In a dark bar in Anyplace America, a Republican sips from a brew as he speaks to a fellow Republican:
“I want them to kill off Obama Care. It’s wrong. It was always wrong. It’s socialism, pure and simple. It smells pinko, too. Softies use it. Obama says the insurance companies can’t cancel me. If I’m already sick, they can’t kick me out. That ain’t right. It hurts the insurance industry. The billionaires should be able to cancel me. Otherwise, they lose money. You know, with my colon cancer, I don’t need coverage. Medicaid will take care of me. I’ll pay for some of my chemo. I don’t have a lot. I’ll pay what I can. And I got Jerry Falwell and Franklin Graham on my side. They’ll pray for me. You’ll see, prayer will fix cancer and if it doesn’t, I’ve got the ER room. Heck, I’ve got Trump. He’ll take care of me. He’ll take good care of me like he took care of the illegals. He really fixed them. He’s a businessman. He knows how to make a buck, to get things done.”
The two Republicans grow silent. They stare at their Republican faces in the backbar’s mirror. One of the them wonders if his face looks older.
24
So there are death panels after all.
19
Is this a GOP a “silver bullet” to shoot down the ACA: the Trump “tax cut” provision eliminating the mandate/penalty to buy insurance? Then the Texas federal judge, and now the Fifth Circuit, could void the ACA, costing 20 million fellow Americans essential medical insurance coverage, not to mention gutting its protections of public health through more covered people.
Could this have been a tactic thought up in a right-leaning “think tank” or by the likes of the late Thomas Hoeffler, who was the GOP’s guru on rigging electoral districts?
My family remaining in Europe in 1939 were murdered because they were Jewish. The Holocaust was cost- and resource-iintensive. Today’s GOP seems to want to return the nation to a smaller, more homogenous (white? "christian"? non-LGBTQ?) population, using malign neglect of social, sexual, and racial minorities rather than active murder. In other words, take away healthcare, Medicare, privatize Social Security, make the Voting Rights Act a sham, etc., in a diabolical game of social musical chairs to Make America White Again.
13
Strictly from a political standpoint, the GOP's goal of eliminating Obamacare is a loser---Knowing this it is a testament to the level of cruelty of both this administration and the party---
16
So they bypass congress and try to invalidate it by poison pill. Typical republicans.
Hey republicans. Vote on ending it the right way through congress. Stop being cowards. You hate entitlements step up and do it. Tired of you cowards.
12
The bozos who want to kill ACA are stupid. If they succeed the number of people walking around with a communicable disease will rise exponentially, increasing the risk of people catching a "bug" and spreading it far and wide, and hopefully to the very bozos that killed it.
8
Re: "...Will specious, bad-faith legal arguments prevail?" {P. Krugman}
...Have Republicans thought, through the politics of removing millions of Americans from health care insurance...and, thus...access to health care, during an, (impending), presidential_election_year??
11
Absolutely agreed! The Republican Party is hell bent on taking away affordable health insurance. Ignore whatever nonsense comes out of their mouths and simply look at their actions. We need to keep the ACA in tact and make incremental improvements. Also, let's lower the age for Medicare to 50. Then, let's have our representatives take steps to lower the actual cost of healthcare in this country, which is out of control. These would all be positive steps in the right direction. However, if Trump is re-elected then we will take a huge step backwards.
10
"Specious, bad faith legal arguments" no longer matter as the Republicans have been doing what they accused the Democrats of years ago; they have been packing the courts to "Legislate from the bench".
I think we should all prepare to defend our homes, selves, and families from the Republican stoked aggression just under boiling. To think the Republicans are not trying to kill the weak and infirm is now understandably naive and unwise knowing the history since 2010 and the ACA passage.
9
No employer in this country is required to provide employees with health insurance- not even the worst plans with $500-1000 per month premiums and $3000-5000 deductibles and $50 office visits (that don't count toward the deductible) before insurance kicks in.
Individuals complaining about Democrats trying to take "my" health insurance- is foolishness. The only entity that can take your private health insurance is your employer. Individuals foolishly believe they will always have the same employer, or another employer with comparable plans- or will never suffer an illness or injury leading to unemployment.
If you're out there rooting for the demise of the Affordable Care Act; you many be cutting your own nose to spite your face.
10
Ken Paxton, the Texas A.G (Republican) had a reason to file in a district KNOWN to draw a particular "conservative judge." The former aide to Sen. Cornyn, a 2007 Bush appointee, and member of Federalist Society -- Judge Reed O’Connor of the Federal District Court in Fort Worth WOULD KILL the Affordable Care Act (ACA); and that matched party wishes.
https://www.google.com/amp/s/www.texastribune.org/2018/12/19/reed-oconnor-federal-judge-texas-obamacare-forum-shopping-ken-paxton/amp/
When Trump ended the individual mandate, many younger, healthier, just-starting wages, and student-debt people WERE FREE TO LEAVE THE INSURANCE POOL. So, this Republican president created MORE difficulties with the ACA's insurance premiums
Now, many more people are not insured. They're at risk. Being uninsured is a BAD POLICY RESULT.
Judge Reed O’Connor was very wrong to kill a Congressionally enacted healthcare solution. Congress has the power to tax. AND Congress has the power NOT to tax. That power was not wrested from Congress. Judge O’Connor's reasoning makes no sense.
The ACA plane has millions aboard. Those who participated in its crash landing -- are in for, the rudest of awakenings.
8
and 3: 25 million Americans remain uninsured. We shouldn't have to wait for A.O.C. to give us a majority to see an improved plan or single payer passed in the House. The Democrats should have been promoting this legislation all along instead of letting the Republicans dominate with their neanderthal repeal narrative.
3
The main reasons we don't have affordable care in this country:
1. Corporations and rich individuals who make lots of money off inflated health care and selling worthless insurance;
2. The huge number of jobs that would be eliminated
3. Blind ignorance and intentional misinformation that prevent regular people from understanding how bad the US situation is compared to normal countries
8
Trump decided to throw the administration's support for this ridiculous suit because he thought it would never see the light of day and it would add to his support from the clueless. So what if it was thrown out? He would brag to his cult that at least he tried to make it happen.
Now let's talk about how this suit's final success would cut out the health care that millions of his supporters depend on and also cut his support not only from his clueless supporters, but also from many millions of independents who are on the fence about his re-election.
Remember 2018 Trump, when you lost control of the House based on you and the Republican's trying to trash Obamacare? Just wait till you rip insurance from 20 million Americans. It's a clear case of beware of what you wish for.
7
When are the average American voters going to wake up and quit voting these people into office? The current Republican party has completely imploded. They could care less about the welfare of the average American. Yet they keep getting voted back into office.
8
Destroying Obamacare may be red meat for the base but it will be political suicide for the Grand Old Party. If Democrats win in 2020 this could be one of the main reasons why. So whence all the complaining?
4
Republican politicians don't believe in the constitution, or democracy. They believe in the rule of Republicans. They will lie, cheat and steal in whatever way is needed to get it.
6
When it comes to healthcare the rest of the world looks at the US and scratches its head.
13
In the end the arguments do not matter, only the judges and as we know Mitch McConnell has been busy stacking the courts. When millions of trump supporters are thrown off Obamacare I can see the trump tweets now blaming Democrats. Nancy Pelosi we just cant wait until 2020, impeach this abomination now.
4
Still, Americans pay 10 times more for their drugs than Canadians. They live in the most extraordinary country in the world.
8
It is clear that the Republicans, and, especially, their Evangilical so-called "Christians," are running in the fear which began already in 1964-65 when LBJ signed the Voting Rights Act (Well, really, much longer ago than that, but space is short). The fear is that others beside good, Christian white Americans will begin to have some say in this country. They simply don't care about anything else, period. Health Care, forget it, when we die we got to Heaven anyway. Environment, forget it, Jesus is coming soon, we'll leave all of you Democrats behind. Fairness and decency, what's that when it comes to winning at all costs?
3
For America and the free world the bad news is that trump & his rep clan boys are not yet in a “death spiral”.
1
Please stop calling it Obamacare. It was the Affordable Care Act and that's how it should be referenced.
9
"it is no measure of health to be well adjusted to a profoundly sick society" - J. Krishnamurti
3
I hope the Courts uphold the decision and chaos results as millions lose coverage going into the election. Maybe that will finally shake Americans out of their idiocy of voting for Republicans (and do-nothing centrist Democrats).
4
The central flaw in the ACA is that private insurance companies control the individual market and even, in many states, the Medicaid market. These private insurance companies have one goal, making their stockholders (or their executives, for the supposed "nonprofits", more rich and powerful than we can imagine.
7
Perhaps, and I stress the Perhaps, the best thing would be for the ACA to be struck down.
First, as shown by the importance of health care in the 2018 elections, it would insure the defeat of Trump and many of the other Republicans.
Second, the resulting Republican defeat would clear the way for Real health care reform without Bronze policies and crippling deductibles.
Yes, 20 million angry voters would go without health insurance for a year, many of them former Trump supporters. Those in Kentucky might even reconsider their support for Mitch McConnell.
Historically, the only way dictators, and wannabe dictators, lose is when they push their people that one step too far.
Unfortunately, 20 million people losing their insurance might be required to break Trump, and the Republican's, hold on America.
And please, put away your pitchforks. I am not advocating for this, just encouraging people to think it through.
9
I'm not sure that Republicans really want to destroy Obamacare. This is all a show remember--like a sporting event without the talent--which is why we have a reality show actor as our president. Republicans want to appear to voters to be trying to destroy Obamacare because it shows they are taking on the other side--but my sense is that they actually want to fail, because if they succeed a whole bunch of people in swing states and swing districts will be mad at them, because they will be faced with the reality of no health insurance.
6
Very bad illnesses CAN befall perfectly healthy people and health care in this country is very expensive so for people like me Obamacare (the ACA) enabled us to receive life saving measures without having to go bankrupt.
Without the ACA my husband (who had a new baby to care for) would have had to sell our house to save my life after a rare pregnancy complication hit at the very end of my otherwise EASY pregnancy, nearly killing me 9 years ago.
Strengthen and expand NOT repeal and replace!
5
anyone with an ounce of common sense would see that in order to force insurance companies to insure people with pre-existing conditions you have to widen the pool of insured to include healthy people by requiring them to buy insurance. in many states people are required to purchase insurance in order to drive. being able to drive is in many of these states as important to living as is good health. if its constitutional to require auto insurance then by extension it should be constitutional to require health insurance. republicans are lying when they claim that they will implement health insurance that requires that pre-existing conditions be insured. their plan will allow insurance companies to charge so much for these plans that it will virtually impossible for 99 percent of people to afford them. once again the top 1 percent come out on top.
2
The one thing we can say with absolute certainty is that Republicans have absolutely nothing to offer on the subject of healthcare coverage.
The ACA, as professor Krugman suggests is quite imperfect, but literally a lifesaver for millions of Americans.
Reasonable people can disagree about how best to address healthcare coverage. There are now approximately 13 proposals in congress ranging from single-payer to modifications of the ACA. Virtually all of the discussion is from Democrats, while the Republicans continue to focus on how best to demolish the current system without regard to the consequences.
My conclusion is that the only hope of both saving the ACA for the short term, and later implementing a better alternative rests exclusively with the Democratic party. Therefore I suggest that all concerned citizens select a Democrat to support across the nation (Senate, House, Executive) and volunteer to help them get elected. Donations, phone banks, texting, postcards are all great ways to support campaigns. Groups like SwingLeft and Sister District Project can help ordinary citizens get involved.
If we fail to oust the Republican party from power millions of Americans are going to suffer and some will die due to their pathological desire to upend the ACA. We must not allow this to happen.
7
Thanks, Dr. Krugman, for another concise analysis.
Too bad that Trump supporters can't think as clearly.
What is wrong with keeping our entire population healthy? What is wrong with encouraging preventive care? With people going to urgent care centers instead of to emergency rooms?
I cannot fathom Republican "thinking". My mother voted Republican for many years, but I'm pretty sure she would not be doing so now if she were still alive.
4
A friend of mine who is a wealthy conservative summed up the GOP point of view when she explained to me, "Why should I have to pay for someone else's healthcare?"
7
It is simple. the ACA was Obama's creation so it has to be destroyed by the Republicans. There was an article many months ago about a poll on this health care law in the rural red states. When asked if the people wanted to get rid of "Obama Care" the Republican Rank and file almost always wanted to get rid of the horrible "Obama Care" but keep the wonderful ACA." Of course, the ACA and Obama Care are the same health care program.
5
The conservatives continue their relentless pursuit to protect the wealthy Libertarians by making sure government doesn't pay for healthcare. Their selfish cruelty knows no bounds.
7
Please. It’s not a plot against ‘Obamacare’ ...it’s a plot against the health, financial security and well-being of millions of Americans.
And please - can we stop calling it “Obamacare”? It’s the Affordable Care Act; it is modeled after what began as a Republican idea; it was duly enacted by a majority in Congress; and it has survived an endless onslaught of attempts by the conservative Republican minority to sabotage the legislation, before and after it became law.
8
Well, let’s see what the ruling is. I presume the Democrats including Krugman will follow the law. So, we fall back to pre-Obamacare...fine, then fix things, RIGHT
1
The effects on the insured of invalidating the ACA are so certain that subsequent mortality can reasonably considered murder. I suggest the ACLU begin putting together the case at the AGs and judges involved be so charged.
7
It's simple, this is darwinism (survival of the fitest) at it's best.
No health insurance = republican population control= survival of the fitest = save the planet.
"Activist Judges!!" Hello? Republicans? Nothing to say?
2
I suspect that if these partisan judges appointed by crypto-fascist politicians like Trump step too far over the line, there will be a civil war. At the end of that war, these judges will have ceased to exist as a genomic source.
3
As these hundreds of comments illustrate, everyone in the United States has a healthcare horror story, which is why this issue resonates so deeply with all of us. That is one reason why our ruling classes -- living in a bubble, and bribed by special interests -- are trailing We The People when it comes to support for issues such as Medicare For All. We cannot call ourselves a great nation if we allow our fellow citizens to be gutted financially when they're unlucky enough to acquire an illness.
6
With luck, the ACA will be struck down by the Supreme Court before the 2020 election, therby throwing the House, Senate, and Presidential elections (as wll as some state elections) to the Dems, freeing them to legislate universal health care.
10
There are two things that need to be said here.
First, it's not about 'them', it's about 'us':
https://www.theatlantic.com/magazine/archive/2019/07/american-health-care-spending/590623/
Second: Kaiser Permanente, absolutely the finest healthcare system in the world (unless you're American described in the article above and looking for a grievance). To keep this non-commercial I won't include a link, but you can search "kaiser permanente plans".
I am okay with single payer as a minimalist healthcare system, as all single payer systems eventually become, but anything that tends to undermine the care presently available to 80% of Americans is simply counterproductive.
5
I was discharged from the hospital this morning, having had a routine test yesterday (Heart Catherization involving emplacement of two stents); This was a procedure originally scheduled in April, repeatedly rescheduled because everyone wanted to make sure the provider would be paid.
It's not just the ACA, Republicans have FAILED to provide adequate resources across the spectrum in our health care system. In my case it was a combination of the VA (Underfunded, not incompetent), and disqualification from Medicaid for "Too Many Resources" (A Modest $2000 inheritance).
We can't all move to Canada.
It is the venal failure of Republican-Reptilian legislators to work for ANYONE but their donor class. They ALL need to go.
16
What's strange to me is how many Democrats want to get rid of the ACA. Every candidate who raised their hand at the debate to say they were pro-Medicare all and specifically would eliminate private insurance, as well as all progressives who consider support for Medicare for All a litmus test, are advocating the repeal of the ACA. Without private insurance, there is no ACA period. Medicare for all will allow Trump to perform political jujitsu, something he's really good at, and say, credibly for one, that it's Democrats who want to take your health insurance away.
4
@Matt Ward Medicare is by definition a public-private partnership. People on Medicare pay for a private Part B supplemental policy, and a private Part D drug policy. And if they want dental insurance, that's another private policy.
1
LOL, "plot against Obamacare." Obamacare is just an expensive policy, not a "right." The moment we can get rid of it, I am all for it. By any means necessary.
4
You'll find that this latest judgement from Texas is being criticised by very conservative legal scholars as being absolutely indefensible. The judge is a partisan hack, and will be overruled. You can't just stomp all over Supreme Court jurisprudence in a district court and expect your judgement to stand on appeal. You know, "the law", that inconvenient thing?
2
Let’s see.
Starve the beast.
Entitlements are socialism.
They want to cut entitlements.
What are the biggest ones?
Mitch McConnell Calls for Social Security, Medicare, Medicaid Cuts After Passing Tax Cuts, Massive Defense Spending
https://www.newsweek.com/deficit-budget-tax-plan-social-security-medicaid-medicare-entitlement-1172941
‘It’s Not a Republican Problem.’ Mitch McConnell Blames Entitlements for Rising U.S. Deficits – Fortune
https://fortune.com/2018/10/16/mitch-mcconnell-us-budget-deficit/
“I think it would be safe to say that the single biggest disappointment of my time in Congress has been our failure to address the entitlement issue, and it’s a shame, because now the Democrats are promising Medicare for all,” he said. “I mean, my gosh, we can’t sustain the Medicare we have at the rate we’re going and that’s the height of irresponsibility.”, said McConnell.
Write Pelosi. One of the reasons the economy is held up is because of government spending. Either raise taxes or cut the military from the house. Nudge the republicans to cut SS and Medicare. We all know they want to. It’s who they are.
1
If you could manufacture this overwrought, tired movement by Trump--Edsel? Can't let go of bad idea? Hopefully in 2020 America will finally realize Edsel Administration did nothing but Drain........
Almost all Democrat Presidential candidates want to get rid of Obamacare. They can’t agree on what to replace it with and how much taxpayers will have to pay. Will you keep your doctor? Will you pay less? But where have I heard “repeal and replace” before?
3
A few of the lies told in this propaganda piece:
In short, Obamacare is a success story.
But Republicans still hate the idea of helping Americans get the health care they need.
If Republicans did care, wouldn’t they have a proposal to replace ACA? As I stands, killing ACA will throw millions of Americans off of their insurance. That is a fact. As best I can tell, republicans are able to convince themselves that these people are on the dole, so throwing them off is okay, and nothing is actually being taken from them. Is that it?
1
Well, twenty million Americans have the healthcare they need from Obamacare. That's a lot of votes. Your presidential election might be rigged by having that ridiculously undemocratic electoral college, but there's also the House, and the Senate...
2
Republicans seem to have no clear message on what happens after Obamacare is found to be unconstitutional (should that eventuality come to pass). Their opinion seems to be that once the ACA is no more then "freedom in healthcare" will step in, which along with the "free market", will lead to some kind of capitalist/utopian healthcare system that's the best in the world. At best it is wishful thinking by arrogant and ignorant fools. At worst they actually know exactly how bad this could go for the common person and simply do not care.
Its similar thought process to our time honored tradition toppling unfriendly governments.
Step 1: topple government
step 2: ?????
step 3: Freedom shall miraculously spring forth.
in the case of the ACA, their opinion seems to be:
step 1: topple ACA
step 2: ???????
step 3: fantastic free market healthcare for all (except illegals, women who need healthcare, poor people, and the mentally/physically disabled).
somehow they view this as a winning formula. How any voter could see this and not run away in horror is beyond me.
Republicans are fantastic at establishing when they don't like something and want to destroy it. But they never seem to have any idea about which policy they'd like to put in place to replace it.
We used to say that the republican mantra for national leadership was "rule or ruin". However, they've grown up a little and have now established the general policy of "rule AND ruin".
5
Hopefully that 14% of Kentuckians who now have healthcare because of the ACA will connect the dots and vote loathsome Mitch out of office.
7
If they vote for Democrats, they will be voting to replace Obamacare with something else that no two Democrat Presidential candidates can agree on.
All one needs to know about Republican voters is that the like the ACA but hate Obama Care. "What?" you say. "But they are just two names for the same law?" Now you know the mind of the Republican voters. Put Obama's photo on milk cartons and the Republicans will stop drinking milk.
8
So true. (As would Democrats on anything labeled ‘Trump’. Just look at voting records on border security and Obama’s record on deportations.) We all seem to immediately retreat to our respective tribes. But healthcare should really be a Republican front-burner economic issue: entrepreneurship and the gig economy cannot flourish if healthcare is still a huge uncertainty for would-be entrepreneurs. Many will not give up their company jobs to retire or start a new business venture specifically because of the prospect losing their healthcare coverage. While I do not subscribe to the progressive ‘everything-free-for-everyone’ unrealistic promises, I am disappointed in the lack of an economically sound Republican proposal. If there ever was an issue that begs for an intelligent, well-reasoned bipartisan solution, healthcare is it. Let’s push the politicians off the ideological pedestals for a moment and come up with something workable. Not perfect, but workable.
Does the GOP do anything other than defend rapists and pedophiles, abuse refugees, and try to take people's health care away?
How is Trump's approval rating higher than ever? I don't get it.
8
And if the ACA were eviscerated in the 5th Circuit, thence that evisceration were affirmed by 'dint' of favor from Scotus's 5-"Catholic"-Male Majority 'Donor Worshippers' (whose catholicity is "universally" republican), thence Congress, meaning to 'reconstitute' the constitutionality of the ACA , reinstated Scotus's former ACA "tax equivalent" in the sum of 1 U.S. dollar -- and if trump were impeached and convicted -- and then pence, fearing he might not stand a chance in 2020 otherwise, signed the 'reconstitution' into law … Would we then have 'our' ACA 'back'? Automatically? Only upon some subsequent court petitions ending with an 'ACA-favorable' Writ of Mandamus?
@Thomas Murray
I don't expect this follow-on will be published … but and nonetheless, I wanna make a record of the fact that I wish my "then pence" clause had been structured to allow me to 'use' the preferable "thence pence."
(I coulda just 'dropped' the "then pence"-preceding "and.")
I'm not a lawyer, but...
I'm not a scientist, but....
I'm not a doctor, but....
Can we please stop looking for advice from people who are not experts in the field?
2
That was a rhetorical device to emphasize the absurdity of the legal argument. Try to focus on the actual question.
2
The fact that Krugman can flowingly write "Republican judge" and not "Repulbican-appointed judge" reiterates a chilling fact: there is no longer any real separation of powers in the US.
3
Mr. Krugman:
You talk about "specious, bad-faith legal arguments" but don't seem to mind the lies told to support the ACA, like "you can keep your doctor."
3
There’s a difference between lying and not anticipating how the GOP would sandbag the bill by refusing to expand Medicare.
