Now that I know the Supreme Court decision(s) on the Affordable Care Act will be public this Thursday, I've been able to overcome enough of my personal stress over the decision to step back and look at it objectively from a political
June 26, 2012

Now that I know the Supreme Court decision(s) on the Affordable Care Act will be public this Thursday, I've been able to overcome enough of my personal stress over the decision to step back and look at it objectively from a political standpoint.

Here's a fact: If the court overturns all or part of the Affordable Care Act, it works to the benefit of President Obama and Democrats, at least politically. It will energize his base and it will, I hope, energize all of us to work hard to toss those woman-hating corporate shill tea party types out of Congress and get one that would actually consider expanding Medicare or something similar.

If, on the other hand, the court upholds the Act in its entirety, including the mandate, it will energize the corporate nutbags to pour themselves back into the streets shaking their fist at things they don't really believe are all that evil for political showmanship and rabble rousing. This wouldn't be a terrible thing, except that Democrats and progressives have not been effective at actually communicating why this law is necessary and good and why it's good that the Court upheld it.

Greg Sargent's post this morning is a shining example of what I'm talking about. The most recent Reuters-Ipsos poll broke down responses to various questions about the Affordable Care Act by party. To no one's particular surprise, everyone hates the mandate regardless of party affiliation, but Republicans overwhelmingly supported the consumer protection provisions, including the ban on pre-existing conditions exclusions and minimum coverage requirements with no annual or lifetime caps. Overwhelmingly. Like on a near 2:1 basis kind of overwhelming.

As Sargent points out, they'd love the Affordable Care Act if it didn't have President Obama's name on it. Yes, our politics have sunk to a Kindergarten or perhaps even pre-Kindergarten level where substance is defined by who supports it. Me first! No, me!

Here's another fact: If the court overturns all or part of the Affordable Care Act, it hurts millions of people already benefitting from it, and hurts them in substantial, meaningful ways. If the Court overturns it in part or in full, people like me and my son will be excluded from the health care system in this country. That's just a fact.

Even if insurers are pressured to maintain the guaranteed issue provisions, there's no way ordinary people could pay for it, particularly working people without insurance who make too much for subsidies but not enough to be able to afford it. People like Susie Madrak wouldn't have access to those high-risk "bridge" policies that give some coverage until the full law takes effect. People who have babies born with handicaps might get coverage, but the costs will be too high for far too many of us.

Politics aside, there are no quick fixes if the court overturns all or part of the law, including the mandate. People will be immediately affected, and in ways too horrible to even think about. New York Times

The tumor grew like a thick vine up the back of Eric Richter’s leg, reminding him every time he sat down that he was a man without insurance. In April, when it was close to bursting through his skin, he went to the emergency room. Doctors told him it was malignant and urged surgery.

His wife called every major insurance company she found on the Internet, but none would cover him: His cancer was a pre-existing condition. In desperation, the Richters agreed to pay half their hospital bill, knowing they could never afford it on their combined salaries of $36,000 a year.

What do we do if the Court overturns it? We fight back. It should be clear to anyone observing that the single biggest and as-yet unspoken issue in this year's elections is the Supreme Court. There will be at least two appointments by the next President, and possibly more. Mitt Romney has already said he thinks Justices Scalia, Roberts and Alito are the perfect blueprints for his judicial appointments. And lest we forget, Robert Bork serves as a campaign advisor to Romney. The current conservative majority has pitched a perfect game this year for the U.S. Chamber of Commerce. Imagine what they could do with an even more conservative majority.

That's the politics, whether it goes for or against. On the personal side, it will be a disaster. As a resident of California, I might hope for the state legislature to implement it's own version of the Affordable Care Act to cover the fact that we've already spent a lot of money to get the exchanges up and running. Here's what the impact of the Affordable Care Act is on Californians:

The cost of treating the uninsured here currently is borne by taxpayers, as well as consumers and employers who pay higher insurance premiums to subsidize their care. California families pay an extra $1,400 each in annual premiums, on average, to cover medical bills of the uninsured, according to the California Endowment, a private health foundation.

The healthcare law that passed Congress in 2010 was designed to ease that burden by pumping in money from the federal government. California could receive as much as $9 billion a year to expand Medi-Cal, the government program for the poor and disabled, according to estimates from the Kaiser Family Foundation.

An additional $6 billion a year would go directly to low- and middle-income people who buy subsidized policies through a state-run exchange that would open in 2014, according to calculations from the Urban Institute.

A Supreme Court decision to toss out the law would turn off that federal spigot.

"California would be a net loser if the court overturns the law, because it stands to receive such a big flow of money for the uninsured," said John Holahan, director of health policy at the Urban Institute, a Washington think tank.

Still, several of the federal law's more popular insurance provisions, such as guaranteed coverage for children and allowing young adults up to age 26 to stay on parents' policies, will remain in place because they are required by state law now. And some of the nation's biggest insurers have already agreed to continue other benefits such as mammograms, diabetes screenings and other preventive care at no cost.

But without the federal law, insurers could still deny coverage to Californians because of their medical histories or exclude pre-existing conditions from their policies.

In the last legislative session, California Senators killed a Single Payer plan for this state because of the Affordable Care Act. It was a bogus excuse for many reasons, but the bottom line is that with that particular avenue closed at the moment, the ACA is our ticket to at least getting some kind of decent health care.

It's easy to get into the ebb and flow of handicapping the politics of a particular issue, but in this case, real people's lives hang in the balance. I don't know how the Court will rule. I could have told you six months ago that I was relatively confident they'd vote to uphold it, but with some of the rulings they've issued just in this term with regard to long-held precedents I can't really say that with any certainty.

Like everyone else, I'll be glued to the SCOTUSblog on Thursday morning watching the decisions scroll by while pretending anything less than full victory isn't the pronouncement of a life sentence on my family and friends. Stay tuned.

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