially since the final ruling is expected to emerge from the Court in June, in the midst of this year’s presidential and congressional election campaign.

From a political standpoint, it would appear that a ruling striking down the individual mandate would certainly energize a movement to move to a single payer model for everyone or at the very least, a public option, given that insurers would be bound to not exclude or charge exhorbitant rates for individuals with pre-existing conditions. If there is no individual mandate, it's likely that insurance would become unaffordable for everyone because of the adverse selection issues. If they uphold it, 2012 becomes even higher-stakes poker for conservatives, who will try to retake the House, Senate and White House to repeal the entire law.

As Ezra Klein notes in the video, it is possible they could simply say no one has standing to bring a case until the law is actually effective, too. If they were to do that, it would set up a situation where the provisions of the law become more popular as they become effective, which would make it more difficult for conservatives to repeal or limit it.

I will update this with more analysis as it's available.

Republicans are always happy when any attempt to help ordinary people is struck down by the corporate-owned courts. So this one's almost certainly going all the way to the Supreme Court!

Reporting from Washington— A federal appeals court struck down a pillar of President Obama's national healthcare law, ruling Congress does not have the power to require all Americans to buy insurance and setting the stage for a Supreme Court decision ahead of the 2012 election.

The 2-1 decision is a victory for Republican leaders in 26 states who challenged the law last year, testing whether the signature accomplishment of Obama's presidency would stand.

The Atlanta-based judges echoed the complaint that the mandate represents an "unprecedented" expansion of federal power.

"The individual mandate is breathtaking in its expansive scope," two judges of the 11th Circuit Court of Appeals wrote in their 207-page majority opinion.

Even during the Great Depression or World War II, "Congress never sought to require the purchase of wheat or war bonds, force a higher savings rate or greater consumption of American goods," they observed. Though Congress may regulate those who buy insurance, it may not regulate those who "have not entered the insurance market and have no intention of doing so," they said.

[...] The Atlanta-based court has a conservative reputation and had been seen as the best forum for those challenging the law. The majority was made up of Chief Judge Joel Dubina, an appointee of President George H.W. Bush, and Judge Frank Hull, a female appointee of President Clinton. The dissenter, Judge Stanley Marcus, was also a Clinton appointee.

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Credit: Boston Globe/New York Times

Ten years ago, George W. Bush was sworn in as America's first MBA President. Now, Mitt Romney wants to be the second. Two years after President Bush completed the worst economic record since Herbert Hoover, Romney the perpetual White House hopeful declared, "I spent my career in the private sector. I know how jobs are created and how jobs are lost." Especially, it turns out, the part about how jobs are lost.

Addressing New Hampshire Republicans Saturday, Governor Romney decried the state of the U.S. economy. "This is the Obama Misery Index, he said, "and it is at a record high. It's going to take more than new rhetoric to put Americans back to work--it's going to take a new president." In a Boston Herald op-ed Tuesday, Mitt regurgitated both his Obama Misery Index and "I know a thing or two about how jobs are created and how they are lost" talking points. At CPAC last month, Romney was clear about who that new president should be:

If I decide to run for President, it won't take me two years to wake up to the job crisis threatening America. And I won't be asking Tim Geithner how the economy works-or Larry Summers how to start a business.

If Mitt's line sounds familiar, it should. In his latest incarnation, the man Michael Kinsley deemed "the most transparent candidate" is once again campaigning to be America's CEO.

On the stump in Florida three years ago, Romney made the case that his Harvard MBA, his tenure at Bain, his Salt Lake Olympics experience and his stewardship of Massachusetts made him uniquely qualified him to lead during tough economic times. The multimillionaire venture capitalist told Florida voters:

"I know how America works because I spent my life in the real economy...I won't need a briefing on how the economy works. I've been there. I know how the economy works."

Days earlier, Romney offered the reader's digest version of his resume:

"I've spent my life, 25 years...in the world of business. I know why jobs come and go."

As his record shows, Mitt Romney is all too familiar with why jobs go - out of state, out of the country or just go altogether.

In 1994, Romney's career as a vulture capitalist boomeranged against him in his Senate race against Ted Kennedy. The tale of SCM, a northern Indiana-based stationery company purchased by Ampad, a firm owned by Romney and a group of investors, came to dominate the campaign. As the New York Times recounted, in that instance in the vulture capitalist label was well-earned in the subsequent crackdown on the workers there:

Management has shed 41 of 265 blue-collar jobs, cut wages, tripled some workers' health insurance payments, abolished most of their seniority rights and junked the prior management's union contract, which had two years to run.