4
@James
Let's see, Obama told one lie, albeit quite a few times, when he said that, perhaps without realizing that the ACA legislation would eliminate many "budget insurance" plans that had high deductibles and were completely inadequate to protect the purchaser. And you care to contrast that single lie with a constant stream of obfuscation? The GOP had eight years to present an alternative plan, which they claimed over and over again to have, only to find out that there was NO PLAN, only the repeal of the ACA! I could go on about the lies of the current occupant of the White House, but that would be overkill. Believe what you wish. It is your right. But don't expect others to be persuaded by it.
8
The number of lies by the anti-Obamacare forces vastly exceeds the number of lies told by the pro-Obamacare forces. The number of retractions, corrections and apologies by the anti-Obamacare forced is very close to zero.
1
The brutal and inexorable logic of corporations assigns no value to human life or dignity.
The Republican Party would like to expand this philosophy to government.
I continue to have a lot of trouble figuring out why anyone votes for these cruel, bigoted, hypocritical ghouls.
5
The greed of the insurance industry is what keeps this country from moving into some form of socialized health care that works perfectly well in most of the advanced countries around the globe. Unregulated capitalism is what the Republicans, and a handful of Democrats, want in place when it comes to our way of governance. This plays right into one of the great American myths....That in America, anyone can succeed and become wealthy beyond their wildest dreams if they work hard enough!!! Just look at the insurance industry CEO's and moguls. Last year 62 insurance industry CEO's made over 1.1 BILLION DOLLARS!!! So there ya' go! The American dream playing out right before your very eyes. How could any self respecting American citizen ever look down upon these great giants of the American dream? Shame on you if you do. You are probably some lazy, shiftless communist or socialist looking for a handout instead of pulling yourself up by you bootstraps. What a LOSER! thinking like some kind of Democrat. So what if one in five Americans are struggling with medical debt. It's your fault you didn't work hard enough.
6
Like Inspector, Harry Callahan, said: "go ahead and make my day"...
The end of Republican Party...
1
I am a type one diabetic and cancer survivor. Kill my ACA insurance, you kill me because I'll never be able to qualify for health insurance again.
Canada is looking more inviting by the day.
145
Fortunately, Republicans have said many times that if Obamacare is replaced, preexisting conditions will be covered. Not one Democrat Presidential candidate, all of whom want to get rid of Obamacare, has been willing to support that.
4
@Richard Winchester
Yes, they said that. But they also said it will just be at a higher price (probably one no one can afford). But that's the Republicans for you. Shallow promises that mean nothing. And their fans just keep on lapping it up.
33
@Richard Winchester
Republicans never offered replacement in
any Bill.
That is why McCain voted “No” for so-called skinny repeal measure presented to senators hours before their vote: hobble the ACA and then start to craft an alternative.
26
I am very sympathetic to the plight of the millions of Americans who desperately need health insurance, who would be thrown off insurance if the ACA were eliminated. But then, it would be interesting to see what American voters would do if the ACA were eliminated and the Republicans have nothing to replace it. In addition to the 20 million who would lose coverage, tens of millions would realize big increases in their insurance premiums. Tens of millions more would be tangentially affected when family members, neighbors, and friends lose their insurance when they need it most. If health insurance was a big reason Democrats won in the mid-terms, how would these many-millions of Americans vote in 2020? Would this be the final death of the Republican party as we know it?
5
I have read all the NYT Picks and am amazed that all of you obviously intelligent people are unable or unwilling to accept the truth staring you in the face: the republican party does not care if people die. It does not care if you go bankrupt. It does not care about anyone in this country except themselves and their hate-filled narrow concerns - power for them and money from their ideologue donors. That's it folks. There is no compassion, no patriotism, no humanity, no decency, none of the values you demonstrate. They are monstrous and have been plotting for years to establish minority rule of the heartless. Now they have it and we must wrest it from their evil grasp.
273
@hazel18
True.
Democrats and liberals (of whom I am one) still maintain that both sides are equally good and bad, bipartisanship can occur, consensus can be reached, people can be reasoned with, all people are good in their core.
No amount of public statements and actions to suggest that republicans hate the poor, hate everyone not them, want to deprive them of sanity, health, and a clean environment, and make sure that all goodies produced in America go to them and no one else - serves as evidence of their evil intents and actions to half of America. Democrats lose gloriously because one too many American is given to not just apathy, but thinks they are really really intelligent when they say things that blame both sides equally. The center left is soft pudding to the right that is all carbon steel, and ready to cut everyone other them then down.
23
@Kalidan
That's one reason we need a "hard" left. I don't mean an extreme left (using normal standards, not the ones of the right-wing broadcasters). I think Bernie or Warren would be "hard" in that sense. I don't think Biden has any of it in him. I suspect all the "moderate" Democrats of softness, of willingness to compromise on principles with the savage Republican party.
14
@hazel18 -- I must make one small correction, or addition to your comment. You write "the republican party does not care if people die". I think you have that only mostly correct.
Rephrase that with 'the Republican Party does not care if POOR people die' and you will have it just right.
16
If the ACA/Obamacare is unconstitutional, then it's time the scrap the constitution and start over. Many of the constitutional protections for average people have already been watered down by a reactionary SCOTUS. A great example is police allowed to search your car because of a broken tail light, was clearly a 4th amendment violation until it was watered down.
4
Think of health care from the corporate perspective. If corporations (insurance companies, healthcare providers, doctors, pharmaceutical companies) cannot profit from you, you should not have access to healthcare. Healthcare is not a right, it is a potential source of corporate profit, nothing more, and nothing less. Of course, the GOP obfuscates corporate greed with their mindless and cynical anti-big government posturing, god forbid big brother gets in the way of corporate profits. The GOP simply feels that if you are poor, or sick, or suffering from a pre-existing condition, too bad. Maybe you should have been born into a more affluent family. American government has long abandoned the working poor and struggling middle class in favor of their corporate donors. This is news to no one with even a passing interest in the topic, but corporate propaganda and disinformation, coupled with American narcissism and ignorance keeps an immoral, greed driven system in place.
Until, of course, your newborn requires major cardiac surgery....
5
If this suit wins in the Supreme Court, it will obviously be a hideous nightmare.
But it will also be a fantastic boon to the Dems in 2020, at all levels, not just the presidency. As 2018 has shown, nothing gets people off their duffs more than attacking their health care.
3
I don't understand why so many Americans trust insurance companies or any big corporation more than they trust the federal agency that administers the Medicare program. My husband and I have had Medicare (only) for nine years. It has covered my husband's three heart procedures and continuing heart care, kidney stones, my skin cancer surgery, screening colonoscopies, mammograms and Pap smears, and urgent care visits for miscellaneous ailments and injuries. We choose our doctors and hospitals and they accept our Medicare insurance. Everything ordered by our doctors has been covered and promptly paid for. By contrast, I don't have space here to describe our troubles with the private insurers we had through our employers. Please, fellow Americans who are still working, do yourselves and my children and grandchildren a favor. Support Medicare for All. You'll wonder why you were ever afraid of it.
261
@abigail49
Because so many have the entrenched belief that the government can never be trusted but the free market will force honesty from the private sector. Forty years of Reagan's famous "I'm from the government and I'm here to help" scare tactics.
While the trustworthiness of the government depends on who's calling the shots, you can count on a bottom-line-first entity to do the wrong thing for everyone but their shareholders pretty much every time.
31
@abigail49 I echo everything you say. My experience with Medicare and a good Supplement plan have been a relief after what I went through with private insurance, and I was relatively healthy during my working years.
25
We should be promoting innovation and creativity by allowing people to go out and try to make it on their own, rather than forcing them to be stuck in jobs they don't want simply because that's where the benefits are (mainly health insurance). We are eating ourselves from within.
Democrats should focus on health care and climate change: the health of our people and the health of our planet. Trump and his fellow Republicans have abdicated all responsibility on these fronts.
We need to take care of one another. That is the only true path to a vibrant and sustainable society.
271
@Blue Moon
Agreed. Trump voters don’t want to pay for someone else’s healthcare. They do, however, want that someone else to pay for their healthcare. So there you have it, not complicated really. Pathetic and ignorant, but not complicated.
31
@Lake Monster
Health insurance coupled to jobs is an artifact of wage controls implemented during World War II. There is no reason we need to continue with that today, except that over time it has become entrenched in American society.
We should work to shore up Obamacare first, eventually moving to single-payer; Medicare for All is too much for the immediate future, but it certainly needs to be our future goal.
People should be encouraged to do what they really want to do for a job; most will not make it and will have to take jobs they don't really want, so we don't have to worry about those jobs not being filled. Still, job freedom maximizes the chances for success in the pursuit of happiness.
Consider America and China. Both have longevity. But China is a dictatorship. The government promotes conformity: "the nail that sticks up gets hammered down." The Chinese are not free, many are not happy, and creativity is stifled. So what happens? China steals ideas from others by engaging in massive intellectual property theft.
America has a much more vibrant and sustainable culture and needs to foster its own citizens. That entails freedom with health insurance and a robust educational system. We don't just want to import ideas on genius visas. We want to promote creativity in the US population.
Single-payer will be key.
25
You fail to mention the thousands forced out of plans they liked simply because the government deemed them as substandard. These individuals were forced into plans they neither wanted or had benefits they needed Of course those higher premiums were relied on to make the ACA work
2
OUr whole legal system is built on the objective of removing bias, with stare decisis, legal reasoning, an appeal, and recusals for bias. Yet Trump got elected on a platform of picking biased judges. The worst legal opinion ever written was Bush v. Gore because it included a sentence that it could not be cited as precedent which indicates that it was the result of bias. Legislators can make a law one day and then make a contradictory law the next day without any justification. When the Supreme Court announced that its Bush V. Gore decision could not be cited as precedent, it was acting like the legislature. And using the courts to strike down Obamacare by selecting judges because they are expected to do so is going to ruin the vitality of our legal system.
3
The broken healthcare system that Prof. Krugman eloquently describes is a stark example of the hypocrisy espoused by those who otherwise sing the praises of the free market. There are clear benefits to a single-payer healthcare net that many European countries embrace. There are also clear benefits to a *true* market based system where real consumers (us) purchase healthcare at real market driven prices from insurance companies that innovate by pooling and managing risk. What we have in the U.S - the *employer* based healthcare system - successfully manages to achieve the *worst* of both models. And there are enough vested corporate interests who benefit from the status-quo to ensure that we will stay there for the conceivable future. Sigh.
3
The GOP wants a healthcare system that covers those members of society that it feels are worth covering. That would be the wealthy and powerful (of course) and those employees that are "productive" enough to warrant insuring them. Those employees are likely younger, better educated and of above average health. Providing health insurance for the productive also helps keep them from moving too often and complaining too much.
Their concern for human life and dignity ends there.
2
My wife and I have great healthcare plans that costs us each $100/month. Prescription drugs are free if generic and very cheap if not. Our healthcare is provided by Medicare and TriCare. Of course, there was an upfront cost. The upfront cost was 20 years of military service. But I loved my Air Force career. TriCare is available to military retirees, not to be confused with the. VA. There are no copays or deductibles to meet. We see any doctor we want, when want, as long as they accept Medicare patients. Of course, there was a year in Vietnam, which I was proud to serve.
4
Social Security didn't try a patchwork of private retirement funds. It has proven impossible to repeal or overturn. it appears that the FDR approach was more durable. There is a lesson here.
1
Switching to Single Payer would cut ONE THIRD of our annual health care budget in the country, totaling ONE TRILLION DOLLARS.
Americans can save ONE TRILLION DOLLARS EVERY YEAR by kicking the private health insurance industry (that provides NO health care) to the curb. Let's have these workers go out and find actual meaningful work. Not middlemen who just steal.
Will America wake up?
6
the drama south of our Canadian border keeps me riveted. I find it amazing that your society can function
10
Great job, Paul. Concise, clear and disconcerting! Hopefully Trumpians in West Virginia and Kentucky read your column. All the rest of us need to vote in 2020!!!
2
Anyone who doesn't understand Republican opposition to universal, single payer healthcare is not applying their priorities. They don't give a damn if people suffer and/or die. They want to reward the for-profit, Wall Street-driven insurance companies and the companies that surround them in order to get back a portion of that payoff money to put them back in office, give their families high paying jobs, erect tributes to slavery, and enforce the white supremacist doctrines they've held since our founding.
2
You'd think that only those who have enough money to provide for their health care and also lack any trace of compassion and empathy for their fellow countrymen would oppose the ACA or a better system than the private profit motivated system we have in the US. But you'd probably be wrong. I am baffled when I hear people who I know would be financially decimated if they ever had a significant health issue complain about ACA or any other alternative system that has been proposed. But it's because they have been conditioned by the GOP to think that way. Against their own best interests. It's why when Kentuckians were polled some time back they were in favor of Kynect but hated Obamacare. Kentucky is one of the few confederate states that actually did largely what the ACA intended by setting up their own state's exchange. And the people there LIKE IT as long as you don't call it OBAMACARE. Then they oppose it.
Democrats must learn from this apparent lack of mental clarity that affects many GOP voters. And Krugman's last sentence is the key. Just like the GOP is now starting to cry "They're coming for your hamburgers!" the Democrats must shout from the rooftops "They're coming for your health insurance!"
4
Helping middle class and lower class AMERICANS goes vs the grain of republican politicians as tax cuts for the rich and powerful are their only interest is tax cuts for the donor class. Trump was so jealous of Obama's popularity and how much he was admired he tried to destroy him with the racist Birther movement . Eliminating everything Obama has done to help the middle class ,fight climate change ,stabilize the Middle East Trump has been determined to unravel treaties that could help our nation did not matter . TRump's out of control ego trumps every thing the world has to revolve around Trump or he will insist reality does not exist.
2
@REBCO Yes. It’s envy of Obama, the Obama couple, and their wonderful children. Remember the famous ‘Jealousy (ie envy) is the green eyed monster that mocks the meat it feeds on’. To debase what you are envious of, to try to eliminate it is the hallmark of primitive envy. Mockery is one of the tools of debasement as is contempt. Contempt and omnipotent triumph complete the picture. Does it remind people of anyone we know? I won’t give you any clues, except it’s contained in the word ‘triumph’.
2
Private health insurance can work OK as long as it is non-profit as it is in Switzerland.
1
“Non-profit,” describes how a company’s incorporated, not that it doesn’t make money.
1
@JSK I can say that in Australia, private health insurance ( there are many companies such as BUPA), in my experience do not provide much except the possibility of a private room, priority in treatment of non urgent conditions (for example hernias, ingrown toenails etc) but there is no guarantee of these benefits. Basic Medicare, covers every basic treatment need. It has it’s flaws, but they are far outweighed by its advantages. The cost of private insurance is also very high, and the government does it’s best to try to control it by various pressures. All my relatives rely solely on Medicare, and have been well covered by it. So, no, private insurance does not work so well. I experienced the private insurance before Medicare in Australia, and whatever it provided me was propped up by government subsidies.
1
Do these federal judges have a conscience? I hope so. Otherwise, the lifespans of those residing in these United States will be shortened.
2
Trump and the GOP are very creative. Creative, that is, not in the sense of building networks and structures in society that protect amd save citizens from the evils that bring death and diminishment, but in the sense of wrecking networks and structures that advance the public good--especially anything constructive that the Obama administration made possible. We see this in regard to health care, the environment, and treaties that obivate war. There is one word that captures the essence of their machinations: evil.
3
During my career as a professional I had good, employer provided health insurance. Even then, there were issues of "in-network" providers, claims delays, claims denials, pre-approvals, coverage caps and other nuisances to deal with.
I now have Medicare with a Plan F supplement and Part D prescription insurance. I still have premium costs, but they are reasonable. Medicare with these supplements is by far the best health insurance I have ever had.
Speaking as a former long-time Republican, I simply cannot understand why (supposedly conservative) Republicans will not embrace Medicare For All. If we were to implement a single-payer as well as other countries do, we could realize net overall cost savings of at least $500 Billion ($1/2 Trillion) annually, cover all our citizens, and have better health outcomes.
Yes, we would pay more in taxes (call them premiums if you will) but we and/or our employers would not have to pay today's outrageous health care premiums. Nor would doctors, hospitals, clinics and pharmacies have to pay the costs of dealing with the myriad forms, delays, denials and recissions caused by private health insurance parasites.
9
Most other countries don’t have single-payer.
And Obamacare made recissions illegal.
1
I think that an attack add campaign in the next Federal Election, focussing on the immanent danger to Obamacare would be extremely effective. It would be true, create a lot of genuine anxiety in potential lower income current Trump voters, and it would be very hard to refute. Conservatives do not have a leg to stand on with this issue. It forces them to deny, backtrack and in a sense it’s an issue that they cannot win on. Democrats...go for it!!
6
This issue is a good example of the breakdown of our system.
5
It's depressing to think, but probably likely, that all those benefiting from the ACA in West Virginia and Kentucky would probably blame the Democrats if Trump and the GOP were successful in taking away these benefits.
10
Not sure where Krugman thinks premiums have stabilized. Here in Pennsylvania they just keep rising. The two dominant insurers in Western PA just keep duplicating services and premiums just keep rising. Obama and the Dems built a system with no teeth that just keeps rolling in profits for the insurance companies and slowly prices out healthcare for the self employed and others who aren’t covered by a corporate plan. They had a great opportunity to institute single payer and they blew it.
2
Tell your Congressman to endorse HR1384 the House Medicare for All Bill. 114 congressmen have already endorsed it.
3
@Wicky "They" didn't do anything. The Republicans blocked and blocked and jumped up and down like children to avoid any part in any health care program...and put forth no plan of their own.
It is imperfect and incomplete because only by the grace of God was anything created. The Republicans refused to take part in its formation and refused to even put out their own version of healthcare. They are to blame.
2
Actually medical cost increases have slowed because of the ACA and insurance companies are capped at how much profit they can make.
1
"I'm not a lawyer." - I guess that means that you tell the truth at least some of the time.
I look at most of what is going on as a smokescreen to keep people from focusing on the real cause of all sorts of problems -- the bloated defense budget.
Providing healthcare of the most minimal sort-- vaccinations, eyecare, (glasses and hearing aids should both be covered). contraception, meds for chronic conditions -- lowers costs -- by avoiding various kinds of potential catastrophes...
Trump likes to link the issue of healthcare to the issue of immigration -- whether families immigrate or not, vaccinations, care should be provided while they are in the refugee camp situation -- just as it is thru-out the world. (Another reason why population continues to increase. Fewer deaths in young children.)
"He's just mean." Might be the only explanation. OTOH the healthcare system itself is hardly angelic.We really should have single-payer -- whatever is this "I like my insurance" nonsense. Middlemen always raise prices ( I don't want to hear about negotiating for drug prices... Unbelievable... all of it.)
3
Republicans actually hate the idea of Americans getting any kind of benefits they need. It’s not just the ACA, it’s also Medicaid, Medicare, Social Security, etc. In short, if they can’t manage to privatize it and make a fortune off it while doing their best to prevent it from actually helping its intended beneficiaries, Republicans hate it. Republicans hate anybody getting government benefits of any kind - except, of course, for themselves. They pay all those taxes, so if the government is going to give away money, then it should rightfully go back to those who paid it. Giving it to someone else means that the government is stealing from them.
4
A court rules a fence can be built after lengthy litigation. It is being built, and other suits get dismissed. After the erection of the fence, it is determined to be 20 feet on other people’s property. It’s only 20 feet, and you approved the fence earlier may sound like a good argument. But the law could make you tear it down, or get an agreement from the other land owners to let it stay. Democrats should negotiate the ACA with Republicans. This isn’t the first lawsuit, but if you lose, it will be torn down. Subsidize people with existing illnesses, keep the 26 and under, require mobility, keep the Medicaid states are willing to subsidize, and leave everyone and everything else alone.
1
@Jay
Democrats should work with republicans says it all.
Because astute observers like Mr. Krugman and others have never actively supported a government sponsored, single-payer system, because it is so easy to convince some members of the public. so often scammed, that it will deplete the budget in spite of the fact every other major nation can afford it, when the enemy to health-care for all is so obviously a selfish oligarchic millionaire class, we continue to suffer half-way measures like Obamacare and the complete lack of medical care for so many who need it but can't afford it.
It's time for a general call by all those truly concerned to join the cry to bring Health Care For All and end this disgrace to our nation.
2
If the ACA is overturned based on these ridiculous arguments, is it over the top to wish that Republicans politicians suffer debilitating illnesses that bankrupt them? It seems that is what they are wishing upon the rest of us.
4
Americans, Wake Up!
Every other civilized nation on the face of the earth has national health care. All of them. There are 3 different kinds in practice.
America pays more for health car (18% of GDP) than every one of them.
Our health outcomes are worse.
Tens of thousands of Americans die annually from untreated diseases that are routinely curable.
No other nation practices medical bankruptcy...nobody.
Is this a GREAT nation?
Or what?
Pay more, get less.
Because the gop
3
The time has come for the Republican party to be thrown out of power and put out of business to the last man, woman, dog, cat and elephant. It has become akin to the British royalists who had to be removed by force in order for freedom to exist and develop in the US, and we are at that point again. Let's be smarter than the French and not wait so long to get rid of the rotters.
2
Everyone should go back and watch Michael Moore's documentary "Sicko." That was about people who had health coverage but discovered it was not what they thought and how even they were at risk of bankruptcy from health care costs. It is ridiculous that the US does not have a universal healthcare system (we do not have ANY kind of "system" now, just a conglomeration of different ways to get or not get it with huge holes to fall through). The fact is the experiments in various ways to have universal health care have been done by many other countries, from full government run service to full private run service with government regulation. It is all there. And is half the cost of our non-system. All we need to do is see which is best for us. What we have now is pathetic and stupid.
3
Repeal Obamacare and replace it with what? How come it seems no one has ever asked the GOP that question?
3
I wholeheartedly agree. Why is the onus always thrown back on the Democrats to figure everything out? The obstructive Republicans have done nothing but try to thwart the ACA’s growth, all on the assumption that they can devise a better plan. It’s been 11 years and I haven’t heard of one Republican plan. It’s partially the media’s fault, too. Reporters need to ask follow up questions (What’s your plan then?, What do you propose that can cover more people?, etc.) when some conservative starts bumping his gums, saying he wants his “freedom” back because some poor person may want need to see a doctor from time to time.
2
The Democrats had someone with vision and skill, who was a political genius who could get things done. Her name was Hillary Clinton. Yet they let the republican anti-HIillary campaign spread lies without any meaningful pushback. I am disgusted by what happened. I do know we would live in a better world today and she been elected.
3
Paul fails to grasp the extent of some voters' willingness to vote against their best interest. I'm not opposed to seeing the ACA dismantled since this will probably get many of the unenlightened to begin throwing Republicans out of office.
