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Dude, Where’s Our Health Care Now? – A Timely Obamacare Update

Remember Obamacare? Despite President Donald Trump’s nonstop efforts to undo the Affordable Care Act (ACA, or Obamacare), it’s still here. And despite earlier debates over whether to “repeal and replace” it with something else, Congress may eventually decide whether to cement Obamacare in place and expand it.

Here’s the latest on the ongoing saga of the 2010 health care law that’s still being debated some ten years after it became the law.

Dude, why is Obamacare back at the Supreme Court (again)??!!
On April 10, 2017, Chief Justice John G. Roberts, Jr., administered the Constitutional Oath to the Honorable Neil M. Gorsuch in a private ceremony attended by the Justices of the Supreme Court and members of the Gorsuch family. The oath was administered in the Justices’ Conference Room at the Supreme Court Building. Chief Justice John G. Roberts, Jr., and Judge Neil M. Gorsuch in the Justices’ Conference Room, Supreme Court Building. Photo provided by the U.S. Supreme Court.

With Obamacare back in the Supreme Court, and with Trump trying to compel the Court to do in 2021 what Congress did not do in 2017 and 2018, we’re back to the usual pundit parlor games. Will Chief Justice John Roberts do again what he did in 2012, or will he finally give Trump what he wants so badly?

As we’ve previously discussed, California v. Texas (previously known as Texas v. Azar and Texas v. U.S. in the lower courts) is rooted in some very odd “legal reasoning” that constitutional law experts across the ideological spectrum reject. Basically, U.S. Attorney General Bill Barr and Texas Attorney General Ken Paxton (R) are arguing that because (the then Republican-controlled) Congress zeroed out Obamacare’s individual insurance mandate in December 2017, the entire health care law must be canceled. 

Photo by Jeff Kubina, licensed under Creative Commons, and made available by Wikimedia

Never mind that the U.S. Senate rejected legislation to repeal larger swaths of Obamacare earlier in 2017, and that Senate Republican leaders pulled similar legislation the following year when it was clear they still couldn’t gather 50 votes for repeal. After a Texas trial court judge called for the entire invalidation of the entire ACA, followed by the Fifth Circuit Court of Appeals sending the case back to trial court for “additional analysis”, the Supreme Court formally accepted this case this past March, and oral arguments will likely commence this October.

Even if Roberts again joins the four Democratic-appointed Justices to save Obamacare next year, the federal courts have already set a terrible precedent by treating extreme ideology-based rants as “valid arguments on constitutional law” rather than crass partisan attacks on what should be settled law. But if all five Republican-appointed Justices vote to strike down all of Obamacare next year, the Center for American Progress now estimates that 309,000 Nevadans will lose their health insurance as a result of Nevada losing Medicaid expansion and federal support for Nevada Health Link.

“Medicare for All” is off the table again, so let’s examine the Obamacare expansion that Democratic leaders are bringing to the table.
Bernie Sanders
Photo by Andrew Davey

While some on the left have expressed schadenfreude over Obamacare’s many courthouse travails, a Supreme Court ruling to strike down the ACA could also hamper any future effort to pass “Medicare for Allsingle-payer health care. But as long as the Supreme Court upholds Obamacare (again), single-payer will continue to face roadblocks as long as a critical mass of Democrats in Congress and/or the White House continue to reject it.

This brings us back to Obamacare. In East Las Vegas last September, former Vice President Joe Biden exclaimed, “I’m going to protect and build upon Obamacare. I’m not going to let anyone, Republican or Democrat, take it away. Period.” And now, the presumptive Democratic presidential nominee continues to promise a stronger Obamacare rather than any further “repeal and replace” or a “political revolution”.

While Biden’s health care plan seems quaint and small compared to progressive Democrats’ “Medicare for All” plans, we’re nonetheless talking about expansion of a health care program that has delivered the greatest expansion of health care coverage to Americans since the creation of Medicare in 1965.

What’s the Patient Protection and Affordable Care Enhancement Act, and how does it change Obamacare?
Photo by Andrew Davey

Rep. Angie Craig (D-Minnesota) introduced H.R. 1425 in February 2019 to boost consumer subsidies for Obamacare insurance exchange plans, such as those offered here through Nevada Health Link. This week, House Democratic leaders have advanced an amended H.R. 1425, the Patient Protection and Affordable Care Enhancement Act, that includes an 8.5% cap on the amount of income that consumers have to spend on a “silver” level insurance plan. 

In addition to the subsidy boost offered in Craig’s original bill, this new version (that’s backed by Reps. Susie Lee [D-Las Vegas] and Steven Horsford [D-North Las Vegas]) also establishes a new system of incentives and penalties to convince the remaining non-Medicaid-expansion states to expand Medicaid, reverses Trump’s rules that expanded access to “junk insurance” plans off the ACA exchanges, and grants the rest of the federal government the same power to negotiate lower prescription drug prices that the Veterans Administration (VA) already has.

While there’s zero chance that H.R. 1425 gets past the Republican-run Senate this year, let alone to Trump’s desk, it’s the clearest sign yet of what House Democratic leaders plan to do next year should Biden defeat Trump and Democrats take the majority in the U.S. Senate. It’s yet another reminder of the choice Nevadans and other Americans face this fall: Whether to risk losing all of Obamacare, or to “repeal and replace” anti-Obamacare politicians with elected officials who will make Obamacare at least a little better for a lot more people.

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