Romney's record in Massachusetts also loses some its luster upon closer inspection. While his campaign this week boasted of creating 57,600 jobs during Romney's tenure from 2003 to 2007, Northeastern University economist Andrew Sum pointed out that Massachusetts' performance lagged well behind the national average. As Reuters reported:

"The state lagged the U.S. average during that period in job creation, economic growth and wage increases.

As a strict labor market economist looking at the record, Massachusetts did very poorly during the Romney years, he [Sum] said. "On every measure you've got, the state was a substantial under-performer."

Two weeks ago, the New York Post, surely no friend of Democrats, documented Mitt Romney's career as a vulture capitalist. As John Kosman detailed, Romney didn't merely produce a "spotty jobs record" when he ran Bain Capital. During a time when he retained a controlling stake, his company reaped huge paydays on investments in firms that later went belly up.

For example, the leveraged buyout of medical testing company Dade Behring by Bain and Goldman Sachs in 1994 was followed eight years later by Dade's failure in 2002. But not until Bain Capital had extracted a rich reward:

Bain reduced Dade's research and development spending to 6 to 7 percent of sales, while its peers allocated between 10 and 15 percent. Dade in June 1999 used the savings as part of the basis to borrow $421 million. Dade then turned around and used $365 million from the loan to buy shares from its owners, giving them a 4.3 times return on their investment.

Bain's slash and burn business model didn't end there. As Kosman explained in the Post:

Bain in 1988 put $5 million down to buy Stage Stores, and in the mid-'90s took it public, collecting $100 million from stock offerings. Stage filed for bankruptcy in 2000.

Bain in 1992 bought American Pad & Paper (AMPAD), investing $5 million, and collected $100 million from dividends. The business filed for bankruptcy in 2000.

Bain in 1993 invested $60 million when buying GS Industries, and received $65 million from dividends. GS filed for bankruptcy in 2001.

Bain in 1997 invested $46 million when buying Details, and made $93 million from stock offerings. The company filed for bankruptcy in 2003.

Of course, Romney's tenure at Bain also produced some big wins - and job gains - at firms like Staples and Domino's Pizza. But as it turns out, Romney's old employer was also creating jobs in Iran.

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The SCOTUSblog reports that the Affordable Care Act has survived the first round of court challenges intact. A federal judge ruled today that the mandate is a necessary part of the overall regulatory scheme and falls within Congress's powers to regulate commerce.

This is a lawsuit brought by the Thomas More Law Center, a right-wing Michigan advocacy group who proclaims themselves the "Christian response to the ACLU." They're funded by entities like the DeVos family foundation, Koch Industries and the Cato Institute.

From the ruling, with regard to the individual mandate:

There is a rational basis to conclude that, in the aggregate, decisions to forego insurance coverage in preference to attempting to pay for health care out of pocket drive up the cost of insurance.The costs of caring for the uninsured who prove unable to pay are shifted to health care providers, to the insured population in the form of higher premiums, to governments, and to taxpayers. The decision whether to purchase insurance or to attempt to pay for health care out of pocket, is plainly economic.These decisions, viewed in the aggregate, have clear and direct impacts on health care providers, taxpayers, and the insured population who ultimately pay for the care provided to those who go without insurance.

[...]

The health care market is unlike other markets.No one can guarantee his or her health, or ensure that he or she will never participate in the health care market. Indeed, the opposite is nearly always true.The question is how participants in the health care market pay for medical expenses - through insurance, or through an attempt to pay out of pocket with a backstop of uncompensated care funded by third parties.This phenomenon of cost- shifting is what makes the health care market unique. Far from “inactivity,” by choosing to forgo insurance plaintiffs are making an economic decision to try to pay for health care services later, out of pocket, rather than now through the purchase of insurance, collectively shifting billions of dollars, $43 billion in 2008, onto other market participants. As this cost-shifting is exactly what the Health Care Reform Act was enacted to address, there is no need for metaphysical gymnastics of the sort proscribed by Lopez.

Wonkroom has more on the ruling, and next steps.

Angela Braly, the CEO of Wellpoint, called for health care reform at a meeting in Indianapolis.