2
We will one day find a cure for cancer, but sadly, there will never be a cure for stupid. This cruel and immoral push to leave Americans without health care would be stopped dead in its tracks if GOP voters--many of whom depend on Obamacare or Medicaid-- demanded it of their representatives. They don't. And so here we are. If the GOP wins this case, and health care is thrown into the brutal chaos that would result, perhaps THEN Republican voters would finally get it and start storming their Congressional offices. But I'm not so sure even that level of pain would be enough.
And destroying heath care is only Part 1 of the Grand Old Party's grand plans for the 99%. With Trump's tax cuts exploding the deficit as predicted, they are only waiting to be in full control of government again for Part 2: the slashing of ALL social programs (I'm looking at you Social Security and Medicare) under the guise of "fiscal responsibility" and "living within our means," all to pay for the handover of nearly all our national wealth to the 1%.
2
What it boils down to is that Republicans have only one goal - to give rich people more money.
7
@Grove
More power.
To the point laws no longer apply to them. Unless it’s really really really bad and even the other people with capital think it has gone to far and might hurt them. Not that they care, it’s purely self interest not morality.
2
Life is THE pre-existing condition. Insurance coverage in this country is a fraud and racketing enterprise.
Millions are paying hundreds if not thousands a month to the medical-industrial complex for nothing more than a chance to decrease the likelihood that you'll go completely broke if/when you get sick.
It's called extortion.
3
The Republican Party is more Keystone Cops than Art of War. Why would you want the Supreme Court deciding on this issue prior to the 2020 Presidential and Congressional Election that you will be hammered on again?
2
I sadly dedicate this comment to my late friend Denise O., who had a pre-existing condition called "cancer", could not get insurance, and ended up with the "ER care" plan.
She died a decade ago.
There are many such stories.
How we could even consider going back to that embarrasses me as an American. And also as a New Orleanian, as the judges taking this seriously are my neighbors. Shame on you.
5
Krugman the Fake Economist strikes again--defending a socialist health care scheme that has done nothing but limit access to doctors and drive up costs. In other words, it's a precursor to what Liberals really want--single payer.
1
Who cares what you label it if it covers more people at a lower cost and provides better outcomes? It’s not fake news that all of the developed worlds’ national healthcare systems provide better outcomes at a lower cost than what we currently have in the U.S.
2
I’m just gonna tell you two basic things.
1. Plato had a point about a fundamental prob with democracy: people vote for stuff without voting for paying for stuff.
2. Malcolm Gladwell was right: you can build a system that gives a minority absolutely everything, or you can build one that provides decent coverage to everybody within limits.
You cannot have both. You cannot have a system that gives everybody everything without limits.
Anybody who tells you different is full of it, as is anybody who tries to sell you a syetem without clearly laying out costs, finances, and plan designs.
1
Speaker Pelosi needs to reinstate even a nominal fee for the individual mandate (anything but $0) as part of the debt negotiation to nip this nonsense in the bud.
3
Can we please stop calling it Obamacare and start calling it the ACA, or Affordable Care Act, as it is properly named. The Obamacare name is a constant irritant to Republican ears, no matter how many Republicans are covered. Many people do not know they are the same thing.
2
@JaneM
Oh tell us why it irritates them? Obama bin Laden. Born in Kenya. Not a citizen (Trump).
Racial Backlash Against Barack Obama - Washington Post
https://www.washingtonpost.com/graphics/national/obama-legacy/racial-backlash-against-the-president.html
1
Attacking the ACA is just a racist dog-whistle, a plank on the Make America White Again platform. Trump is trying to erase all traces of Obama, regardless of merit. And his minions love him for it.
It’s also convenient cover for the real story, which is 2 million more people are now without health insurance under Trump, due primarily to ACA sabotage. In 2017, we had the first increase in uninsured since 2010. Those 2-3 million on the exchanges who don’t get subsidies are paying much higher premiums
And there is no GOP plan; they nearly passed a bill that would have cost 20 million plus their insurance.
4
@David Doney
There never will be a GOP plan. It’s a total lie and anything they do will simply be an expensive money stream for already privileged people.
Mitch McConnell tells Trump the Senate will not revisit Obamacare repeal before 2020 elections
https://www.cnbc.com/2019/04/02/mitch-mcconnell-tells-trump-the-senate-will-not-revisit-obamacare-repeal-before-2020-elections.html
2
Paul writes: "In Kentucky, it (the uninsured rate) fell from 21 to 7. Whoever runs against the self-described "Grim Reaper" needs to put that fact on a loop for all Kentuckians to see in the 2020 elections.
4
If people in LA and NY are so impressed with Single Payer, why haven't you passed a law making Single Payer the law of your land?
This is pretty simple. Either CA or NY has the population to make this work.
Please? Set an example for the rest of the country. Ban private insurance in NY and CA...then let the rest of the country watch to see what happens.
That would be the moral thing to do...leading by example..yes?
1
I know that the ACA is a good thing and people should have a right to healthcare. But when you remind me that Mitch McConnell's voters and other republican state's voters like WV benefit the most from it while doing their best to dismantle it I'm very tempted to support them in their quest. It seems like it is high time for republican voters to suffer the highest price for their own stupidity. I no longer care about their suffering since seeing them support crooks, criminality, underhandedness and cruely. If evangelicals want to be saddled with unwanted children, bankrupted and begging for medical care then I want that for them. They should not be able to threaten our common standard of living and democratic system government without paying a very heavy price. If it's he'll they want, I'm becoming very inclined to give it to them.
3
@CR Hare
I’m in the same boat. Give them absolute pure unrestrained capitalism and zero military and subsidies to those states. No more socialism for them. Start walking the walk red state folks. Don’t like it, migrate.
1
I think that I just figured out the perfect health care plan for all Americans.
“Congress Care” !!
All Americans should have the same healthcare that is available to Congress People.
5
Can't help but ponder this: Are Republicans so adamant about destroying the ACA simply because it came about during the administration of a man of color?
4
@Alan C Gregory
See the tea party.
Racial Backlash Against Barack Obama - Washington Post
https://www.washingtonpost.com/graphics/national/obama-legacy/racial-backlash-against-the-president.html
Even though I use it andabsolutely need it, I find myself hoping the ACA will actually be overturned and that millions of Americans will suddenly find themselves without health care.
Because that would be the end of the GOP. Those millions of Americans who don't bother voting, or who vote Republican, would suddenly get themselves to a polling place and vote for Dems. We'd take potus, the house, the senate, the state governments--the whole enchilada. Americans are lazy and apolitical, but when it's literally their own lives on the line, they'll riot. Health care is this generation's Vietnam. The GOP know it, too, which is why they don't really want trump to do this.
5
Obamacare saved my life once, and possibly will again if it's still around. Sorry to disappoint McConnell and Trump, but I'm still alive, voting against them in every election.
I think they simply want to publicly vilify it, like good little Republicans whose first priority is to renounce anything Obama, without actually dismantling the program. They just want to *look* like they're against it so their voters will feel secure that they sufficiently hate our former and last legitimate President in whom the U.S. could take pride.
7
Two of our friends are Republicans and Trump voters. One is 75 and covered by Medicare while the other is 62 and covered by the ACA (Obamacare). Yet, they support Trump who wants to end their ACA coverage. I don’t understand why anyone would vote against their own pocketbook.
5
Apparently Mr. Krugman understands as much about the law as he does about economics. Although there is a certain logic to the law and general principles, silly results occur and it is up to Congress to fix absurd results, not the judiciary.
Under O'Care, the law required citizens and legal residents of America to purchase compliant health insurance from private for-profit and non-profit corporations. That was clearly unconstitutional. However, the federal government wasn't actually forcing individuals to buy insurance, it was asserting that either you do what the technocrats are ordering or pay a tax. So the 5-4 Scotus decision was the law was constitutional under the federal government's right to tax.
Obama asserted that absent the mandate and the push to induce individuals to purchase insurance or pay a tax that would burden them without providing any benefit, O'Care would collapse. That was their argument, which has now come back to bite them.
Krugman's argument that the deficit has declined because of O'Care is deceptive. Obama asserted that because of the cost reductions, computer recordkeeping, experimental package pricing and the like, federal government spending on healthcare over a ten year CBO estimate would not add one thin dime to the national debt. We are at $1.5 trillion and growing at year eight.
The political compromises that resulted in O'Care were entirely internal to Democrats. Obama couldn't even get 60 Dem Senators to vote for it.
5
@ebmem
"Obama couldn't even get 60 Dem Senators to vote for it."
Yeah, because after Teddy Kennedy died in 2009, before the final vote on the ACA, and Republican Scott ("I'll be NO vote number 41") Brown won the election in 2010 to fill his seat for the remainder of his term (to January 2013) THERE WERE NOT 60 DEMOCRATS IN THE SENATE.
Look it up.
3
Good economist, not entirely up to speed on state politics.
The reason there was such a huge improvement in coverage (especially through Medicaid) in West Virginia is that the governor was a Democrat when the ACA was implemented. It was the most whole-hearted embrace of the Medicaid expansion, from the first moment it was allowed, as you can imagine. They contacted everyone who might possibly be able to sign up by letter, by phone call if the letter was ignored, by follow-up letter, by follow-up phone call. They knew how important this was.
West Virginia is a complicated place and many were registered Democrats and still voting for a Democratic governor at the same time that they were shifting toward the GOP nationally. Remember too that one of their Senators, reelected in 2018, is a Democrat, Joe Manchin. So don't paint with too un-nuanced a brush.
To digress, I got a sense of the complexity of West Virginia on the Democratic side when I was doing phone calls as a volunteer for Obama during the 2008 primary season. The West Virginians were some of the best, kindest Democrats I talked to, whether or not they supported Obama or Clinton. I particularly recall a nice older lady who said "We voted for Bill Clinton and we have been waiting for years and years to vote for Hillary Clinton. But don't you worry, if your young man is the nominee, we will be very, very happy to vote for him in the fall."
2
Whatever happened to the idea of the public option? That seems to me to be a fairly simple solution. It's "public," so administered like Medicare, and an "option" -- no one is forcing you to do it. As a recall, during the ACA discussions, this idea was dropped pretty early on. A shame.
4
When the law is repealed the Republicans will not be able to act and replace the conditions for pre-existing conditions. Trump and the Republicans will then try to blame the situation on the Democrats. They are consumed with rolling back every initiative by the previous administration and care nothing for the disruption across the nation. We will see how McConnell does in Kentucky when the rate for no health care goes back up to 20%.
3
If this case gets to the Supreme Court, maybe it will give Roberts a chance to "redeem" himself.
2
Price controls have to be instituted, sorry but true
1
It seems like there ought to be some way to prevent no-chin Mitch McConnell of Kentucky from destroying more of the judiciary between now and when we win back the Senate....
1
[an addendum to my previous comment --
Krugman was only able to devote one clause to this point "it [the mandate] is hence unconstitutional, and so therefore is the whole law," (called severability) but some elaboration would be useful. The plaintiffs are claiming that all parts of the Act are so tied together that if one fails, it all fails. But, that's ridiculous. It makes perfect sense that Congress could require all health insurance to cover preexisting conditions and to create a market even if it wasn't able to require everyone to purchase health insurance. Those who did purchase it would get those benefits.
After I wrote this comment, I went back to the Supreme Court decision. The four rabid-right wing justices found the entire ACA unconstitutional. The individual mandate and the Medicaid expansion were NOT severable from the rest of the ACA. So, as ridiculous as that result is, there's ample authority for it.
@Neil COhen
Roberts initially believed the individual mandate was constitutional but severable...RBG convinced him that is was too important to the rest of the law to be dispatched with. Leaving Medicaid up to the states was the compromise along with his finding about the individual mandate.
2
Overturning all of the Affordable Care Act would reinstate the Medicare Part D Prescription Drug Coverage Gap (Donut Hole). Of all the tens of millions of people who have Medicare Prescription Drug coverage, I cannot believe that there is even one who would vote for a politician who supported bringing back that coverage gap, assuming that they are made to understand what the coverage gap would mean if they became ill. If the coverage gap does come back and if the democrats are smart enough to make that a central campaign issue in 2020, then I think they will win both the presidency and the Senate.
4
Not being a Chauvanist and believing in the full worth of women in society, I'm deeply troubled by Speaker Pelosi's lack of earnest defense of the Affordable Care Act she ushered through Congress. I am deeply troubled that there are no strong democrats heralding the wonders of the Act and the fact that the Republicans are actually trying to endanger all Americans and that the Democrats don't drive home the point that Republican voters are actually voting against their own lives. Speaker Pelosi must be a Robot. She must either fight or take flight from her perch and let a strong defender of all Americans lead. Krugman does a better job! It's not an apple on the desk but just the plain truth.
1
Under the ACA, insurers, including for employer-provided health insurance, have to:
- insure people with pre-existing conditions
- cover expenses without lifetime limit
- cover children up to age 26 under their parents' insurance
If the ACA is struck down, all of those benefits disappear.
As Prof. K mentioned, hundreds of thousands of people are now covered in WV and KY under provisions of the ACA, many for the first time in their lives.
Are people who lose their coverage if the ACA is struck down just going to "take it" or are they going to express themselves at the polls?
If the 600,000 or so people who gained coverage in KY between 2013 and 2019 lose that coverage, will they still support Mitch McConnell?
Time to plan to broadcast ads explaining who is trying to take away your medical insurance coverage, and if the ACA is struck down, "whodunit."
3
@Joe From Boston The doughnut hole also opens backup under Medicare part D
The taproot problem with the Affordable Care Act since 2010 is that it is not affordable unless one gets a government handout to pay the high premiums.
Nothing was fixed that's been broken inside the American health system since the 1960s. That would require taking on Big Medicine/the AMA, Big Hospitals (including now the problematic conglomerates owned by Vatican Inc.), Big Pharma, Big Insurance.
ObamaCare doesn't do any of that.
3
@Maggie It makes the "pool," bigger. Once the pool is reduced, premiums for those that don't get a subsidy will skyrocket. Also, those with preexisting conditions will be left in the lurch.
@Walter Ingram
ACA was never designed to do that. It was from inception designed by Obama industry consultants to be a tax on the middle class, especially the self-employed and small business owners.
It was sold under various lies and flat out subterfuge by the Democratic Party. Even today, many people on these threads still try to claim "but, but 22 million American got health care". Nope. Nearly half of all ACA sign ups already had health insurance, another 10 million were immediately shunted into Medicaid - esp. the able bodied millennials, with only 2 million receiving insurance who'd never before been insured.
* Insurance is not the same as actual medical care, so after 2010, ER visits soon skyrocketed by those 2 million receiving ACA subsidized (free) policies, because they wanted free *medical care* and had no intention of making co-pays or paying for anything.
1
You know, Maggie, Kaiser Family Foundation and this paper’s own “Upshot,” section (yay, Ms. Sanger-Katz), offer excellent primers on the PPACA.
I very strongly recommend that you read them.
Ironically, if the GOP succeeds in destroying the ACA, it will usher in support for a more comprehensive approach to guaranteeing health care. The clock cannot be pushed back by force, the country has already moved on, and the swell for Democratic control of all wings of government will be guaranteed. The GOP does not understand the limits to power. There are uses of power that increase your power, and there are uses of power that consume it. Eliminating the ACA is self-destructive.
3
Complete health care (not health insurance), which includes dental, vision and Rx care provided to all, would result in huge benefits to the national village. Dental care, for example, reduces the need for cardiac care down the road. People could get treatment for what ails them without worrying about payment, leading to less spread of infection. It would also mean jobs for health care workers, job that cannot be moved overseas. Also jobs in administration and clerical, but no CEO's making multi-millions annually. The better the general population is provided with access, preventive care and the like, the lower the nation's overall medical bill will be. It is all connected, one big, complicated and convoluted system.
4
I don’t understand. I’m a small business owner in a creative field and a high earner. Obamacare enables me to be independent and not have to work for anyone else. Aren’t the Republicans supposedly pro-entrepreneurship and business? If so, then why do something that stifles entrepreneurship and puts the burden of paying for health care on employers?
They might say they don’t want government to get too big but putting this burden on companies is not pro-business, and forcing people to rely on their employer for health insurance hinders entrepreneurship.
14
Thanks to continuous, heartless and malign Republican sabotage of the ACA, at the national and red-state levels, we may finally get what every American needs and deserves: peace of mind about their family's healthcare and an end to needless suffering and preventable deaths. As well-intended and progressive as the ACA was, to even get enacted, it had to let the for-profit insurance and pharmaceutical companies set their own prices to maximize their profits. It tells insurance companies who they must sell policies to and what they must cover but not what the premiums, deductibles and co-pays for their policies will be, and it gives pharma companies the green light to charge anything for any drug without competition from safe imports. No wonder so many working Americans still cannot afford insurance and so many others can only afford high-deductible plans that pay for nothing short of a catastrophe. No wonder so many workers are trapped in jobs like indentured servants to employers who pay 70% or more of those premiums as long as they don't get laid off, as millions did during the last big recession and will again in the next. There can be no real "affordability" and no peace of mind as long as profiteers remain in the driver's seat of our healthcare system. There will only be winners and losers, haves and have-nots, survivors and casualties. Every life matters. Medicare for All, now.
6
I do not believe there is a single program designed to protect Americans - Social Security, Medicare, Medicaid, Voting Rights, ACA - that has not been fought tooth and nail by Republicans. Why don't the people who would be most impacted by the loss of any of these programs - primarily those white voters without a college education - ever get to the point that they realize that every time they vote for a Republican they are voting for someone determined to take from them a program they desperately need?
10
Because the republicans fill their heads up with nonsense about how the democrats are going to take away their bibles and guns and make them all have abortions, that’s why. Not all republicans are low information voters but the wealthy base of the Republican Party make up such a small portion of the total vote that republicans have to mine the low information voters and religious right with scare talk to win votes. Those voters will only vote those social issues no matter what the republicans do to them.
1
I am an electrical engineer who, some years ago, worked on a C.A.T. (now called C.T.) scanner. Several of the design group met with an administrator from a hospital to discuss the possible purchase of a scanner by the hospital. At the time, and I believe it is still the case, the hospital needed to have a Certificate of Need from H.H.S. in order to purchase a scanner.
The administrator was asked if there was some federal law that prevented the hospital from purchasing such a scanner. The administrator answered that there was no such law or regulation and that the hospital could purchase a scanner any time they wanted to.
However, he explained, that without such a Certificate of Need, the hospital would not be reimbursed for using the scanner on Medicare and Medicaid patients. And since 50 percent of hospital revenues came from the Federal Government for Medicare and Medicaid patients, the hospital could not make a business case for having such a scanner without the Certificate of Need.
The point is that Medicare and Medicaid actually subsidizes equipment used for patients with private insurance.
Health care is not like other purchases. For one thing, there is no way of determining the cost of treatment. Likewise, purchasing decisions are different. When a man is told he may have prostate cancer, he does not go home and try to decide whether he should get surgery (or treatment) or if he should buy an SUV.
10
If any piece of legislation would be ruled unconstitutional, why wouldn't it be the tax-cut bill itself - which introduced the offending language to the ACA? Has anyone made that argument?
Is there another example of Congress essentially repealing a piece of legislation by rendering it unconstitutional through subsequent amendments? If this stands, it would seem to introduce an absurd parliamentary maneuver where Congress can repeal an Act by adding poison pills (that may even seem innocuous), and not actually be held accountable for it.
4
Taiwan, one of the most ardent anti-communist low-tax low-welfare states in the world, saw fit to implement a single-payer system. It enjoys extremely high levels of support and satisfaction. Co-pays are reasonable. Health standards are high and life expectancy is quite a bit higher than in the US. People strike out to start businesses all the time without worries over healthcare burdening that decision. Family impoverishment for cash-only health care is no longer a thing. It's called progress. It can be done in the US, but for it to happen someone (i.e., doctors, pharma, hospitals, etc.) may need to get a haircut. And that's why it doesn't happen, or hasn't happened yet. When trillions (yes, trillions with a t) are at play, resistance will be massive. Meanwhile, we struggle with declining life expectancies and awful outcomes, with some groups in some places faring no better than people in some of the poorest countries on earth. We also find ourselves fighting to defend half-baked policies like the ACA. Sad!
8
Taiwan’s system is excellent.
It also charges premiums that all are required to pay, and relies mostly on private providers.
2
Excellent indeed, and a model its angry neighbor across the Strait would do well to emulate.
1
There's one very compelling argument against single-payer in the real world. Estimates are that 1.5-2 million jobs would disappear, most of which are medium to high-paying middle class positions that generate a over trillion in household income and hundreds of billions in tax revenue yearly.
Wouldn't the smartest solution be a Medicare based public option with the inherent price competition that would go with it? Do we REALLY want the health care sector to go the route of the manufacturing sector?
1
How about if we re-deploy all those smart people who are now doing make-work jobs that actually IMPEDE good care, and instead have them concentrate on improving care? What a concept, health care sector work that takes care of people!
4
Paul, mea culpas aside::If The ACA was so great for the American people why did premiums continue to rise, coverage and availability of physicians (as they refused to accept pay cuts) diminish and all healthcare related stocks and CEO salaries went on a ten year tear - straight up. Single payer, totally eliminating private insurance companies from the equation, except for optional procedures like cosmetic surgery etc. as in some countries is the only answer. As long as private insurance paying higher fees to Doctors is available a public “ option “ won’t work, the docs simply go to concierge type operations or flat turn down patients with a government sponsored policy that pays less, they will serve who pays them the most, and BTW why are Medical Schools limited in how many new docs they can turn out, also if were so keen on immigration how about fast tracking a few million Doctors from Cuba or even India, I know they’re anxious to get on the American healthcare gravy train after receiving a free or almost free education in their Socialist, gasp, countries. The real argument is what do we do with the millions of unemployed in the insurance business, well Paul that didn’t seem to be a problem while you and Friedman were glorifying globalization: of course that was the lunch bucket crowd so they were expendable when factory jobs were going to China, well guess what it counted plenty, we’ve got Trump and a nation that is so divided a civil war would not surprise me.
3
Sure, premiums have “stabilized”. We are paying $1400 a month for two adults for a $9000 combined deductible.
4
@DC c
the results of the implementation of the ACA by state is complicated but overall premiums have fallen.
"Georgia uses the federally run health insurance exchange, so enrollments are completed via HealthCare.gov. Enrollment dropped by 16 percent in 2017"
Source: https://www.healthinsurance.org/georgia-state-health-insurance-exchange/
States that opened their own marketplaces had a slight rise in enrollment this last year by 1%.
States that used federal enrollment had drops. The fear-mongering by the Republicans is likely responsible for the lower enrollment, along with lower enrollment from fewer people needing help after the 1st years success. https://www.commonwealthfund.org/blog/2019/aca-marketplace-open-enrollment-numbers-reveal-impact
More people getting in the insurance pool would lower costs.