One of them most powerful women in the nation is calling for health care reform. Wellpoint CEO Angela Braly says she supports guaranteed coverage for everyone - as long as everyone gets and stays covered [...]

"The high and rising cost of health care in America is just not sustainable," Braly said. She said the current system, including Medicare, which is administered by the federal government, was inefficient and promotes quantity over quality. She also said it posed "a real threat to the social and fiscal obligations of the government and to the health and prosperity of the American people."

"We believe insurance companies have a role to play. We can and are making a difference," Braly said. She said Wellpoint's strategy was moving beyond processing claims and managing risk, noting employee incentives when customers get healthy.

Braly says the what worries her most about the plan currently under consideration is the "public option."

This is, essentially, the insurance company-approved argument for health care reform. They see it as forcing everyone to buy their coverage, making refusal to buy their insurance a crime, and offering no competition to their monopoly over it. I'm sure they don't want to see that anti-trust exemption of theirs lifted either, the one that has led to 94% of the individual insurance market becoming "highly concentrated" in the hands of one or two companies.

Braly kept talking about how the current system is inefficient and leads to skyrocketing costs, as if she has no agency over that whatsoever. There are issues with how the fee-for-service system promotes quantity of medical care and not quality, but that's due to the profit incentive, which is exactly the same in the insurance market. Braly's argument seems to be that it's doctors and hospitals at fault for chasing profit in health care, but insurance industry CEOs like her are good samaritans and innocent bystanders who just so happen to do the same thing. If a profit-driven health care system is wrong, then it's pretty much wrong across the board. And she actually advocated for an outcome where insurers would be "free to offer a range of choices," while worrying about a public option... which would just be another choice, one that could deliver quality coverage at a lower cost.

Braly tried to argue that health insurance profits aren't all that big:

According to Braly, the difference between the Medicaid or Medicare payouts and actual costs are shifted to the private plans, costing you $1,500 a year. Add that to the $1,000 a year shifted to the private plans to cover the uninsured and it costs you a total $2,500 a year.

"Sounds a lot like the Fannie Mae for health care and I think we all know how that experiment is going," Braly said [...]

"If you completely eliminated insurance company industry profits which is clearly the aim of some, you would pay for two days of health care in America and in the process you would eliminate the market mechanism to control costs and improve quality of health care being delivered," Braly argued.

I don't know what any of this means. The market mechanism in health care has not controlled costs in America whatsoever, yet throughout the industrialized world we see public programs that control costs and provide better health outcomes. Private industry has begged off completely from limiting health care costs through any means other than denying coverage to their customers and rationing. Health care spending in Medicare and Medicaid is lower than spending through the insurance market. And insurers have used the employer market effectively to confuse employers and employees alike about the true cost of their service. Braly throws out "Fannie Mae" for health care, but the current system is clearly "Goldman Sachs" for health care - where the relentless drive for profit at the expense of people creates a spending bubble that nobody ever bothers to burst until it's too late.

In the end, Braly calls Wellpoint a "supporter" of health care reform. That's funny, I would think that a company committed to health care reform wouldn't illegally force their employees to lobby against it.

Consumer Watchdog in Santa Monica has asked California Atty. Gen. Jerry Brown to investigate its claim that UnitedHealth Group and WellPoint Inc. pushed workers to write their elected officials, attend town hall meetings and enlist family and friends to ensure an overhaul that matches their interests [...]

WellPoint, whose Anthem Blue Cross unit is the largest for-profit insurer in California and employs 8,000, took a more overtly negative tack.

"Regrettably, the congressional legislation, as currently passed by four of the five key committees in Congress, does not meet our definition of responsible and sustainable reform," Anthem said in a company e-mail last week. The proposals would hurt the company by "causing tens of millions of Americans to lose their private coverage and end up in a government-run plan."

The appeals amount to illegal coercion under California law, Consumer Watchdog research director Judy Dugan said. "While coercive communications with employees may be legal, if abhorrent, in most states, California's labor code appears to directly prohibit them," said Dugan, citing sections forbidding employers from "tending to control or direct" or "coercing or influencing" employees' political activities or affiliations.

Insurance companies like WellPoint support health care reform, all right - completely on their terms, and guaranteed to provide them a financial windfall. Anything else would be unacceptable, and they will take any tactic - no matter legal or illegal - to stop it.