Your Senators are Republican so I think you should look to laying the blame for the high costs on them as well as your governor, Brian Kemp.
1
The main issues that the GOP has with ACA is the wealthy have to pay taxes to support subsidies, and insurance companies aren’t able to make as much profit.
8
"Will specious, bad-faith legal arguments prevail?" Sooner or later they probably will, since Republicans have a way at picking at things, real or imagined, and making them bleed; their idea of "first aid" is enlarging the wound and making it hemmorhage. Unless....
The only real medicine for saving the ACA is voting as many Republicans out of office as possible (starting at the top). Next, the new Democratic administration must support the existing law and fix what was meant to be fixed as the process went along. As passed, the ACA was meant to be a work in progress, not the end-all and be-all.
3
@CP It was a Democrat turned Independent, Joe Lieberman, who cast the deciding vote that killed single payer or the public option, Im sure he is living quite well as a suit representing Insurance companies in his home state today. Blaming each other and maintaining the status quo is a grand charade and won’t change until people face up to the fact, we’re being played by both parties and the money men behind them.
3
@Ted, but since we live in a two-party system, I'll cast my lot with the one that will probably do the least damage and the most to fix our problems - and it's not the Republicans. Also, as a two-decade plus former Connecticut resident, I never trusted Joe Lieberman to be anything but a DINO - Democrat in name only.
In the meantime, someone has to at least try to do something. Doing nothing accomplished nothing.
2
@CP I agree CP doing anything is better than doing nothing, at least we are allowed to participate in the process no matter how illusory.
1
The Federal universal healthcare act has become for us, unaffordable this year. We used to pay $325.00 monthly for my wife and myself. This year they wanted us to pay $800.00 monthly and our copayments and deductibles nearly tripled for medications and doctors office visits! We had to reduce from silver to bronze which pays for practically nothing!
And medications are for 90 day supply now, as if that cures an individual just using med's for 90 days! We didn't have health insurance before and now, this has become unaffordable.
5
@Robert,
There is no "Federal universal healthcare act."
The ACA is not for health care, but for health insurance, and is deeply flawed and inadequate for many people.
That's why a single payer system is needed.
3
@Jerry Engelbach I agree. However, given the clout the insurance industry lobbyists those critters will attempt to keep every penny of income they receive which would include those companies putting their noses into the single payer tent.
Single payer, if run by those companies, will have that pesky fable of intrusion into our healthcare come true only it will not be a government person.
Single payer to me means medicare for all, and, keep the private companies hands out of it.
If those companies still need profit then they can sell supplemental policies.
There has never been a pharmacy plan that’d hand out more than a 90-day supply, for some very good reasons that have zero to do with costs. Amd lemme guess: you’ve aged into the 55-64 age bracket, the most-expensive in health insirance.
And the fact that the ACA had limitations, and has been attacked for years now, does not logically lead to the conclusion that single-payer is the only way out.
It would be helpful if the COST of seeing a doctor and having tests was addressed. People don't want health insurance - they want health care.
5
@479 Are you sure of that people don't want health insurance?
What good will seeing the costs of care when one cannot afford the cost of care and needs charity care, a government program, insurance or bankruptcy.
I am 70. I have never been without some type of insurance be it employer-provided or government program of medical insurance.
So, please, provide the proof about seeing the cost vs insurance. Providing the cost of care does not solve the issue of bankruptcy caused by healthcare.
This all played out in Britain seventy years ago - differently.
Winston Churchill opposed universal medical care in the run-up to his 1948 re-election.
And lost.
Despite winning WW2 just a few years before.
He came back - and was re-elected this time - after becoming an ardent supporter of what's now the most-socialist medical system in the developed world.
The British understood that these people are not to be treated as heroes (even when they are) to be followed, but employees to be instructed in their duties, and fired if they fail to comply.
The British have better medical care because the government is afraid of its people.
The Republicans are not afraid of their base in Kentucky losing medical care because they are not afraid of their base. Their base elects them because their base sees itself as fighting for their beleaguered culture, fighting for America. No sacrifice is too great for that Great Struggle for Real America; not their jobs, not their environment, not their health.
They fought against the ACA as it was clearly described as helping them. They were utterly deaf to clear, written explanations of the benefits, totally credulous to the doom-crying.
After watching Trump's numbers not budge for two years of low comedy, previously-inconceivable corruption scandals, and revolving doors, it's now at least clearly pointless to reach them.
Every resource should be devoted to reaching others who can be reached. Get out that vote.
6
Single payer is not the answer. It would cost highly skilled professionals a fortune — $15,000 a year for a single $100,000 earner and $30,000 for someone earning $200,000 (the latter barely being middle class in parts of the country). It would devastate rural hospitals, also. Also, how can you possibly expect citizens to support the huge costs of single payer when Democrats demand we offer it for almost free to twelve million illegal immigrants?
2
And where did you get those numbers? Off some insurance company website? Or off the top of your head? Health insurance would probably be less because the pool would be larger. Also, if the part of your health benefits that’s paid by your employer is returned to you as part of your pay (because employer provided health insurance is a part of your, untaxed, earnings) it can be applied to your share of government supplied health insurance. Plus, if you are concerned about all that Republican drivel about ‘government making your health care decisions’ I’ve got news for you, your health insurance is already telling your doctor what he or she can do for any treatment you require. As for all those people who will be out of work in the insurance industry, no they won’t not if we have duel system like our seniors have today. Or they can go work for the government.
1
During the last presidential campaign many interviews were shown of republican voters who stated that Trump would not take away their health care that they received via the ACA (that is, if they understood they were getting it via the ACA!). Now that they have seen Trump and his judicial and political cronies doing everything possible to take that health care away, what will they do they think about it and what will they do in the next election? Any bets?
3
@Joe Rock bottom Same thing. Trump will tell them they will get better insurance. When it doesn't happen he'll blame the Democrats. They will then vote for him again.
1
@Joe Rock bottom,
Trump's troops tend to believe his lies rather than what's right in front of their eyes.
2
Trump has tried to manipulate the fed and markets through tariffs and trade to weaken EPS projections, create uncertainty to force Powell to cut rates. As much as I believe in the ACA, and as a premedicare retiree, need it, and value it, it would be the one thing Trump cannot control: the Supreme Court ruling either way. I do not believe Roberts will toss out the ACA. But tossing out the ACA in July of 2020, as example, would be the death knell to Trump and the GOP senate, more so than Mueller, or Putin or Epstein, et al.......tossing out Health Insurance in front of the election would sink him, so I'm torn on this one........
1
Not until America shifts away from a mostly oligarchic/plutocratic system of political representation where the wealthy select most of the candidates that voters can choose from, and those same candidates, when elected, focus on getting themselves reelected by catering to the wealthy, aided by mechanisms that allow them to consolidate their power by selecting their own voters by way of gerrymandering.
The system is more like the Russian system, and that would in part explain Republican's and Trump's admiration for its leadership and system of governance.
2
Your headline reads "The New Plot Against Obamacare."
Republicans nicknamed the Affordable Care Act "Obamacare" to ratchet up the anti-Obama passion within their base. They did not foresee that one of the most fired-up would become president and that their wish to end the ACA would become the president's command to the party because of the name they gave it. Republicans are now stuck with the job of killing the ACA by any means necessary, thereby taking it away from those already covered by it and leaving the rest of the uninsured in the cold as they already were. Fixing what needed to be fixed in the ACA would have been the most practical and logical way to close the coverage gap. It still is.
Everyone should have group health insurance, either private or public, irrespective of what it is called.
4
“I’m not a lawyer, but I’m pretty sure that if a legal argument has absurd implications, it’s an absurd argument.“ I’m not sure all that many lawyers would agree with you. At least not honest lawyers, possibly a small number.
To be brief: Being self-employed, I had an individual policy for several decades, and never met my high deductible. The ACA rescued me from the trajectory of premium increases that had tripled mine in the eight years preceding (from $280/month to $800+ for our family of 2, with a $6,000 deductible). Not to mention removing the lifetime benefit limit and the preexisting conditions exclusion, and expanding required coverage. Didn't solve the limited network problem, though, and I had to change insurers each year as they left the Exchange in our county. Finally, I aged into Medicare. HUGE RELIEF. "For all" would be a start.
11
Since the argument was made yesterday that the state of Maryland had no standing to bring the emoluments case against Trump, why can't the defendants in this case use the same argument and say the 18 Republican attorney's general have no standing in bringing this case because the ACA is a Federal law? Seems simple to me.
6
The essential problem is that Obama thought he could get around being criticized for taxing and spending by calling it something else. This is why the Republicans have been able to constantly challenge ACA in the courts.
The solution is to levy a real tax on the mega-rich, and spend real tax funds on the healthcare of all Americans. Taxing and spending are in the Constitution, because it is a basic function of government. A simple healthcare plan based on simple Constitutional principles cannot be challenged in the courts.
The good news is that it would be less expensive in the long run!
Dozens of other countries get BETTER CARE for LESS MONEY per person, by INSURING EVERYONE and using BEST PRACTICES, not corporate profits, as the basis for healthcare decision making.
The basic structure of health insurance precludes it from being a market good.
Competition requires large numbers of sellers. Insurance requires large "pools" of insured people to spread the risk. You can either have many insurance companies or large pools spreading risk. Mathematically, you cannot have both.
Each state only has a few insurance companies (that make huge campaign donations). Even if we took away the state borders from insurance, as Republicans propose, they would just consolidate into a few insurers again.
I believe in markets, but some things cannot be efficiently provided by markets. Comparing U.S. healthcare to European healthcare proves this. Do the research as I did.
2
Except for England, all the Euro systems rely on regulated markets.
" ... you should know that if Trump is re-elected, he will, one way or another, take away your health insurance."
Seems as if the Trump administration is planning their own loss in 2020. Loss of health insurance is a powerful motivator for voters. It is claimed to have been a major factor in 2018. Moreover, fear and hatred have been proven by Trump himself to be effective in stimulating voters.
So Trump should be paying attention. He's not. He's dancing with glee at the potential destruction of the ACA healthcare accomplishment of Obama. Trump hates Obama so much that he's lost track of the fact that he essentially wrote the quote above.
Democratic candidates need to use the contents of the line in quotes above. "Trump is now supporting a court case in the Fifth Circuit that will take your health care away." And so on. Fear tactics work.
5
Prior to the ACA, there was no healthcare for the people, even to say, something similar or better than the ACA.
Ever since the ACA was introduced, there was so much criticism, and attempts after attempts to repeal the law. Because, the Republican Party, felt it was unconstitutional. All that time, and continuing to this day, we do not see any alternative to the ACA, being presented to the people.
Today, approximately, 20 million Americans are covered under the ACA. Large numbers of those enrolled into the Plan, see the benefit, and understand what their plight would have been with no healthcare insurance. Premiums have stabilized. People feel comfortable with the ACA.
This being the case, why are we seeing so much determination to repeal or do away with the ACA?
Time to time, we do see experts comparing our situation with other countries. And, the argument that if several countries, large and small, provide some form of healthcare insurance coverage to the people, why is it a problem here in our country? It is so very disappointing, and now become a hopeless subject to talk about. The irony is that as always, our elected leaders, would spring into action to fix problems outside our shores. Yet, fail to seek the solutions for problems at home. Problems, none other than that matter to the people of this country, our leaders are expected to take care of.
2
I'm not a mean person, and I know having the Court declare the ACA unconstitutional would cause a lot of pain. I wonder, however, if for this to happen might not be in the long term best interest of the nation. Let Republicans have their way, and let Americans deal with the consequences. Of course, given recent experience, we know that a significant percentage of voters are incapable of connecting the dots.
1
In 1883, Ultra-reactionary Otto von Bismarck implemented the first universal national health care system and it is essentially the same system used not only in Germany, but most of Europe. It works.
Bismarck saw the benefits for national unity in universal health care. Doctors attended school at no cost, have no administrative overhead and are essentially free of law suits. The downside is that it is not as efficient as socialized medicine, e.g. Britain. But costs are still lower and the rapacious pricing of prescription drugs is not tolerated.
Our national fabric is falling apart under assault from the far right reactionaries who have less sense of national good that anyone in Bismarckian Germany or anywhere else.
Our Medical system is suffering from the continued assault from Republicans who are totally negative, resisting any policy that is good and rejecting the notion of appropriate proportational taxes.
They’ve created a dense tax system that makes it profitable for big money thieves to steal other people’s pension funds and shift the cost off to the government or just discard the retirees. Led by Mitch McConnell, the GOP goes after Social Security, Medicare, Obamacare and they lie continuously in the process. The poverty of our educational system is seen in the ignorant who support them.
There are relatively simple solutions to controlling the cost of drugs, but the same companies that negotiate with the governments elsewhere buy lawmakers here to stop it.
7
I’d add that McConnel, Trump et al are currently doing what the far right’s been doing to the NHS in Britain for years—strangle the funding, then run around howling about how it don’t work.
1
I've tried to figure out what the ideal Republican health insurance plan would be, and I think it would be a system like the private insurance we now have where insurance companies offer health insurance plans and consumers can shop around and find one they like. If the cost is too high, the consumer would go uninsured. Employers could offer insurance if they wanted to and the plans would cover as much or as little as the employer wanted.
Since Republicans object to any subsidy and resent contributing to anyone who can't pay, the uninsured would be turned away by doctors and emergency rooms, so that the better off wouldn't have increased costs to pay for the uninsured. Thus, the uninsured would get better or not at home, with just family members to tend to them, or if there's room for them, at a charity hospital.
I'm pretty sure that would be the most ideal Republican healthcare plan. Government has no interest in or responsibility for the health of citizens. We're all on our own. Have I got that right?
8
Right - but please also spell out the massive “hidden” costs - financial and population health - that would ensue. Because Republicans are selfish and will only respond if the neighbors’ measles or diabetes or preventable widow-and-orphanhood affects THEM.
1
@Ms. Pea,
Rep. Alan Grayson had the Republican plan reduced to a simple phrase: "Just die."
1
Why would ANY program benefiting voters (health care) be objected to by any political party (Republicans)? Why would Mitch McConnell ("In West Virginia, uninsurance fell from 21 percent to 9. In Kentucky, it fell from 21 to 7.") think it proper to disenfranchise so many citizens in his state?
4
One problem with conservatives is they hate anything that makes them pay directly, even if it saves them money overall. They'd be happier paying x amount in hidden costs than 30% less, directly. Call that what you will, but it's true.
6
Yes, the insurers are making money. And a lot of their ACA insureds are going broke from the exorbitant premiums and sky-high deductibles and copays and all the non-covered medications and services.
Yes, I’m grateful to have insurance. I’m healthy now so don’t need much care. But I’m uninsurable under pre-ACA conditions. If I ever get seriously ill I will be even more grateful. But you have to realize most ACA plans are basically catastrophic coverage, even if they don’t call it that.
I’m a fan of the ACA but sometimes I wonder if the Medicaid recipients have better coverage than I do.
It is high time for single payer or at least early Medicare buy-in.
4
I understand that Krugman isn't a lawyer, but I wish he had consulted one before he wrote this article, so that he could have articulated precisely why the G.O.P.'s argument (and the lower court's ruling) is so silly.
The doctrine at issue here is severability: Whether the fact that a portion of the ACA (the penalty-free individual mandate) has been ruled unconstitutional invalidates the entire law. Or whether, alternatively, the unconstitutional provision can be severed, leaving the rest of the law in place.
When answering the question, the court must presume severability--that the unconstitutional portion be removed and the remainder left intact. To overcome that presumption, the court looks to Congressional intent. That generally means guessing whether Congress would have eliminated the entire law if it had been aware in advance of the constitutional defect.
The reason this case is so straightforward is because there is no need to guess at Congress' intent. Congress debated repealing the ACA, then voted on repealing the ACA; that vote failed.
For a Court to now rule that Congress intended to repeal the ACA, when it in fact voted NOT to repeal the ACA, is ridiculous on its face.
8
How about we consider the idea that anyone who advocates taking away someone else's health insurance should first give up her own?
5
Perhaps this will be the catalyst that sweeps the GOP out of power. Getting rid of Trump alone isn't enough.
7
The challenge to ACA is all the more reason to begin extending Medicare. No point in having all the eggs in one basket. Lets get a couple of steps ahead of these guys instead of looking like a hooked trout out of water.
McConnell should be attacked by any means possible. One method is to start anti-McConnell groups in Kentucky. Take a page from our blessed CIA. He and his wife received some $25 million from one of the wife's family members. That can't be legit.
4
These Republicans get elected. Somebody out there votes for them. I guess there are a lot of mean people out there who, for some reason, enjoy hurting other people.
8
If a panel of judges rule in favor of the unconstitutionality of Obama care, The losing party can ask for a rehearing enbanc, which, if granted, means that all the judges on the fifth circuit will consider the case. Given the importance of the case, it is likely the case would go enbanc.
1
Healthcare for all Americans through ACA "unconstitutional"... Hmmm... It seems that us Americans look at the future riding a cart and a horse... as this constitution was designed in those times.
The Constitution can be a "clear and present danger" to the health of the Americans.
3
trump followers will be too busy cheering his bashing of liberals, immigrants, and gays in the military to notice he has taken their healthcare...... and by the time they. do notice? they will have been trained to believe that the democrats took it away by not working with the republicans.
5
If there were justice in the world, the GOP would manage to kill Obamacare and all those MAGA voters in Kentucky, West Virginia etc. would lose their healthcare until 2020.
When enough of them die off, then maybe the remaining citizens in those states will have high enough IQ's to understand what has happened and act on that epiphany.
Is this a callus calculation?
No, it is democracy.
2
I bet some of the folks in Kentucky who now enjoy ACA health insurance think McConnell is the reason.
2
trump followers will be too busy cheering his bashing of liberals, immigrants, and gays in the military to notice he has taken their healthcare...... and by the time they. do notice? they will have been trained to believe that the democrats took it away by not working with the republicans.
1
At another of his screaming turbine deafen-the-press news conferences, Trump just called this newspaper an "enemy of the people".
Good luck, America.
5
Healthcare may just help the Democrats win.
1
I could write a long, civil argument about this again, but I am SO tired of it all. So this time I'm going to say only ONE thing: Man, do I HATE these republicans....
6
Great piece. Well thought out and it clearly explains the thesis. Too bad it was published in the wrong place. NYT readers are all keenly aware of this. Those who don't read Dr K's NYT column are the ones who need this data.
This could influence some to vote in their own best interest. How do we get this information to those who need to know it?
2
When the Court made the dubious conclusion that the penalty was a tax, the liberals applauded the brilliant reasoning that saved a poorly written program they supported. Now that the same logic may destroy it, the arguments are specious and in bad faith.
As to the severability issue, the Court accepted the argument that without the individual mandate, the entire law would fail. That was a cornerstone of the effort to find legal cover for its retention. Now that it is possibly going to be cut out, that is no reason to eliminate the entire act. Consistency is not a strong suit, is it?
1
Dr. Krugman is right. If the Supreme Court were to declare the ACA unconstitutional (at the moment I lean to thinking that John Roberts believes that he needs to vote to find it constitutional, but you never know), the Trump Administration would propose to replace it with "voluntary" high-deductible plans that would exclude pre-existing conditions and otherwise offer minimal coverage, and whose premiums even so would be overpriced. Insurance companies would be allowed to reject anyone who they imagined might develop medical problems in the future. The Senate would pass the proposed bill on a party line vote and the House would defeat it on a party line vote, and Donald Trump would run on the slogan "the Democrats took away your health care". To the extent that the minimal policies could be offered without new legislation, they would be and few people would choose them because they wouldn't want to waste their money (and no subsidies to help them) on plans that did them no good. And Republicans would claim that this showed that most Americans don't want or need health care.
The Constitution clearly empowers Congress to impose taxes for measures to promote the "general welfare" of the populace. Republicans argue that Congress is not empowered to require people to be insured, only to tax them if they are not.
By what logic would the Founders have approved of a tax, the purpose of which is unconstitutional?
Congress MUST have authority to pass laws requiring people to do things in promotion of the general welfare (such as healthcare), if they clearly can compel such conduct through taxation.
2
Krugman was only able to devote one clause to this point "it [the mandate] is hence unconstitutional, and so therefore is the whole law," (called severability) but some elaboration would be useful. The plaintiffs are claiming that all parts of the Act are so tied together that if one fails, it all fails. But, that's ridiculous. It makes perfect sense that Congress could require all health insurance to cover preexisting conditions and to create a market even if it wasn't able to require everyone to purchase health insurance. Those who did purchase it would get those benefits.
4
One radical and draconian path to better healthcare for all would be to let Obamacare die (or wither and die); let the millions of people without affordable insurance suffer, especially those with serious pre-existing health issues; and then let the groundswell build for a system that offers universal government-funded healthcare along with the option of buying private insurance.
@Charles Michener Except that's not what will happen. We had that system, and the best we could get in improvement was the ACA.
3
The whole problem is that America monetized healthcare. If we considered such care on par with the protections we expect from our Armed Forces we wouldn’t be having this argument.
Jonas Salk never patented the Polio Vaccine!
5
I do not understand why supporters of the ACA do not point out that repealing the ACA would bring back the Medicare Part D prescription drug "donut hole"? As a lawyer and employee benefits professional for a career, when retirees (Medicare participants) indicate support for repealing the ACA, or for public officials who want to repeal the law, I would urge them to ask the question: If you repeal the ACA what are you going to do about MY donut hole? I would then add that for prescription drug coverage in Medicare the "donut hole is NOT a tasty treat".
5
"The first is that right-wing partisanship has already corrupted much of the judiciary."
The Federalist Society, Trump administration, and Mitch McConnell are collaborating to place rightwing ideologues into lifetime judicial positions every week. As of January, Trump was on pace to place more judges on the federal bench than any of his five predecessors. And McConnell has built what is in effect an industrial process to ram as many judges as he can while Trump is in office.
"A new analysis by Lambda Legal, which advocates for the LGBT community, reports that five of the country's 12 circuit courts are now composed of more than 25 percent of Trump-appointed judges."
https://www.npr.org/2019/01/02/681208228/trumps-judicial-appointments-were-confirmed-at-historic-pace-in-2018
7
So, Mr. Krugman agrees with the President? We have Trump judges and Obama judges? Or, maybe these are just judges making decisions Mr. Krugman doesn't like? Judge Englehardt (one of the two on the panel Krugman complains of) was a district court judge for 17 years, and was confirmed by the Senate - even in this environment - 62-34. He was deemed by the ABA to be unanimously qualified. The other, Judge Elrod, has sat since 2007, when she was confirmed by a voice vote (after the ABA rated her unanimously qualified). At a certain point, either we embrace we are a nation of laws - even if judges rule against us - or we don't. Me, personally? I think the Roberts decision was preposterous, that the ACA was constitutional as an exercise of the taxing power even AFTER SG Verrilli ARGUED BEFORE THE COURT it was a penalty, not a tax. But, I guess my view, too, is specious and offered in bad faith.
1
"...even though Obamacare is now part of the fabric of American life, even though many of the beneficiaries are Republican voters ... Trump and his party are as determined as ever to destroy it."
This makes no sense--unless the Republican Party does not even care what Americans want. Ya think!
I checked some polls, and according to a 2019 Kaiser poll, only 27% of respondents want the ACA repealed. Plus, a majority of Americans want pre-existing conditions protected, lower drug prices, something done about surprise medical bills, and they want the keep the ACA and want it expanded.
So what is going on with the Republican Party? Call it intentional GOP cognitive dissonance.
Red state Utah is an example. The day we arrived here in 2017, several neighbors came by, and each set said the same thing: Welcome to Utah; it is beautiful here, but the politicians are really out of touch with the citizens. Sure enough: Utahans voted in 2018 to expand Medicaid, but the legislature passed a watered down limited version that covers far fewer people.
The investigative question we need to get to the bottom of is:
Why are Republican politicians so against decent affordable health care for Americans and not only refuse to shore up some of the needs in the ACA, but are determined to repeal it?
And if Republican voters believe that Trump and Mitch McConnell will come up with a less expensive and better health care bill, I have a bridge to sell them.
7
The GOP's ideology is "life for one's self without others." For Trump it is the resentment of destroying all things Obama created. These two forces have wed. It is a socialism for the elite - tax breaks for the wealthiest, corporate personhood and unlimited financial control. It is not enough to be wealthy. In that ideology one must sit back and know others will suffer and die. The GOP has no better plan for health care. Health care will never be a human right under them. This is an old old plot - that of Aristocracies of days gone by - now returning once again. I watched a GOP Assembly in my state defeat the expansion of Badger Care. Naive citizens expect both parties to get over their differences, but the GOP is now solely corporate interest and anti-public. From environment to health care. This nation can afford health care for its' citizens. Right now "the wealth care" of GOP policies is taking us in the complete opposite direction. No doubt, this will be one issue at the heart of the 2020 election.
4
Dear Mr. Krugman,
Interestingly, NYT also has an article by Kalla and Porter titled " Politicians don't actually care what voters want." This is true for both Republicans and Democrats. Once in office, they become beholden to big donors ; and the interests of their constituents, and ultimately the nation, become secondary. No wonder, the word " politician" is not a complimentary term.
4
The ACA without the individual mandate may be constitutional but would it be viable? The purpose of the individual mandate was to create a more favorable risk pool which would reduce the cost of coverage for those electing to enroll in the program. Underwritten risk is fundamental to any form of insurance where premium cost is directly related to the makeup of the risk pool to be insured. How much of the ACA would have to be changed to make it "Affordable Care [Act]".
Can someone please help all of us understand what motivates Republicans to be so opposed to the ACA even when it's in the best interests of their own Republican voters? I get why they want to sow chaos and potentially deny healthcare benefits to Democratic states but what logic or conservative principle drives their obsession to work against their own voters and the American people in general? It doesn't make sense. And it's not enough to claim they hate it because of Obama. Self interest alone should counter that animus. I just don't get it.
3
I wish I shared Mr. Krugman's belief that the Supremes would refuse to relitigate this issue. Sadly there is now a majority on the court that seem more interested in payback than constitutionality.
5
@BC Indeed. Allegiance to the grifter is now due.
The individual mandate has cost me hundreds of dollars. With my spouse's income and mine (self-employed) we are just above qualifying for the subsidy. At my age the premiums for a market-based plan (with a big deductible) are now around $1400/month. So I've had to fork over the penalty for the past four years, for not buying insurance I can't afford. I can no longer support the ACA, and would be angry if the mandate returns. It's some form of single payer or nothing.
2
@RAC Remember when Trump promised a grand plan to replace the ACA and provide people in your situation relief. I remember and never anticipated the plan would appear.
3
Republican governance is premised on two rules, and two rules only:
1) No issue that distracts from their pursuit of eliminating every part of the social safety net is ever final.
2) if an issue is ever final, see rule #1.
Wait for a second Trump term, and as surely as the sun rises in the East, they will go again and try to eliminate Social Security and Medicare.
6
Let’s cut to the chase:
Healthcare is a huge business. A significant percentage of the Market.
Business means maximizing shareholder value (economic speak for who cares about anyone else).
Private sector has no business in Healthcare.
Research can be done by the NIH and the plethora of superb universities and medical schools funded by our tax dollars and/or charitable giving (tax deductible of course).
So what is the function of the private sector? Especially in insurance which is paperwork and nothing really innovative?
None that I can think of that can’t be done by Medicare administration (ok let google do something useful and give them some excellent software - tax deductible of course).
Write about these things Paul. You can do it best.
And support Warren/Sanders in whatever combination for 2020.
7
The GOP has never been a party that supports social services, which is why I can't understand why people would vote Republican in the first place. This op-ed only supports the fact that the party has become more cruel and heartless over time.
12
"Republicans still hate the idea of helping Americans get the health care they need."
[Trying to argue like a Republican here:]
Republicans are just trying to keep the government small; they don't want the government interferring with citizens' lives or the market, which is the best friend Americans have. Capitalism has raised more people out of poverty than any other system in history.
To portray Republicans as not caring about people is untrue and unfair because, one, they do care, and, two, real, long-term improvement comes only through the marketplace, where all prosperity comes from. (The government prints money, but it makes no profit; the money it uses is yours.)
And Republicans don't want to go further down that slippery slope where government is so big that it kills the goose laying the golden eggs.
Thus, to win this economic war, some casualties are unavoidable; but the end justifies the means. [Kant would hate that.]
Sadly, not everyone can live the high life, getting expensive medical treatment. Life is too restrictive. Therefore, some must bite the bullet so the vast majority can survive. But if it were feasible and rational, Republicans would have every American enjoy 100 percent medical coverage. As Jimmy Carter famously said, "Life is unfair." It is, and Republicans are ready to deal with reality, not impose unworkable theories.
[I did my best. Now maybe a real Republican can correct me. (Trying to think outside the box here; it's only fair to try.)]
@Jim Muncy: This is a mixed economy, as are most others. The public sector taxes and spends. That is called fiscal policy, and it keeps an economic flywheel spinning. The public sector synergizes with the private sector where it has not been subverted in the name of plutocracy. Here we're just the biggest funder of the global arms race and worst denier of climate change. There is no difference in the multiplier effect of the private spending of a person employed at a particular salary in the public or private sectors.
6
obviously you have always had medical insurance. I was just like you until, I wasn't insured. going into the market place b4 ACA was prohibitive, but I had to have insurance. it cost me $1600 a month for a plan with high out of pocket expenses. I was lucky that I had the money, $19,200 a year. think of all the American Citizens who couldn't afford that, are you willing to help them out,NO. thankfully a real president did, thank you President Obama.
8
Jim Muncy,
Do you feel that social security, VA care, or any other benefits are coming from the 'marketplace'? How about the government fumding the building of the NY Erie canal built in 1825, that the 'marketplace' could or would not fund?
Maybe we should dismantle the federal highway system that dame marketplace could or would not fund?
Why not get rid of it all? After all, if only capitalism has all the answers, such investments simply did/do not generate economic benefits that pnly advance the interests of a selected few only.
We should probably scrap socialist measures like California Prop 13, that seek to combat the market force impact of real estate prices (for a select few homeowners only).
1
It appears to me that all Trump wanted to do was to get Obama's name off of everything he instituted. He has systematically done that in most cases. He has a personal hatred for Obama which was shown early on when he came out with his "Birther" stuff. He has blasted Obama at every opportunity. When he said that he wanted to repeal and replace the problem and pushed that into the Congress, in fact, he had nothing to replace it with. The Affordable Care program got a lot of people into insurance that they could not otherwise obtain. I really do not have to work with the ACA or any other insurance company because I have wonderful care through the VA. Being totally disabled, all of my services are basically free.
Trump has also time and time again said that he instituted the Choice program. That was put into effect during Obama. Trump has this penchant for taking credit for things he had nothing to do with. He has replaced the Choice with another program and that will not work at all. For some inane reason, both the president and veterans think that they can get an appointment with a private physician quicker than they can with the VA. Let them try that! Private physicians and hospitals that have done business with the VA find that the VA is very slow pay. Private physicians and hospitals have a lot of expenses that must be met and slow payment does not assist them with taking care of those costs.
7
@Bill Dooley Daffy Donny expanded the Choice program thus he can now take credit.
And you are correct-the veterans who use the program will find it takes longer to be seen and are shown the door faster than a hobo in a fine restaurant due to the need to churn the patients to remain profitable.
ACA has issues. There is no argument.
And many will say socialized medicine is terrible.
Well, I am a beneficiary of socialized medicine for many years-VA, Tricare (military) and Medicare. And I have never had to fear a "death panel". The government has never intruded into deciding what care I can receive save for the exclusions with Medicare and Tricare-just as one would expect to see with private insurance.
2
With health care and other policies, we all must remember that, "vastly improving many Americans’ lives" has never been the GOP agenda. "Vastly improving" the lives of the .1 percent is the their unabashed goal and they have pursued this with alacrity.
16
"Yet, as I said, one Republican judge has already ruled in favor of this nonsense, and it looks at least possible that the two on the appellate panel will follow his lead."
I wholeheartedly agree with Professor Krugman's points on the ACA. But I'm sad to see him use the phrase "Republican judge." I would like to believe in Chief Justice Roberts's assertion that we don't have Republican judges or Democratic judges. But too often, I'm afraid this isn't the case.
5
All this conservative whining about Medicare, including charges of inefficiency and other lies regarding not being able to choose one's doctor and hospital is nothing but right-wing propaganda. For all of our working years my family had excellent health insurance, with- as the decades passed- the premiums split 50-50, 85-15, and eventually 80-20 between employer and employee. The insurance company was a non-profit, by the way. The transition from private insurance, thanks to Medicare's nearly 60 years of fine-tuning its procedures, was seamless.
Since we became eligible for Medicare, we have noticed NO difference in the quality of services. In some cases, the co-pays can be substantial, but they are fair and within reason considering the amount of the total bills. This includes a heart attack and several less serious but somewhat costly treatments, as well as preventative care and screenings. The premiums? $134 per month, each.
7
@malibu frank But, but the anti-Medicare for all, or socialized medicine if you will, has pesky government intrusion that dictates what we will receive and what level of care, along with Sarah Palin's death panels.
Yeah, right.
There is much focus on pre-existing conditions, but the ACA also prohibited annual and lifetime caps on what insurance policies will pay. If the ACA goes down those caps will come back, including for those people who, we are told, love their employer-provided insurance coverage.
Thanks, GOP zealots. Good luck everyone.
17
Absolutely. In my last job, which I lost before the ACA became law, I well remember the cap on health insurance benefits was $1 million. It sounds like a lot, but if you have the misfortune of being afflicted by a devastating chronic condition I’m sure it’s not difficult to exceed.
5
It's too bad the damage this suit will do can't be limited to the people who elected the politicians who support the suit.
15
@Theodore R Indeed. Many will pay for the "socialized cost", a cost spread throughout those who rely on the ACA. But, never fear, relief is near. Trump and his enablers in the GOP have promised there will be a replacement for the ACA. It will be called "Too Bad Medical Care". Too bad you don't have coverage.
1
"Insurers are making money and premiums have stabilized." And 20 million more Americans are now insured.
But the president and hardline Republicans still want to repeal Obamacare. Even if they don't succeed it will likely favor Democrats in 2020 elections as Healthcare is the #1 issue voters are concerned about. Despite the apprehension centered around the law suit that's a silver lining in this law suit.
8
Why is it that every act, (in this case The Affordable Care Act), that helps the people, the Republicans oppose with "it will bust the budget?" Yet, their tax cuts for themselves (and not the middle class), they always seem to push through?
15
There is a new rule kicking around under the radar and scheduled to go into effect on Jan 1 2020. It will allow employers to kick high cost (ie sick people) off of employer sponsored health insurance and only reimburse the cost that employee incurs going on the exchange. This will improve employer experience and thus lower insurance premiums for the company. It will also push sick people onto the exchanges and cripple that market. Another insidious Trump scheme to ruin rather than improve the ACA. Weak leadership from a weak and corrupt administration.
6
It is really scary when we refer to a judge as a "Republican judge," but under the Trump regime and the police state of Republicans, that is the case.
10
I still can't believe that there is no mass political retribution against the Republican party for what they are doing to America.
Do not the majority of the country including Republicans use the services they they want to eliminate? I would think that someday, they will put the cause and effect together and vote Republicans out of office for what they have done. At least I sure hope so.
7
@Charleston Yank, I agree with you. The American people ARE protesting and speaking out. The problem is that trump has drawn vile, powerful men around him, and they work toward one-party rule with slimy tactics and propaganda. (All Democrats are traitors, as is the free press we've had since 1700!) They ARE a minority, but they attempt to control media, the court system, the Supreme Court, the Dept of Justice. They LOVE minority rule, if they're the minority, dontcha know.
They shame and investigate law enforcement agencies that warned of Russia's efforts, and they laugh at us for wondering what trump, Putin and Kim say in secret. WE all saw trump and Vlad giggle about the stupidity of having a free press, but it just doesn't sway the followers of DearLeader. When trump's followers see him, they think he's the mightiest force on the globe, bless their hearts. His actual reality of a mob-style grifter who's desperate for inclusion in the golden oligarch's club is obvious to a majority of citizens. When the curtain is pulled back and the little pipsqueak is revealed, his followers hate all of us with a white hot retribution. trump is a gold-loving simpleton; we need to get past his daily tweet-fest and look instead at Miller, Bolton et al. They are very busy bees.
We will have to take to the streets by millions, to protest Miller and his fascists as they reach further and further into the heart of our values. Those who love America's highest goals are many in number!
This will be a test of the credibility of the courts. Americans are watching to see how thoroughly corrupt the courts are. When they start accepting ridiculous arguments to achieve political means, it will be time to dismantle the court system and start over.
8
@Doug K: Discrediting the courts is a plus for the overall republican goal of tearing down government and the rule of law.
2
As health insurance companies continue to buy up hospitals (own them!) it becomes more than iffy which hospital they will cover, and those that they won’t. Yes, private insurers can and will get vicious. Try getting a brain tumor in America and see how much they won’t cover.
6
What has the Republican party done in the last 40 years that has genuinely benefited the American people? I can honestly think of nothing. They are a party of sadists, extremists, and nihilists who work overtime to ensure that life for every American (besides the wealthy, of course) becomes more dire, more difficult to manage, more stressed, more precarious, more angry, more unstable, more polluted, more costly.
Our health "care" system in this country is a barbaric international disgrace. It's an extortion system that erodes or eliminates the quality of life for millions of Americans. It's a racketeering operation that forces each and every one of us into the cliche stick-up question: 'your money or your life?' Too often, we give up all of both. It's inexcusable on every level.
Medicare for All.
13
On the larger question of “The first is that right-wing partisanship has already corrupted much of the judiciary,” the Republican right-wing has corrupted the Wisconsin Supreme Court and restricted the powers of the state’s Attorney General. Wisconsin’s radical Republicans convened a lame-duck session to restrict the policies upon which our newly elected governor campaigned and won. Republican right-wing partisanship is a cancer at the state level in both the judicial and legislative branches.
7
Elsewhere on today’s print Op-Ed page, one can read that there is no statistical evidence whatsoever that any politician in the US cares what their constituency thinks. Who knew?
8
The sad irony in all these "goings-on" is that US residents who should benefit from health care pay the price of being denied what is a right in countries that consider the support of the well-being of their inhabitants to be a worthwhile endeavor.
I believe that no judge, politician, or other official in the developed world would attempt to deprive their residents of health care.
Shame on the USA!
7
The argumentative speciousness of today's GOP is concerning enough but equally, if not more so, is the clear evidence that the Republican Party, one of only two viable political choices in the USA, has given itself over entirely to angry cruelty on all matters of collective responsibility.
Conservative approaches to the economy and social organization should not worry us too much. After all, democracy mandates a rules-based competition of ideas. In a textbook world, sometimes you win; sometimes you lose.
Today's GOP, however, is ideologically anchored in nothing more noble than vituperative spleen and procedurally contempuous of constitutional guardrails, refusing to accept the possibility of losing and rigging the system to avoid it.
Any political entity that plays the mindless sycophant to Vladimir Putin and Kim Jong-un while routinely trashing the likes of Angela Merkel, Theresa May and Justin Trudeau is equally inclined to trash the tradition of liberal democracy at home.
Don't simply blame President Trump for this. Republicans found Trump to lure them into the dark netherworld of authoritarianism which is where they were headed in any case, not the other way around.
7
The hypocrisy of Republicans boggles the mind. They voted, futilely, to overturn ACA (Obamacare) 54 tines! Their attorneys general and the Trump Administration are prosecuting this case. Republican appointed judges have brought us to this place where we may lose the insurance coverage for pre-existing conditions, have reinstituted limits on coverage, and 20 millions dumped from insurance coverage in one fell swoop. Yet Mitch McConnell and Congressional Republican are acting like this is surprisingly happening to them and scrambling to assure constituents they will fix it immediately should it happen. Such cognitive dissonance! Only in America.
3
For those that don’t want heath insurance or coverage of certain conditions, when you get sick or are in a horrible auto accident and find you are not insured, don’t cry you need help with the hospital and doctor bills. You are on your own.
5
There are two solutions to the problems we face in the U.S. 1. Turn out Trump and every possible Republican in any public office in 2020. 2. Impeach Trump and remove him from office ASAP.
Solution 1 is preferable because Trump is only the festering sore that has arisen on a very sick Republican Party. His departure could leave us with a President Pence, a festering sore plastered over with a flag and a bible, much harder to treat.
5
This lawsuit is just one more example of the reality of today's Republicans. All they care about are tax cuts and making life miserable for those less fortunate than their donors.
They are a destructive cancer on the country. 2020 needs to be the last time they compete in an election.
4
People are always shocked, SHOCKED! that states like WV and KY vote so overwhelmingly against their own people’s best interests. Two things here: first off, poor people don’t vote. Secondly, distain for the poor is (also) local; people of means who are self-sustaining are righteous and see those around them who are not-all-that as undeserving takers.
2
Existential question: does it make me a very bad person to wish that those who not only voted for this president but also for GOP legislators get their health insurance snatched away from them? Am I going to the netherworld?
2
"Will specious, bad-faith legal arguments prevail?" In a word; Yes!
1
Why, Mr. Krugman, do you talk of the "Republican judge" who took a position contrary to your own, and why do you write of "two Republican-appointed judges" who may shortly do so?
You are doing exactly what Trump does. Every time a judge rules against Trump's position, he ascribes the ruling to the presumed political party of that judge. With no grasp of logic and an abiding contempt for facts and the law, he pins every judicial loss or slight on "terrible bias." In Trump's mind, he could never, ever lose on the merits of his own case. That is ridiculous, but your latest column veers toward that same track.
Criticize the ACA rulings as you like, but please try to distinguish yourself a little more from someone you clearly despise.
Sorry, despite what Chief Justice Roberts piously claimed, judges do have politics - and political affiliations. His Panglossian pronouncements on calling balls and strikes and how to "stop discrimination on the basis of race" conceal privilege behind the language of even-handedness. You may doubt this, but Republicans do not. Think of the way McConnell blocked enormous numbers of President Obama's nominees - including the unconscionable denial of a hearing for Merrick Garland - followed by his still-more energetic work to confirm dozens of Trump nominees, overwhelmingly chosen by the far-right Federalist Society. The single purpose has been to pack the courts at all levels with conservative - that is, right-wing Republican - judges, and to thwart the popular political will.
3
You have not been paying attention to the partisan "vetting" that the GOP has been putting all their judicial nominees through, have you Tim? They have found a way to corrupt the supposedly blind US judicial system.
1
Paul has been lucky - he has never had Obamacare. Ask 100 people who do not get a subsidy and 99 could only dream of something better. Yes, a family of four could spend $25,000 or more before getting a cent back from the insurance companies.
1
@Erik: So, if someone in your stereotypical family of four had a catastrophic illness or accident requiring $250,000 in medical expenses, they'd be better off without any health insurance at all?
The number of uninsured Americans was reduced by 17 million between 2013 and 2016. That's because of ACA.
You want to eliminate high deductible policies? Increase funding of ACA.
4
What sensible person argues against health care for the well being of it's population and therefore the well being of society?
3
Once again (many, many again's) the Republicans have shown their propensity for treating the law like an exercise in semantics. Isn't it somewhat surprising that the "law and order" party has such complete disrespect for the law that it works so hard to get around the spirit of the law, whenever it suits them ? I would have thought that to Republicans the law would be sacrosanct; obviously not, just a collection of words to be contorted like a circus rubberman. Any student of language knows that words and sentences are inadequate to describe every possible situation that might arise, and so the spirit of the law, it's intent needs to be paramount. Those lawyers who play sophomoric games with the sentences in which our laws are written ought to be ashamed of themselves.
2
Aside from repeating the same things he had already written in previous columns, Paul Krugman's criticism of Red Judges goes to the heart of the "legitimacy" of the courts. Throughout its history, partisans have criticized the courts, even before the American people divided into the Reds and the Blues. Didn't Thomas the slave-owner Jefferson accuse John Marshall's court of "twistification"?
Using Red or Blue standards, each side views opposite color judges' claims as wrong interpretations of the "Constitution", hence illegitimate. However, evaluating the courts with the standard of correct ethics, rather than what the Founders wrote, we can see the history of court rulings violating ethics.
Do we need any more examples to understand the illegitimacy of the courts?
In a democracy, one vote doesn't always get you every thing you want; so to avoid more "downer" columns, I propose we give Krugman an extra ten million votes every election, with a bonus of appointing a dozen new SCOTUS judges to pack the court. I'd like to read one upbeat column accompanied by a photo of Krugman doing the jump for joy.
5
@Jamila Jones: Should all court decisions in democracies be above criticism? How about the Dred Scott decision?
Sorry, judges are human, they have biases, some more extreme than others, and so sometimes they make errors. Federal Judge Reed O'Connor's decision in this case is not only politically and morally wrong, it's intellectually vapid and inept. Krugman made that case pretty well and you can read quite a bit more about Judge O'Connor's decision if you are curious.
And if you're looking for "upbeat columns", maybe you should stick to Parade magazine or similar.
1
@Lew
Thank you for your response. Your argument that "judges are human ... and so sometimes they make errors" might be an attempt at a (partial) explanation, but hardly a denial of my statement, "we can see the history of court rulings violating ethics."
Your recommendation that I "should stick to Parade magazine" sounds a bit snarky -- was that your intent? Although I am unfamiliar with it, your recommendation does not address my proposal that would help Krugman get the government he might like. Before submitting my comment, I had looked at the webpage showing the titles of his recent editorials, many I had read and learned from, but show his disapproval of government policies. If Krugman had more power to get the government he wants, wouldn't he write more columns explaining its success, rather than failures?
1
Do we like the military? How about Social Security and interstate highways. Looks like Americans are good at "socialism." You would think enough people would recognize this fact for their own health. Yet we allow the Republicans to deliver worse outcomes at twice the cost of other industrialize nations. Where are the pitchforks?
2
You realize this is a trial run to attack Medicare and Social Security. The GOP really wants to eliminate government leaving us with untaxed corporations, the 1%, and a dictator class. The fight wing judges are nothing more than political operatives. Oh, and women and children will be attacked first as you can see already.
2
The Justice Department's failure to defend the ACA, which happens to be the law of the land, illustrates how Trump has corrupted and subverted all our institutions of government. If he succeeds in killing Obamacare, he can kiss the White House goodbye in 2020, the Republicans will lost control of the Senate. As it is, Mitch McConnell is gearing up for the Senate loss by stacking the courts with as many conservative judges as he can get confirmed before the election. He has informed the Senate that his priority is the "personnel business" to the exclusion of all else.
2
These attacks on the Affordable Care Act have this uncomfortable feeling, as does a lot these days, of the Scopes trial in 1925. It feels like rationality vs superstition being made into law. I can partly understand how Republicans and conservatives might resent a government mandate to spend money that they don't want to spend by buying insurance. (This is a complicated topic since even the uninsured depend on the system being functional even if they claim the don't use it. The uninsured, if injured by say a drunk driver, will get taken to a hospital.) But, like Dr. Krugman, I see nothing but personal animus driving the remaining attacks on it. Rationality seems to be at war with a delusion, backed by a claim that something better is coming, but with nothing having ever been proposed.
Unfortunately, the Democrats do not have a Clarance Darrow who seems sufficiently at home in the rural world to make the case for rationality. (? Biden) The New Yorker profile of Darrow at the Scopes Trial written in 1925 is feels strangely relevant. (https://www.newyorker.com/magazine/1925/07/11/dayton-tennessee
1
With chronic Gratitude for Dr. K’s support for the People. His reports have continued to Enlighten us, while our “President”
has continued to Stifle us at a major point of Public Need....
the issue of Health Care. With his Words, I believe Krugman
has given more actual Service than has our “President” who, in
occupation of the Oval Office, “Served” mostly Himself I have
little actual Voice, but would Beg our People....PLEASE VOTE.
1
Thank-you Paul Krugman for never forgetting about the ACA. The ACA saved my life by allowing me to go to the very best doctors for my very rare cancer. The stress that this administration has put on me and many others in similar healthcare situations can only be called evil. Everyone suffers from some kind of discrimination from this immoral presidency.
2
Herr Krugman:
Quit calling it "Obamacare," sir, and you're halfway home again.
Yes, more healthcare was a good idea but it was also a law of coercion, forcing folks to sign on or pay a fine.
The ACA rubric is not the right way for a representative democracy to represent us.
Shame on Obama and shame on Pelosi. We still don't know what it all means, other than permanent indebtedness and more holes than Swiss cheese.
Think of the plot more as a Bastille attack on way too much cake and no way to pay for it.
1
Krugman has never tried to hide the shortcomings of ACA. But only a fool fails to see & commend its benefits compared to what existed before or the nothing the GOP would replace it with.
From the GOP perspective, the US citizens who benefit from the GOP-designed Affordable Care Act are all in the bottom 50%. They have no interest in helping “those” people. I know several persons whose lives were saved by the ACA.
Most recently a lovely lady close to 60 years old. She had attended the finest private schools growing up and is now long divorced with two grown children and had a part-time job—no benefits. She got insurance through the ACA. She became increasingly short of breath and was found to need a mitral valve replacement which was done with the DaVinci surgical assist system at Duke. Without insurance, that would have been impossible. Her body would have filled up with fluids leading to a slow agonizing death.
That is what the GOP wants for those people. They use racist dog whistles and abortion rhetoric to get votes out of that group, but they really do hate those people.
3
How is tis not an impeachable offense, not faithfully executing a law, ACA. dutifully passed by Congress
1
"I’m not a lawyer, but I’m pretty sure that if a legal argument has absurd implications, it’s an absurd argument."
Clearly, as you say, you are not a lawyer. You fail to allow for the fact that a law degree is a wasting disease of the frontal lobes.
2
The G.O.P. seems to have a plan. Not a plan for real healthcare reform. They don’t care about that. Their plan for the needy, poor, uninsured, sick and disabled is to get rid of them. No healthcare? Fine, let them croak. Let society’s “dregs” die out. Don’t believe me? Just look at Trump’s treatment, G.O.P. enabled, of real live human beings, little children for God’s sake, in detention camps. The members of the G.O.P. see themselves as society’s elite whose responsibility it is need to clean up the streets, so to speak. The evil in their hearts in alarming.
2
The Republican plan for health care is called "pay or die" See, freedom!
1
Let's please stop calling it Obamacare. Call it what it is, the Affordable Care Act.
As former Representative Alan Grayson stated on the floor of Congress, the Republicans idea of health care is that if you get sick, you should just die.
1
Stop worrying Paul Krugman! Whatever happens with Obamacare can only hurt the GOP, so long as the crazies who want Medicare for All are kept at bay.
I don’t think the GOP hates the ACA, many red states like the ACA and many red states employees lots of people in the ACA industry. What the GOP hates is the moniker Obama Care and how it morphed out of ACA. It’s really unbelievable since the GOP gave Obama Care it’s name when they were fighting against it. They also hate it because it’s was a Democrat idea and was passed by Democrat party. If the GOP was smart they would tweak it and call it ACA1, and sell it as only the president can. Also the public needs to buy in that their days of sugar, overeating, smoking, over medicating, and little to no exercise are over. They can no longer just over indulge and expect the government to just pick up there health bills.
Coverage of pre-existing conditions requires the mandate. Since there is no longer a penalty the mandate ceases to exist. Thus, in effect, people are free to purchase insurance when they need it.
As far as I can tell, the only reason for repealing the ACA is that it is associated with a darker-complected president. I have yet to entertain a compelling argument in favor of repeal when there is nothing substantive to replace it.
1
Trying to undo Obama care is not more a plot than when the Dems plotted to get it through Congress without a single Republican vote. What would one expect?
1
The Dems "plotted" to get ACA passed with multiple republican votes, but the GOP decided to vote against the bill for partisan purposes, regardless of its merits.
1
Please tell us why you want to throw 20 million off health care. We’ll wait.
1
The political compromises were needed to buy off moneyed interests, particularly the health insurance industry. This deeply flawed law was all about the money and the unwillingness of Obama to lead the people who supported him in a rea fight for what is right.
Dr. K and I probably do not agree often on politics, but we both made the $1 vs. $0 argument to pop this absurd balloon of a legal argument.
The law seems to involve a lot of game theory, in the sense of "kicking the tires" for absurd implications, and they exist, then the cause of those implications usually cannot be the law - unless all the alternatives are worse. Game theory has a much longer shelf life than data.
In the grand scheme, there was never really a mandate. If I remember correctly, a utility disconnect notice would waive the mandate for the month it was received. One can be reasonably wealthy and get a utility disconnect notice - I am an expert in this area. No matter how high the penalty, there were plenty of exceptions, which means some had a penalty of $0.00.
With or without insurance, you will be expected to pay for unwarranted care. With insurance, you will get protection for most of your wealth for necessary care that can sometimes cost more than a new car or even a house.
If you have essentially no wealth, however, what does health insurance really mean? It means we either are denying some people necessary care because of their poverty, or it means insurance is meaningless for the very poor. It seems like we should be working towards a system where the latter is the case.
The Republicans argued that the mandate made the ACA unconstitutional, but the SC ruled that the penalty for not having health insurance constitutes a tax, therefore the ACA is constitutional.
Now some Republicans and a Republican judge say that with a penalty of zero dollars, you effectively have no tax but apparently still a mandate, which now makes the ACA unconstitutional. But the proper argument is that with a tax penalty of zero dollars, you effectively have no tax AND no mandate, so the ACA is as constitutional as it was before. I expect the SC to rule as such. The Republicans cannot have it both ways.
1
I get so tired of these discussions. There are only two questions to consider--how much should we have to spend, as a nation, on healthcare, and how should the cost be distributed? Now we spend far more than other Western countries with worse results, and costs are irrationally distributed, with, for example, the uninsured facing far higher costs for the same care as insured person (so many go without). This is crazy, and private insurance is one of the principal causes. We need national healthcare, in one form or another.
4
Yes, but that's an irrelevant argument, given the reality of the GOP.
1
"Before the A.C.A. went into effect, 24 percent of California adults too young for Medicare were uninsured. Today that number is down to 10 percent. In West Virginia, uninsurance fell from 21 percent to 9. In Kentucky, it fell from 21 to 7."
In Kentucky, Amy McGrath's senate campaign to "Ditch the Mitch" needs to hammer Monarch McConnell with this point, and the part about covering pre-existing conditions.
7
The fight against health care is a more libertarian argument than a strictly conservative one. Libertarians embrace the pull-yourself-up-by-the-bootstraps, dog-eat-dog, survival-of-the-fittest approach to individual "liberty." They also love unfettered free market capitalism, which mandates that there will be winners and losers--a bad proposition in public goods like health care and education (for example). "Socialism" violates their principles, and so any benefit provided by the government is inherently bad.
Libertarianism as championed by the Kochs has invaded every facet of American life and erstwhile conservative thought, from "small government" to deregulation to "individual liberty." Once a crackpot fringe, this is now mainstream, and has yet to face a coherent argument in favor of the role of government in providing valuable services that a majority of individuals can't obtain on their own. In this world, only those who can afford good health care, good education and safety will thrive--all because they can pay for them. Wealth is equivalent to moral superiority, and poverty is due to sloth and poor character.
Framing the health care argument in terms of "health insurance" is accepting that free market capitalism has a role in public health. Huge deductibles, co-pays, and restrictions also impede good health care. Surely there is a way to remove--or at least limit--the pure profit motive from health care and stop punishing people who can ill afford it.
5
@cjsigmon
" In this world, only those who can afford good health care, good education and safety will thrive--all because they can pay for them. Wealth is equivalent to moral superiority, and poverty is due to sloth and poor character. "
That's the basis of puritanism and the concept of pre-destination. If you're well off then obviously you're going to heaven, and if not then you're going to hell. This viewpoint gives those who have it all license to do terrible things to those who don't have it at all. It's not even christian; after all Jesus healed the sick with no strings attached except promise to do only good deeds.
1
Sad, but this is not a new plot against Obamacare. Republicans have been fighting it since inception.
I remember seeing pictures of President Obama signing the legislation in March, 2010. I was an RN Case Manager in the largest hospital in Wisconsin, weary, torn, sad, during the recession when innocent people lost their jobs and their insurance. Without their group insurance which had to accept their pre-existing conditions, what were they going to do?
I also remember seeing a picture in our newspaper of a man enlisting in the service, leaving his home, his family, because he lost his job and their healthcare insurance. This was not about him. It was about his wife who needed chemotherapy or she would have died of her cancer. He enlisted in the military pronto, after losing his livelihood, and hers too, literally, so they could have insurance provided by our government through his newfound military stance.
People were desperate in those days. They will be desperate now if the ACA and it’s provisions are decimated. Millions will go without chemo, they will go without insulin, they will suffer from the ramifications of their multiple sclerosis. They will die.
Is Donald Trump going to come to their funerals? Is Mitch McConnell going to preach he did all he could do? Even Paul Ryan couldn’t take it anymore and at least he had proposed an insurance plan (although I wholeheartedly did not agree with it).
This administration is not for the people. At all.
13
@MIMA: US politicians represent ONLY those who bought them into office.
3
@MIMA
"Millions will go without chemo, they will go without insulin, they will suffer from the ramifications of their multiple sclerosis. They will die. "
I agree except for the future case "will". It is happening NOW.
For example the cost of pharmaceuticals has become out of reach for ordinary americans, just look are the rising price of insulin and of all the little devices involved in monitoring insulin levels.
2
An excellent article, and I agree heartily with you, Dr. Krugman.
I can't understand the effort to declare mandatory health insurance as unconstitutional. I am required to have insurance to drive my car, and if stopped by a trooper, one of the first demands is "Let me see your proof of insurance." Is that unconstitutional ? I think not ; neither is required health insurance.
6
Agreed. And I will never understand why Democrats aren't running on Republican efforts to destroy Medicare, Social Security and the ACA. These are things that nearly *every* voter agrees on, and whose attempts at destruction have Republican fingerprints all over them.
3
What concerns me is that if SCOTUS rejects an appeal of the Appellate Court which may have ruled against ACA will that decision be the final word and thus do away with ACA?
I don't think we will ever see the end of it until we have some form of universal health care. You can call it what you like, but it will be something close to Obamacare with provisions for pre-existing conditions and health care for all who can and cannot afford it.
1
"At the same time, none of the dire predictions conservatives made about the law have come true. It didn’t bust the budget — in fact, deficits came down steadily even as the A.C.A. went into effect." Ironically, the position that Democrats have taken with single payer, Medicare for All, Obamacare or any system that lowers healthcare costs relative to GDP or by any other measure is the conservative position, not the other way around.
1
If the courts destroy the ACA as has been said tens of millions will be left in the lurch. Mitch McConnell has said that the GOP will patch together something for those needing coverage for chronic life threatening conditions but even that is indefinite as to who and how people would be covered. but it does nothing for ordinary people just above the poverty line or Medicaid recipients. Republicans have big mouths but dismal records as far as health care policy is concerned and no one expects that to change. People will suffer and die especially many Trump supporters if the ACA is overturned and that will be on the heads of Republican lawmakers. Will it be enough suffering to finally get them to listen to Democrats who are fighting for their health?
3
The Republicans do not care about anyone except the very wealthy. You and I could die in the street, and they wouldn't care, as long as they had the money to pay for themselves.
2
And so it goes. The fight for a national system of healthcare has been going on since Harry Truman first proposed it, spanning my lifetime. Opposition, to say the least, has always been fierce. Republicans, by and large, have always opposed it, but they used to have strong allies like the AMA and the insurance companies. Much has changed over time. The AMA has long since dropped their opposition, and even insurance companies, under the ACA's iteration of national healthcare, has come on board in support. That leaves the good old GOP left to wail about "socialized medicine", name-calling being the last refuge of their opposition. This is despite the fact that the GOP has NO PLAN to replace it, just empty threats. I have no problem with a public-private option to healthcare, the logical extension to Obamacare. I also have little to no problem with single payer healthcare, much like Medicare now, which works pretty well. What I can't countenance is blind opposition to progress simply because a Democrat proposed it. To my Republican friends I say, look at what your party stands for TODAY, not what it used to stand for, because that party is dead, killed by an extreme faction that has overtaken your party. We must make ourselves heard. The November 2018 elections were, at the time, the most important election of my lifetime. The next one is 16 months away, November 3, 2020. We got ourselves into this mess, but we can also get ourselves out of it.
11
@TRA Yes, the last refuge of the GOP is "socialized medicine". And that braying resonates with a demographic that is susceptible to the braying.
Yet those who would eschew "socialized medicine" will appear at the door of the medical provider and seek charity care, or, fail to pay their debt to the provider thus using another form of socialized medicine-let the rest of us pay the bad debt.
And those who are against "socialized medicine" will cherry-pick stories that depict failure from countries that have national healthcare plans.
My advice to those who subscribe to the bleating a braying of conservative talking heads on Fox "News", the bleating of the GOP politicians who have Big Insurance as their sponsors, and Dear Leader, if you don't want socialized medicine then don't seek charity care and do not enroll in any of the government-run or sponsored, such as Medicare, as those alternatives are, well, socialized medicine.
2
@Dan
Thank you for commenting. Well said.
2
It's time to let all red states opt out of everything from ACA, birth control/abortion rights, employment equality (unless with a proper male chaperone), voting rights, environmental restrictions and so on.
Just divvy up the Federal money on a state by state basis and let each state do as they please. No excess amounts of Federal taxes can be spent anywhere. Farm states could band together to help other farm states with disaster relief and flood insurance if they desired and blue city/states could band together to create transit solutions, housing, healthcare, and education as they desire. Each state would get exactly what their citizens pay in from the Feds. SSI and Medicare would all be paid cash in/cash out to the individuals, regardless of where one retired.
All US Citizens could vote with their feet (as President Reagan urged) and let the chips fall where they may (there is no society, said Margaret Thatcher). We would have to more incendiary weaponizing of the First Amendment and unending states resistance to acting as a unified nation. We could be 50 little nation-states with a unified currency, defense, some federal highways, and air traffic control.
The Federalist Society groomed judges would become largely irrelevant. Each state could implement the constitution as they see fit. Best of all, there would be no more caterwauling by Fox and right-wing talk radio.
Everyone would get what the want. Isn't that Democratic?
4
@Almighty Dollar I say cut the red states off altogether. They're "welfare queens" that take more than they contribute -- one hand extended while the other hand gives the finger. States' rights, right? Progressive states will move forward and thrive, and regressive states will (hopefully) eventually swallow their pride, get over the fact that they lost the Civil War, and realize they need to look inward for solutions instead of outward for scapegoats.
2
The ACA is a compromise which did not deliver all that liberals in the Democratic Party wanted and which did not impose all of the Government-controls-everything that Republicans feared. The belief by many Democrats was that a compromise would not offend Republicans and in the end would provide a framework which was good enough. However, Democrats failed to understand the seismic shift in the Republican Party and how that shift would cause Republicans to view any plan by Democrats as the first step towards healthcare under total control by Government.
So what are the lessons for Democrats?
First, stop worrying about what Republicans want. Republicans do not lie awake at night worrying whether the Republican agenda will distress Democrats.
Second, it is impossible to do a good deal with a bad actor. The Republican agenda includes undermining the institutions of Government and a viable healthcare system directed at least in part by Government undermines the undermining.
9
Roberts won't allow the ACA to fail. Period. He knows the dirty little secret that everyone in Congress and virtually all politicians know: The ACA is a subsidy program that has saved the private health insurance industry from bankruptcy. It provided private insurers with millions of new customers and billions of federal dollars.
Without the ACA the private health insurance's employer and private based insurance programs would become so expensive and so unsustainable that they would collapse within months. Employers and employees could not bear the cost of private health insurance and the deductibles, co-pays and benefits would make health insurance affordable for most Americans. Without the ACA, many hospitals would close and our entire health case system would eventually collapse. It's not just 20 or 30 million Americans who would suffer: everyone would suffer.
Another thing that has generally escaped notice is that health care is about a sixth of the economy. If the health care system becomes unsustainable, the economy will become unsustainable. Given that businesses, individuals and the government are leveraged up to the neck, it is likely that our economy would crash if the ACA were declared unconstitutional. It would make 2008 look like a mild downturn.
I think Roberts knows all this and also knows that the Supreme Court as an institution would destroy itself if it failed to uphold the ACA. Therefore, the attempt to destroy it legally will fail
2
The 330 comments have pretty much covered everything I was going to say about the obvious fact that Republicans simply don't care about people of lesser means getting adequate health care. But another aspect of this issue is the fact that the Republicans are increasingly using the courts instead of the legislative process to get what they want.
This is what the Republicans used to - and amusingly, still do - accuse the Democrats of doing; that is, not getting their way in congress and using the courts to "legislate from the bench". Using the courts to explicitly reject legislation passed by the people's duly elected representatives. I don't believe that in all of American history has one party's hypocrisy been more blatant.
10
If the courts overrule the ACA, I hope they will adopt the recently advanced idea that it be overturned only in the states that are parties to the lawsuit in question. Giving the people in those red states a readily available comparison between the ACA or not would be a wonderful experiment in the joys of using the states as laboratories of democracy.
10
Since some people may now be too young, and others may not have researched the systems in the 50 states pre-ACA (as I did, and I've kept my notes), I wish to point out that the pre-ACA system was highly problematic for people without job-related insurance or Medicare.
Besides problems for lower income people who just couldn't afford insurance, even people with pretty good incomes had trouble and worries.
If you had passed pre-existing-condition screens and gotten individual insurance, the company might, if you got pretty sick, then contact doctors and request detailed records, and decide you had left off a pre-existing condition, and not pay your bills, and drop your coverage.
There were also gaps in eligibility for the high-risk-pools that were supposed to cover people with pre-existing conditions. You had to wait 6 months for coverage to start sometimes. The pools were often closed in IL and FL.
Some of the high-risk pools had very high rates. In 2012, a male in CT 60-64 had to pay $2077.18 a month for the lowest cost high risk pool plan, ($7500. stop loss).
PA didn't have high risk pools, but had an insurer of last resort. Around Philadelphia, the insurer of last resort capped maximum payments per year for your bills at $35,000-$60,000, depending on how long you had the plan.
It was bad.
It's better with the ACA, though still there are serious problems.
(The problems will be hard to solve given our political problems and voracious special interests.)
3
The wisdom behind the ‘Medicare for All’ formulation for a government assisted healthcare system in the US is now apparent: Medicare is a program that has withstood all legal challenges since the 1960s. It’s a broadly popular program affecting millions of people. Any conservative republican judge who would strike it down would be killing their own grandmother.
4
I find it amusing that many who oppose the ACA, many who are supporters of the grifter from Queens, oppose the program on the basis of "government intrusion in our lives", that is, the mandate one must have medical insurance of some sort.
So, I suppose their alternative would be to have no insurance and rely on the good graces and charitable acts of the care providers who in turn pass the bad debt costs onto all of us and our insurers.
Based on that premise, not having coverage, I believe we should eliminate the mandate. Say good bye to the mandate.
And when those who will bleat in delight at the elimination seek care, well, too bad. You missed your chance.
Callous? Maybe. Honest? Yes. It is apparent many do not desire to have medical insurance, so, let them deal with the consequences.
1
Most people I know either enjoy their highly-subsidized employer-based coverage, or even more highly-subsidized insurance provided to them by the taxpayer, some on Medicare. None of them have much of an idea of the challenges faced by those who must go into the "individual market" to obtain health coverage. I had my own small consulting business for 21 years and having to go thru underwriting and accept a policy where the insurer could retroactively rescind coverage was the norm. Those people who obtained their coverage some other way have no clue about that. As my company was incorporated, I was able to define a group, and obtain coverage without underwriting or rescinding, but the premiums was astronomical, based on the oldest person in our family. When the ACA became law, I obtained the exact same plan from the exact same insurer, but the premiums were based on the ages of the individuals, saving us over $832/month.
7
While Donald Trump and some "conservatives" might prefer that sick and disabled citizens who can't fully pay their way just vanish to pay for the tax cut given to the Republican Party financiers, that is not what happens. Without good health insurance, ill and injured working Americans often become poor and unemployed Americans. They stop paying taxes, families lose breadwinners and society picks up the cost of both healthcare and welfare for them and their dependents.
There is no doubt that giving all Americans good healthcare, would extend their ability to work; make them more productive; Keep families together; Avoid bankruptcies, and actually do more to make America great than slogans on hats. The ACA, (Obamacare), should have been named the keep Americans Working Act, because that is exactly what it accomplishes in the long run.
8
My wife had an appendectomy on France. ER visit and 3 days on the hospital. It cost $3,400.
I had a prostate biopsy in the US. 1/2 day in an outpatient surgery facility. It cost $11,000.
Now why is that?
16
Ah, was wondering when all those unqualified right-wing ideologues masquerading as judges were going to start showing up. Didn't have to wait long!
I think Democrats need to think seriously about how to start undoing all this damage to our judiciary. Court packing; term limits; etc. Otherwise, might as well give up on this little experiment in democracy.
9
I hope the 2020 election is about health care. That’s how Democrats waved through the House in 2020. The Republicans have zero credibility on health care reform and their lack of compassion is bone chilling
9
Americans want not just affordable health insurance. We want health ASSURANCE: The assurance that, if something bad happens – a car accident, a cancer diagnosis – that the family won't go bankrupt.
The ACA has been health assurance v. 1.0. Now we need v. 2.0.
8
If the courts decide to end the ACA then Medicare for all suddenly becomes a real option. With millions of voters suddenly no longer insured the voters will speak. The next step should be to remove the tax advantage of employer based plans and put them on even footing with Medicare. With corporate subsidies not included as income and workers able to pay with pretax dollars they have an unfair advantage versus self employed people purchasing healthcare insurance. Level the playing field , have a medicare OPTION for all and lets let the consumer choose.
9
There's almost something masochistic about Republican voters. There's a million people in Kentucky who depend on Obamacare who voted for Mitch McConnell, and even if Mitch McConnell succeeds in taking away their health care, they'll still vote to re-elect him next year.
I guess it's authoritarianism that has imbedded itself so deeply in culture and people's patterns of thinking. If Republicans take something away -- even something as critical as access to doctors, or food, the Kentuckian says to himself: I guess I wasn't good enough to have it in the first place, because the party is always right.
Mixing of religion and politics distorts democracy to such a degree that people think they must do what politicians tell them to do, instead of the other way around. That seems to be where we're headed for Red State America, at least.
10
What happened to the supposed ACA windfall that Obama was utilizing as the primary benefit of the Act? The incredible savings that would accrue as the focus would be on outcomes and not doctor visits. None of that, as expected would come to fruition.
Also, ACA has cost me more annually in the ACA (Medicare) supplemental tax than the cost of my annual insurance premium. This is simply wrong.
1
@Jazzville: The employer-based insurance you probably had before the ACA may have had lower premiums, but it would also have had annual and lifetime caps, and you would have lost it if you were laid off. And don't forget that the Republicans undermined the ACA where they could after they failed to repeal it without a replacement, and your supplemental insurance would have been even higher than with the ACA.
2
Two points:
1. That judges need to be defined by party affiliation tells us just how broken our legal system is.
2. Trump does nothing that is not cruel to somebody. In this case, he is harming the most vulnerable of his 37%. The Koch's, Adelson, etc are laughing all the way to the bank.
7
In the wake of WWII, much of Europe had an opportunity to start over and essentially created some version of universal health care. These systems are imperfect, but they get generally better health outcomes than those in other countries. (Disclosure, a close relative works for the National Health Service in the UK.) Ironically, the "socialist medicine" the Republicans so hate, has been accepted and succeeded in so much of the civilized world. So, our Republican think tank version, installed during the Obama administration is neither revolutionary nor particularly threatening to civilization as we know it. A good question is whether Republicans even know why they oppose it other than that a Democratic President succeeded in making it law. The second question, is whether we should automatically vote against all Republicans until they start showing an interest in doing their jobs rather than simply waging partisan warfare.
13
A full destruction of the ACA by the 5th Circuit would lead to chaos in the insurance world almost immediately. Not only would SCOTUS have to agree to again consider the case, they would have to provide an injunction against the ruling taking effect in order to not cause a major worldwide economic disaster. Healthcare is somewhere around 18% of our GDP. Destroying the ACA without any plan to replace it or stabilize the market would cause insurance companies to fail, hospitals to close, denial of care to millions and a global recession that would make 2007 look like a temporary downturn.
Personally, I would benefit from the catastrophe that would follow, my health is currently excellent, and my political view that health care is a right that should be provided without consideration for profits makes me hope the 5th Circuit stays true to their partisanship and overturns the entire law. The GOP would die a quick death, single payer would be the only response and we would be free of non-medical personnel making medical decisions.
8
Paul, you may be missing the bigger point and that is that the Republicans and especially the corporate Republicans are now legislating not through Congress, but the Courts on a whole host of laws including, Obamacare, labor laws, tax laws, women reproductive rights, voting rights, environmental regulation, gerrymandering, campaign finance, etc., etc.
The Republican Congresses no longer legislate so much as they make sure that they get the right judges on the various courts. People misperceive that there is gridlock in Washington. Yes, that is true legislatively, but not Court-wise. The primary driver are the super rich wealth class that realized about 20 years ago that their defense and preservation would be the Courts and getting the right judges to pack those courts. This is why a "Wealthy Tax" has very little chance of becoming law. The Democrats seem oblivious to what has/is transpiring, a takeover by the wealthy via the courts facilitated by Republicans.
14
Obamacare “failed” because it was never allowed to be implemented.
Example: Not one Republican governor allowed the exchanges to be tried. We will never know if competition between insurance companies would have worked to reduce costs. Instead, the lack of the exchanges and their objective doomed Obamacare.
Republicans knew that, made Obamacare fail and the left didn’t have the sense or political capacity to defend or fight for its full implementation. In the end we are now faced with a disaster as the courts decide if a partially implemented and gutted healthcare plan is constitutional. We lose.
The Republicans have no plan but have won in the court of public opinion because the term Obamacare is now aligned to a failed healthcare policy by both parties. Biden attempted a defense in the debates but it was weak and too late.
Democrats now stand in line, raise their hand and say the solution is Medicare for all. Warren “has a plan”, Sanders says Americans like it because costs are lower. Everyone conveniently forgets to mention doctors and hospitals are being paid little, their costs are not decreasing and this is unsustainable. Doctors are salaried hospital employees.
Is there a plan that allows the US to join other nations who provide their citizens with a sustainable healthcare system? I have no doubt. But I also have no doubt nothing will be resolved until both sides decide to work together. I’m not holding my breath. It’s unhealthy to do so.
4
Several republican states set up exchanges, e.g., Tennessee, Arizona.
I'll never get my head around the insatiable appetites of republicans to vote against their own economic self interests. Why would anyone vote to remove the Affordable Care Act before Congress approves a concrete plan to care for people with preexisting conditions. The mind reels.
18
@SteveCitizen's United has given the system enough dark money that our "representatives" represent their sponsors only.
4
Dr. Krugman need look no further than the Supreme Court’s recent decision in the census case to see how the GOP has corrupted the judiciary. 4 justices essentially ruled that even if Trump lied about the reason for the citizenship question that it’s just fine. In other words, to these 4 GOPers, Trump can do what he wants, regardless of the complete lack of justification.
If Trump wins in 2020, and appoints one or two more Supreme Court justices (and God only knows how many more to lower courts), the judiciary will completely become an arm of the GOP for decades, and voter preferences won’t mean a thing.
11
I believe it's called, "legislating from the bench." Please note that it is only acceptable, if Republican judges or justices do it. It is a non-starter if Democrat appointed judges or justices do it.
5
It must be said. No Republican candidate for Congress, Senate, or the Presidency deserves the vote of any American. Even if that American has employer medical insurance, the knowledge that Republicans are trying to take away insurance for his fellow American citizens should be disqualifying.
14
The only people who don't have a "preexisting condition" are people who have never seen a doctor. So, why hasn't the nonsensical idea of denying coverage because of preexisting conditions been tossed out long ago?
11
I'm reading, "In My Own Words," by Thomas Merton. As for, "Chief Justice John Roberts ruled that the penalty constituted a tax, and that taxes are clearly constitutional. So the law stood" it is something to be meditative with. I can barely justify spending 45.00 on cable TV. And, I am very grateful for being able to pay my respects.
The book is truly something worth spending time with this summer. As for death spiral I think we have a lot of addictions.
Wait.
I am not sure what Prof. Krugman means when he says the Supreme Court will likely "reject the suit." If he means that it will hear the arguments and find Obamacare still constitutional, fine and dandy. If he means that it will deny cert, don't the findings of the lower courts become standing law--at least in the circuit in question?
"If you're an American who suffers from a pre-existing condition, or doesn't have a job that comes with health benefits ..."
There is a perception that pre-existing conditions, long hospitalizations, periods of under- or unemployment ... happen to somebody else, or somebody else's family.
No! They can happen to anybody. They can happen to you! The probability is higher than you'd like to admit.
So everybody should ask themselves, "If I, or a member of my family, land in the hospital for 3 months, what penalty should I be expected to pay."
7
I've read a lot of comments and so far no one has addressed exactly WHY the GOP does not want to spend our tax money on health care. Is it to pay for the wars and the over bloated military expenses? Is it to because the wealthy would need to be taxed properly and they are the ones funding all the campaigns? Those types of roadblocks to health care need to be addressed, because as one person put it, if the will of the majority of people is to have the affordable care act, why is the GOP just ignoring us?
8
Is there a logic to this insanity? Do the Republicans really want to take health insurance --and thus access to medical care --from their own voters? What could they be thinking? Won't this maneuver enrage those voters?
Well, maybe that's the point. Trump and the Republicans thrive on popular rage, which they stoke at every opportunity. It works for them because they've been able to have this anger directed at Democrats. The great Republican conjuring trick is to obfuscate their own responsibility for what angers their constituents. They do this by shifting the blame and by offering up scapegoats. When people lose access to health care (because of Trump and the Republicans), the GOP will point to this as evidence that Obamacare was a failure. If people don't buy this bogus explanation, they'll change the subject by screeching about the crisis on the southern border.
The sad thing is, it could work.
8
Republicans know that their supporters would blame Obamacare and Obama. That is was an easy one! Try asking us a more challenging question next time.
For profit "health care" is a travesty that brands this nation as a pariah among the civilized. That universal health care has eluded us through the lifetimes of so many is a blot on the national character that can't be erased.
I'm beginning to agree with the conspiracy theorists who say that if a cure for cancer were to surface, it would be suppressed by the profiteers.
12
President Johnson famously spoke of "the war on poverty " today we have Trump who applauds a " war on the poor" , so we should not be surprised that his attack on the ACA will , if successful fall heavily on the poor.
Maybe this is an important wake up call that the "war on poverty" has a long way to go. The poor of america are still likely to be minorities, women and children. The poor of america are still likely to have employers not offering health insurance, and they are more likely to be in poor health, live in poor housing and are unlikely to be able to afford physician visits and medications. The ACA has helped but poverty continues to be a major barrier to good health and health care.
The republicans war on the poor is a way of blaming the victims and rewarding the victimizers. The Trump tax cut did not encourage corporations to improve health coverage, instead stock buy backs made the crazy rich richer. Amazon wants to replace workers with robots, meaning the lowest paid jobs will soon disappear. They are claiming that they will retrain the workers for other jobs, yet if history is any guide the vast majority of those workers will lose their jobs, health insurance and descend into the labyrinth of poverty. America needs to revisit the "war on poverty" and understand that without a system of "health care for all", we can not hope to address the sources of poverty itself !
6
For themselves, members of congress receive a gold-level Obamacare package, subsidized 72% by the taxpayers. They also get free medical outpatient care at military facilities in D.C., and free/low cost care from the Office of the Attending Physician. The thing is, before Obamacare, they had an even better deal through the Federal Employees Health Benefits Program. If they get rid of Obamacare, they will go back to a much more comfortable situation. Does anyone besides me think this might be affecting their decision making?
6
Professor Krugman, the saddest fact of the whole matter is that the GOP stalwarts talked about "plans" yet never gave us the details of a single plan. Paul Ryan was supposed to have the answer however nothing ever materialized.
I am a business owner that has seen my premiums rise and the level of healthcare go down. This is part of the overall strategy of the GOP to dismantle the ACA. Those of us that are realists know that something has to be done with healthcare in the United States and that the GOP strategy is about destruction of the ACA with nothing to replace it with.
I would have all the respect in the world for a member of Congress that would initiate legislation to put all members of Congress on the same healthcare system as the rest of us. Let's see if there is a single member that has the courage to do it? We all know that it would never pass!
14
The only good thing about getting old is becoming eligible for Medicare. I wish every American could get on Medicare and thereby have decent healthcare coverage.
23
In some respects I hope they repeal the ACA. Enough of this. Ok, Republicans, give it your best shot. And I can hear Trump's speech now...."Americans will be willing to endure some pain until we enact the best, cheapest, brightest, most comprehensive, preexisting conditions included healthcare all at the ridiculously low price of....". And like the farmers.....the Republicans will then pass one subsidy after another to keep the enduring of pain Americans on their side. Because those on the right have been complaining about Democratic healthcare reforms since Hillary Clinton tried to do it in the 1990's and in all that time have NO proposal. None. Really? The only way to stay in power is to repeal and oppose. When will Americans who vote for these (mostly) guys realize 'replace' is no where in the cards. You bought the car, as imperfect as it is. It gets you to work, and is fairly reliable. Republicans say they can get you into a car so much better and so much cheaper. You'll love it so much you will sleep in it. Except the model they describe is never on the sales lot. But it's coming. Just you wait and see.
8
"On one central dispute, the constitutionality of the individual mandate — the requirement that individuals be insured, or pay a penalty — Chief Justice John Roberts ruled that the penalty constituted a tax, and that taxes are clearly constitutional. So the law stood."
Paul, even Obama went to great lengths to not call the individual mandate a tax:
https://www.youtube.com/watch?v=_0ZUBMqMnWs
As for Chief Justice Roberts, he was simply wrong in his interpretation. There is nothing stated nor implied in the Constitution that the federal government has the power to compel any individual to purchase any product or service. It doesn't matter if Roberts tried to justify it by calling the individual mandate a tax - the federal government still doesn't have that power. State governments, on the other hand, might have that power depending on what's in their own constitutions.
"I’m not a lawyer, but I’m pretty sure that if a legal argument has absurd implications, it’s an absurd argument."
Chief Justice is a lawyer and a jurist and he still came up with an absurd argument.
2
@hm1342 Or, you could interpret the Roberts decision as your choice to accept the worst insurance the US offers, that last resort, the one the rest of us pay for, if you end up going to the hospital as a victim of an emergency and the hospital accepts you rather than throwing you out to die on the street. Think of it this way--we all pay education related taxes that some without children will never use. You may never use that last resort insurance, but you might. You do get something for your taxes; consider it a plus.
1
In Kentucky, it fell from 21 to 7.
In the interest of fairness, why don't we let the states whose Attorney Generals are fighting to have the ACA overturned bow out. Their citizens can reap the ugliness of loosing health insurance, and the consequences thereof. Maybe the citizens will rise up and carry these monsters right out of their offices. If not, well they have only themselves to blame.
I especially relish the idea of the effect on Kentucky, home of the illbegotten Mitch McConnell.
17
The fundamental problems of our health care system will not be addressed by single payer, multi-payer or no payer. In fact, Medicare for all will make things worse for middle class Americans already facing long waits to see their doctor and disappointingly brief and impersonal interaction with the MD (or maybe PA or nurse practitioner) when finally the appointed date arrives. I have no objection to universal care. But it is foolish to offer it as a panacea without examination of its consequences.
Obtaining a medical education is very costly. Not only does that mean young physicians enter practice with heavy debt, but they are inclined to specialize in practices that are most lucrative, in part to pay down that debt. So not only are there not enough doctors, but those who are doctors may not be the best candidates since the cost of education is so high and they are not satisfying the greatest needs in specialties such as family, pediatric and geriatric medicine. Nor are they attracted to practice in geographic areas where need is greatest but the population is poor.
Adding to the number of patients seeking routine regular care without increasing the supply of trained medical personnel to provide treatment is an invitation to a disaster. Instead, as a first step, provide a free or cheap medical education to the best qualified in return for a 10 or 15 year commitment to practice in specialty areas and geographic locations where need is greatest. Then do universal care.
1
I give up. Still working at 68 (and on group health insurance) I am eligible for Medicare as soon as I quit working. My wife is similarly eligible.
I have voted in every election since 1972 and give up. If a significant number of my fellow citizens continue to vote Republican, I simply give up on them.
4
I think you are eligible now.
2
4 things have to happen for the ACA to survive.
There are some good elements, and REpublicans know the public likes the 26 year old kids staying on insurance and the removal of lifetime caps, even the Medicaid expansion (though someone still has to pay for it..need to put that 40% tax back onto cadillac plans offered by most unions).
1) Allow health insurance underwriters to offer up skinnier plans that make ACA actually "affordable."
2) Tie any Medicaid expansion to each state putting in place a law that mandates each resident have insurance coverage under penalty of law. The fact Massachussetts has a mandate (only one of the states) is proof that at least someone somewhere has read the constitution which says mandates are not a federal power; it's reserved by the states. Make the fine 90% of the premium cost of the bottom tier policies..so nobody is able to 'game' the system.
3) Require proof of continuous coverage in exchange for providing coverage for pre-existing conditions. You can't go to State Farm today to buy insurance for the car you wrecked yesterday. That's not how this works.
4) Allow the states flexibility to experiment with what works best in their state for high risk pools. The Pareto Principle applies here were 80% of the health care costs are borne by 20% of the people. Why ObamaCare negated that power by the states is beyond me.
All this leads to the ultimate debate about state vs. federal rights and powers.
I choose the state. I trust my neighbors.
3
"But Republicans still hate the idea of helping Americans......"
Which Republicans Mr Krugman? Name some names in fact name all of them who are opposed. Is it every Republican representative in the House and Senate? Some ? A few?
If we the people are to have representative government it must represent all of the people. However it appears those who purport to represent all of us in fact do not represent anyone but those who offer a quid pro quo.
If there is a whistle blown it should be more than the empty however shrill sound emanating from generic accusations.
1
I generally agree with PK, but one sentence in this op ed is misleading -- the main reason deductibles and co-pays are too big is that making patients pay for care out of pocket is a deliberate effort to reduce so-called "moral hazard," that is, to make people use less health care. There is an entire intellectual edifice -- dating back to Mark Pauly's 1968 AER article and enthusiastically embraced by almost all Republicans and many Democrats -- devoted to increasing out of pocket costs. It's ironic, because Americans actually go to the doctor and the hospital less often than Europeans -- even though (or perhaps because) our costs are so very much higher than theirs.
My adult son works in the restaurant industry where most often there is no insurance through the employer. He gets excellent affordable insurance through the NYS healthcare exchange. Last summer he was bitten by a tick and developed Lyme Disease related carditis. Two weeks hospitalized with a temporary pace maker. He received excellent care with NO COST out of pocket. I hate to think of the possible outcomes without insurance. Possible death, disability and catastrophic debt. It is way past time to do better. If we, as tax payers, can fund the largest military on the planet then surely we can manage to provide people with decent healthcare. There is no logical excuse.
17
Since spending private money on political processes is considered free speech our politicians of all stripes listen and act solely to the concerns of the upper class of this country. As in the film “Godzilla: King of Monsters” where humanity needed to pick and support a monster in order to survive against the others movements that aspire to provide good governance to the majority of the people need to woo as many good mega “onesters” to use their money to support and achieve that good governance. Widening income inequality, worsening climate change, inadequate health insurance, and diminishing democracy are existential threats to our country and are sorely in need of good governance.
6
My bother died from a treatable form of cancer in 2011. He lived in North Carolina and did not have access to health insurance. If he had had health insurance he would have been able to afford the cost of seeing an oncologist early on. He could not and therefore died.
As a doctor friend of my says, he failed the wallet biopsy.
15
If the Supremes rule ACA unconstitutional, within a few years some form of single payer/Medicare For All will be made into law.
So, I say to the Supremes: go ahead, make my day!
8
The theory of the ACA was that if Congress could compel everyone to buy insurance, insurance companies would be able to make enough money from new premium payers to enable an overall reduction in insurance premiums AND cover the additional services—including coverage for people with pre-existing conditions—that the ACA required. To get everyone into the insurance pool and make the economics of the ACA work, Congress created the requirement that everyone buy insurance. The latter requirement was known as the individual mandate.
Conservatives reasoned that the ACA would be unworkable without the individual mandate, and in the first ACA Supreme Court case they took aim at it. They reasoned that if the individual mandate fell the ACA would collapse from its own weight.
The only question that the Court was asked to answer about the mandate was whether the individual mandate was permitted by the Constitution. It was not asked to decide whether all of the other provisions of the law were legally dependent on the individual mandate, and, accordingly nothing in the opinion implies any such link.
Regulating insurance coverage is completely consistent with Congress’s power to regulate interstate commerce. In other words, Congress could have passed standalone laws requiring insurance companies to cover adult children and not discriminate against people with pre-existing conditions without requiring everyone to jump into the insurance pool. That’s why this lawsuit is absurd.
The rule of law.
One person, one vote.
Government for and by the people.
Liberty and justice for all.
Access to affordable health care.
How quaint these U.S. bedrock principles have become.
5
Perhaps as a New York City resident and physician I am missing the rationale for reflexive defense of the ACA by my fellow Democrats and Independents. From my standpoint, without full national buy in by all states, I see an ACA that presents cost prohibitive, unaffordable insurance premiums for most of my lower middle and lower income friends, for barebones, high deductible, and frankly laughable insurance options. As a physician I feel an ACA that has imposed onerous bureaucratic burdens upon healthcare entities and healthcare providers, such as charting requirements that force physicians to spend more time looking at computers than spending with patients, easily by factors of 2-3 to 1. If Democrats cannot achieve full national buy in then perhaps they should scrap defending this legislation (that defends deeply entrenched financial interests of insurance companies) and move towards supporting single payer, retaining the rights of people to hold private insurance. The continued defense of the ACA in the context of a successful GOP effort to demonize it feels like a forced beating of ones head against a wall.
13
Don’t let the perfect be the enemy of the good.
5
@Z
Yes, we Democrat-oriented citizens have been conditioned to accept half-way measures, as the collective "we" are afraid of upsetting donors and the rightwing noise machine. Pathetic.
If the GOP is successful in repealing the ACA, the very same people who regard Trump as their king will suddenly lose health care, and most likely not get it back, right before the election.
7
I will never understand Republicans opposition to a single payer system. Most countries that have the system pay half what we do on medical care. For 27 years I had employee based healthcare and then I was laid off. I could not afford the 1200 per month COBRA payment on Unemployment Insurance so I opted out. Two months later a minor fall lead to a major injury and because I owned a house, there was no program to help me. I also now had a pre-existing condition. My injury went untreated for more than six months until I qualified for Obamacare and my injury could not be a pre-existing condition. During that time, I was in constant pain, I didn't know if I would walk again, the anxiety alone was debilitating. Once I had Obamacare, I had surgery and physiotherapy and was able to get a job. I put my house up for sale and moved back to Canada. I will never live in the US again. I'm grateful every day for my 'socialized' health care. I have needed it, I have used it, but above all, I know I will never have to worry about it again. I miss New York, but not enough to risk my healthcare.
951
.
@thewriterstuff,
.
Ty Writer, well written
.
44
@thewriterstuff
Would just comment that the phrase "socialized medicine" is just another name for health insurance of any kind, even if it is widely used to imply single payer government insurance. In any health insurance scheme, whether government, for profit private or not for profit private (e.g. Blue Cross) a pool of money is created that has to be managed. If you need health care for an injury or illness, it is the money from the people paying into that pool that ultimately pays for the medical care, hence it is "socialized." It comes from your neighbors and fellow citizens more than from you. The issue is not whether it is single payer or even government payer, the issue is the rules of the road for anyone who wants to create an insurance pool for health care and sell insurance to citizens. This is why the "single payer" issue is far less important than establishing rules governing how health insurers are allowed to operate in the US. That was, in fact, the guiding principle of the Affordable Care Act.
71
@thewriterstuff I think I understand why Republicans are opposed to a single payer system — it is because they and those that back and fund them would not make nearly as much money.
91
This is a good article, but it's talking to the choir. I try my hardest to get people I know to read articles to become informed of what's going on around them, but they'd rather read a made up post filled with anger and half truths. We shouldn't be here now, the midterms should have changed the Senate, too. And, there's a lot that can happen in the next 18 months of the current Trump presidency.
6
This is an excellent article and should be on the front page of NYT and not off to the side. many do not know what is at stake and will die
6
America, wake up! The health insurance industry works exactly like the Mafia. First they shake you down for "protection" money, backed their congressional enforcers, and then they leave you one of their totally owned and junior "providers" to guard your health and that of your children. Why are we allowing this?
1
"You pay for this, they give you that". How a rube in any of the Rubeville states could still vote for these clowns is way beyond me. I shake my head and just wonder, what will it take to open their eyes? Answer, nothing.
4
Thanks, Paul....
Love to know your thoughts regarding the editorial in yesterday's NYT regarding the possible rate cut by the Fed...
2
Amazing that a Republican Party that is supposed to be against freeloaders and moochers eliminated the financial penalty for all the deadbeats who can afford to get health insurance, don't, and still go to the emergency room when they get sick.
5
Let the Republicans and the courts kill Obamacare. The blowback to losing coverage for children under 26 and preexisting conditions alone will be swift and sure.
2
"Activist judges."
1
Your update about Trump's (and republican) cruelty involved in trying to deny health care affordability to the millions of poor, elderly, women, children, etc that otherwise would be unable to afford it. Not only that, and thanks to Obamacare, the entire healthcare system would suffer, and the vast majority of folks in these United States already insured via their employers would see their benefits irremediably cut (and yes, coverage of pre-exisitng medical conditions added because of the A.C.A. would be eliminated by the private for-profit insurance companies). This brutish intent to deny the same coverage that republicans in power take for granted for themselves is pure hypocrisy...and a racist attitude towards Obama, a black president whose 'sin' was that he did care for the least among us (a concept too foreign by the uppity G.O.P. to comprehend). Let's trust that, with your updates, the people will rise to the occasion, and their interests...and show our ugly American in-chief...their teeth!
3
Paul, your fave, Elizabeth Warren, wants (at this point) to do away with private health insurance. This is a recipe for another Trump win. You know this. Even anti-Trump voters who get good insurance through their employers will vote for Trump, rather than risk their (good) insurance in return for insurance of unknown quality.
Warren is smart. Maybe she'll listen to you, as opposed to listening to Bernie? Say something!
1
Maybe it's time for the progressive "blue states" which, like California, are proudly moving forward to cover even more of its citizens, to just stop fighting with places like West Virginia to cover those who need it. Much as we may think they should have it, they seem most ungrateful, while the blue states pick up the tab by dint of California's/New York's/Massachussetts' extra contributions to the federal piggy bank.
Red states are like the Middle East, there will never be any peace and harmony imposed by outsiders.
Let the red states have their version of nirvana and learn to wallow in it...or people can just move out these states, which is more frequently the case.
2
Everyone commenting is making perfect sense.
Perfect sense, however, has no relationship whatsoever with the republican party of 2019 and is unlikely to for the foreseeable future.
The republicans are bound and determined that more of you sicken and die while they and their benefactors, cronies, friends and families benefit from their unrestricted access to the best and most expensive by far medical care in the world.
They're not going to change that or even entertain the notion of changing that.
Until you stand up, walk away from the keyboard, organize and confront them, at the polling booth, on the streets, at their offices even if need be at their homes with your overwhelming and overpowering numbers. And never stop. Arguments, logic, meetings and op-ed pieces by Nobel prize laureates mean next to nothing to them.
Unless you do that - well...last one out turn out the lights.
Here endeth the lesson.
2
Pretty funny Krugman, Obamacare passed by 5 votes in the House and one vote in the Senate
1
I read this from start to finish, hoping something had changed. But what I found was another Krugman anti-Trump anti-GOP screed that misstates some things and omits salient facts. For example, he states that "...there are many judges who will rule in favor of whatever the G.O.P. wants, no matter how weak the legal arguments." But he glosses over the fact that 1) judges do not have (D) or (R) after their name as elected officials do, and 2) Republican-nominated Chief Justice Roberts was the deciding vote that brought Obamacare into effect.
Krugman further does not assist the cause of creating a solid understanding of statistical inference; he just abandons the task. When we talk of mean or median or average Americans, we speak of no individual American in particular but rather all Americans in aggregate. So don't get in a huff when you read this lucid, objective, and insightful article that exposes the real problem with American healthcare:
https://www.theatlantic.com/magazine/archive/2019/07/american-health-care-spending/590623/
If Krugman cared about solving problems rather than trashing the half of the nation that has a different opinion he would write more like a professor (or Freedman) and less like a political hack. A serious problem requires a deft solution, not an ineptly wielded poleax.
2
Don't be naive.
Social Security and Medicare will also be on the chopping block.
The GOP will party likes it's 1929.....
1
Paul
All the air and your credibility as an economist went out your window when you voiced your strident negative opinion on the US economy.
You don't like the economic results under Trump.
You don't like the record breaking economic improvement because it is due to Trump's administration.
Take a look at your retirement plan assets investments!
A rising tide floats all boats, even the naysayers.
I love you Donald!
1
The high expense, high profit ACA has improved many American lives. We started at a low level. Multi millions are still uninsured. Now, we still have to fight for what other countries achieved for their people long ago.
From True Cost Blog:
Country Start Date of Universal Health Care System Type
Click links for more source material on each country’s health care system.
Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
Belgium 1945 Insurance Mandate
United Kingdom 1948 Single Payer
Kuwait 1950 Single Payer
Sweden 1955 Single Payer
Bahrain 1957 Single Payer
Brunei 1958 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Austria 1967 Insurance Mandate
United Arab Emirates 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Denmark 1973 Two-Tier
Luxembourg 1973 Insurance Mandate
France 1974 Two-Tier
Australia 1975 Two Tier
Ireland 1977 Two-Tier
Italy 1978 Single Payer
Portugal 1979 Single Payer
Cyprus 1980 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
South Korea 1988 Insurance Mandate
Iceland 1990 Single Payer
Hong Kong 1993 Two-Tier
Singapore 1993 Two-Tier
Switzerland 1994 Insurance Mandate
Israel 1995 Two-Tier
United States 2014 Insurance Mandate
4
Totally agree w/ Krugman's points. I have an idea: Why not just rename it "Trumpcare" or "Republicare", make it even less effective/efficient as the ACA has evolved, add subsidies for the rich (i.e., above 400% of the FPL), and call it a tax cut... I bet it'd sail thru the Senate and signed in triumph by the Orange Marmalade LOL!
I wish Paul Krugman would come up with a more comprehensive explanation WHY the Republicans persist in their destroy Obamacare crusade. All I can get from him is that they are compulsively unimaginably evil, (possible, maybe) but that seems simplistic.
I'd like to see a little more info on the real forces at work here - who is paying whom, stuff like that.
1
Paul,
Give up with this wishy washy arguments.
Single-payer, Medicare for All. Easy. Works in other civilized countries in some form or another.
Obamacare is the MINIMUM workable solution. Even the public option version got killed thanks to Lieberman the Insurance company lobbyist in the Senate. And we know Obamacare is really nothing short of pathetic. It is better than the alternative but that is about it.
Let’s all get behind Bernie and/or Liz Warren and get them to win big with co-tails in the House and Senate elections. We will still need to get Roberts’ vote in the SCOTUS or impeach Kavanaugh but we have to start somewhere.
Your article is filled with obvious stuff. Try a bit harder to remember your menschkeit. You had it as a young prof at MIT. These things come back.
1
It seems to me that the Republicans are playing with fire. If they do succeed it killing AFCA, they will have turned many many voters against them. Enough to end their control, I would hope.
The question I have is: why they are dead set on ruining peoples lives? The Republicans are the real enemy of the people.
3
"Plot Against Obamacare"
The marketplace prices keep climbing at double digit rate every year. Do you really believe a plot is necessary ?
I say let the lawsuit prevail. It may be the only way the duped republican voters ever get the message. Perhaps some short term pain can convince them to put their thinking caps back on. Brain in the ‘on’ position please.
So, I’m wondering if the SCOTUS (Supreme Court of Trump’s United States) decides to strike the law entirely then does McConnell need the House in order to reinstate the one thing they like? He’s recently stated they would immediately rescue the provision covering people with pre-existing conditions. But if he needs Pelosi and the Dems in the House to put something together and vote then she should flat out refuse.
Seems pretty darn cruel right? Crueler than not expanding Medicaid for millions in red states? Crueler than spending nine years trying to kill the law in the first place? Crueler than actually killing the law in the end?
Pelosi can simply argue the country made this man president on his word he would abolish the ACA and they straight up voted for it happen. Heck, many of his voters didn’t know they even had ‘Obamacare’ due to their bubbly media chambers.
But there’s got to be some personal responsibility for maga voters. You want healthcare? Stop voting for the people whose sworn duty it is to take it away. There is no need to save McConnell’s face in any way at all. Besides he can always tuck it into his neck! Ha! Seriously, let this man go down with the ship he has personally sabotaged for these nine years. Time to start playing hardball Dems. McConnell has performed as a weapon of mass obstruction and if the Dems show some spine they can return the favor. People might actually vote their interests next time!
2
Unfortunately, I doubt there are many readers of the NY Times and Paul Krugman's column that reside in West Virginia & Kentucky. Perhaps if your column was printed on the side of an opioid box, they may read it, but, even then, a long shot.
2
It always amazes me that the hoi poloi upon whom republicans depend are regarded as expendable. Who will be left for conspiracy believing voters to give them a pass? They will be dead.
1
Yay!! Two judges appointed by Republicans (one by W and the other by trump) will rule that Obamacare is unconstitutional.
This should make everyone happy because there will be no more pre existing conditions protections.
Trump says he is for this so you should be too. Don’t think. Just support Trump.
We all love dealing with insurance companies and now it will be easier to deny coverage because of pre existing conditions.
YAY!! Down with socialism.
Sarcasm alert!!
1
Simply, the republicans do not care if Americans have health insurance, destroying the ACA has been their goal. Kill all things Obama, trump and mcconnell legislature goals.
Make America last.
The USA was once the leader in healthcare and education, it now ranks 27th!
When I read this stuff I always ask: “What is the GOP’s vision for America and its people?”
Judging from the most popular Reader Picks, the GOP is going to wind up out of power for their actions in stripping healthcare from their constituents alone. Let’s hope they are out of power for a long, long time so they can change their ways and our nation can begin to recover from all the horrifying damage they’ve been causing.
1
Because Republicans read The NY Times...
The sad fact is that medical care at the standard we all expect is Expensive, even if made less so it is still expensive. A good portion of the country, 20-30% maybe more, cannot afford to pay their own way fully. When Republicans show me a credible, better alternative they can repeal the ACA with my blessing.
But in 8 years of "Repeal/ Replace" there has been no alternative given.
1
The ACA is better than no insurance, but it is too complex, too costly and is unsustainable. We cannot have 30M uninsured, 44M underinsured and the trends in the wrong direction. How long will government prop up insurance companies, increasing subsidies even while the insurance companies increase premiums, co-pays, deductible and their own profits. Just stop it and take the plunge toward single payer, improved medicare for all. Join the rest of the world.
2
If Republican judges succeed in abolishing the ACA, I guarantee Republicans will have no problem convincing the public that it "failed" because it was intrinsically flawed. Fox and their ilk will push that claim relentlessly, and the "mainstream" media will uncritically allow official and unofficial Republican spokespersons to say it because, of course, "both sides."
Here are the numbers of Americans who selected an ACA (Obamacare) plan in the most recent enrollment period.
You'll notice many millions of red state Republican citizens enrolled in the ACA.
USA total 11,444,141
Florida 1,783,304
California 1,513,883
Texas 1,087,240
North Carolina 501,271
Georgia 458,437
Pennsylvania 365,888
Virginia 328,020
Illinois 312,280
Massachusetts 301,879
Michigan 274,058
New York 271,873
New Jersey 255,246
Tennessee 221,533
Washington 220,765
Missouri 220,461
South Carolina 214,956
Ohio 206,871
Wisconsin 205,118
Utah 194,570
Colorado 170,325
Alabama 166,128
Arizona 160,456
Maryland 156,963
Oklahoma 150,759
Indiana 148,404
Oregon 148,180
Minnesota 113,552
Connecticut 111,066
Idaho 94,430
Louisiana 92,948
Kansas 89,993
Mississippi 88,542
Nebraska 87,416
Kentucky 84,620
Nevada 83,449
Maine 70,987
Arkansas 67,413
Iowa 49,210
Montana 45,374
New Mexico 45,001
New Hampshire 44,581
Rhode Island 34,533
S Dakota 29,069
Vermont 25,223
Wyoming 24,852
West Virginia 22,599
Delaware 22,562
N Dakota 21,820
Hawaii 20,193
Wash, DC 18,035
Alaska 17,805
These are the people that Donald Trump and his Grand Oligarch Party are trying to make sick or be injured without affordable healthcare....who will inch closer to death because of unaffordable American healthcare.
Don't vote for these misanthropes unless you're looking for an assisted-suicide specialist.
Don't vote for GOPeople who are trying to hurt you.
"Take two tax cuts and call me from the morgue"
GOP 2019
33
@Socrates Thanks for posting these numbers. I guess the Trump supporters like getting medical care too as long as it's not called Obamacare. The same probably applies to Social Security and unemployment if they are entitled to them. I wonder how many would give those dollars up if they were told that those programs are socialism and welfare of a sort. I'll bet not one.
2
I am too tired to look it up now, but my recollection is that one, if not the main, lines of attack on the ACA before was that Congress had no power to penalize Americans for not getting mandated insurance. The deciding vote, Roberts’, was that the penalty was really a tax, and therefore it and the ACA were constitutional. The argument that reducing that penalty to zero makes the whole act unconstitutional is absurd. It simply makes it somewhat less efficient.
1
This is further evidence that Mitch McConnell's deal with the devil - blocking the confirmation of Merrick Garland and supporting Trump in order to stack the courts with conservatives - will have a generational impact upon our nation.
If Trump loses but the Senate remains under McConnell's control, judicial appointments will again grind to a halt.
It's a cynical, but highly effective strategy to maintain conservative control over the nation as long as possible.
2
Democrats can learn something here, not from the inane arguments trotted out by GOP against the ACA, but from the tenacity with which Conservatives pursue their policy goals. Rightwingers are relentless and rarely discouraged by the setbacks. Much of the Democrat Party establishment is too quick to cave in and compromise, though an increasing percentage of the Democrat constituency is fortunately becoming more radical and determined.
4
The sad thing about all this is Trump's moves are directed at making his base happy. The nutty thing, though, is his base has most likely benefitted from the ACA, but if you attach Obama's name to something, the base feels it has to be overturned, even though it is benefitting from it.
Abe Lincoln was correct: "You can fool all the people some of the time, and some of the people all the time, but you cannot fool all the people all the time." However, Trump capably demonstrates that you can sure fool "a lot" of the people "a lot" of the time.
4
@Mike Well, the thing that really galls me is something reported in the news shortly after the 2016 election: people in the red states were exultant that Trump was going to abolish what was termed Obamacare. Then they found out that it was their Affordable Care Act that was on the line! They didn’t even know they were one and the same! As a retired teacher I am doubly appalled, at the blatant ignorance of citizens who one would think knew their own health plan’s identity, and their lock-step reflexive hatred for anything labeled after President Obama. Talk about “disgrace!”
So after team Trump fulfills half his promise to destroy the ACA but fails to keep his other promise of "cheaper, better healthcare that leaves no one out" will his followers just applaud him for the first half? After they lose coverage for preexisting conditions and their college age kids no longer have medical coverage then what? Will they understand they've been conned finally? What's the end game for republicans? Trump still wants to be president in 2020 but seems like that will just keep him power during the fallout of his bad policies. The economy will start burning out too by then.
His usual MO is to leave wreckage and then skip out letting others clean up but it looks like his desperation to avoid legal problems may cause him to try to stay "president" as long as possible . I'd be starting the popcorn to watch this ... If I lived in another country but sadly I'll just be suffering from this fallout here.
2
Maybe this is a good thing, with the caveat that the Supreme Court ultimately throws out any deranged appellate ruling. It will keep the matter fresh in the minds of those who have the most to lose in 2020 and finally, finally, finally, they may put two and two together and realize which party is trying to send them to an early grave.
2
Stupid is as stupid does. The barefaced malice shown by Republicans towards ordinary Americans is apparently bottomless, and they’ve already made it abundantly clear that they couldn’t care less about what voters want. The good news about ACA facing the judicial firing squad in the 5th Circuit is that if, as expected, the panel upholds the lower court’s decision, then it heads to the Supreme Court, which will occur right in the middle of the Presidential campaign. Once again, health care will be a very live issue, and GOP candidates will have to answer a lot of awkward questions about insurance coverage. We know that worked for them in the midterm.
5
The obligatory comment to say that the much demonized ACA is the Heritage Foundation's response to 1994's "Hillarycare".
That's right, the bill that no Republican voted for (at the insistence of McConnell and Boehner) was the compromise bill from the far-right Heritage Foundation to transform Romney-care (remember him, he ran against Obama in 2012) into a national program.
No wonder Republicans love to hate it and Democrats hate to love it.
Please please please destroy the ACA! This will give the Democrats a huge gift in 2020, and hopefully destroy the radical insurgency that we all pretend is a legitimate political party. However, I do have some reservations. First, the Democrats are exceptionally bad at messaging (for example, why aren't they ALL referring to the tariffs as the larges tax hike in modern history??), so they might actually find away to squander this, which is sadly a strong possibility. Second, many people in those red states will -- despite having their lives destroyed by the Republicans -- continue undermining their own interests, voting for the party that clearly hates any meaningful and modern concept of society and humanity.
With that said, our best hope is to have the partisan SC destroy this law and let Trump own it. If the Republicans win anyway, it won't matter much; civilization will cease to exist as we know it, either through nuclear war, or through the long-term implications of anti-environmental policies -- not to mention civil-unrest-inducing levels of wealth disparity. Even if the world doesn't end, the U.S. will not be even a quasi-democratic country by the time they're done destroying institutions -- we'll look more like Orban's Hungary.
3
Please, Mr. Krugman, keep making the point that Republicans act in bad faith. Republican lawmakers, Republican judges, Republican provocateurs, all start from the principle that dishonesty is the best policy.
This is why Dems should not be pushing for a coddler like Biden. We need someone who will explicitly attack and atrophy Republican influence with in-your-face policies.
3
An impish part of me would love to see these Republican judges quixotically mount their noble steeds, point their legal lances and impale Obamacare. It could be the proverbial straw that broke the camels' back and effectively destroyed the GOP as a national party. If a Democratic landslide followed in 2020, there might finally be a congressional majority to tackle the backlog of problems facing this now stalemated country. If right-wing Federal judges remained defiantly obstructionist, there would likely be a move to pack the courts and redress the current imbalance.
Chief Justice John Roberts is not a fool and has his eye riveted on his place in history. He understands the possible political scenarios resulting from a total evisceration of Obamacare as well as anyone. As a self-styled institutionalist, he knows that throwing out Obamacare based on flimsy legal reasoning throws more fuel on the already raging fires of cynicism and despair. But upholding the ACA would subject him to the wrath of the right-wing extremists with whom he has long identified. It would present him with a serious dilemma.
If the 5th Circuit declares the ACA unconstitutional, Roberts' vote on accepting a Supreme Court appeal will define the eventual outcome. He gains nothing in voting to hear the appeal unless he is prepared to reverse the Circuit Court and uphold the statute. But if he declines to hear the appeal, he will be unhappy with how future historians view his failure of moral courage.
1
Face it. The ACA, ("ObamaCare"), stinks.
The non-existent Republican plan will stink if if it ever materializes.
Here is MikeCare. It almost doesn't stink.
You know how the government pays to provide us with universal necessities like cops, education, libraries, road construction and repair, fire departments, snow removal, defense, garbage removal and the like? That's what we need in regard to medical care to make sure that everyone in the country, regardless of wealth or income, is covered. Just like with the other services medical services should be paid for using the taxes which we pay.
You go to whatever doctor you want, you pay a deductible to discourage frivolous medical visits, and the medical providers get paid according to a reasonable government schedule that is tailored to region. Medical providers who do not want to accept what the government is paying can do so by posting a notice in their offices to that effect. You either pay the difference or go elsewhere. In any event you get the best possible care which is what we all deserve.
What is the argument in favor of letting people get sick and die just because they are financially distressed? And that's the end of it. Welcome to the 21st Century! If it makes the prez feel any better call it "TrumpCare".
The government is not equipped to run what in essence is a large, all-encompassing medical insurance company so job it out to private companies to run, like FEMA does with flood insurance.
1
"Aha, said the law’s opponents: Since the mandate no longer collects any money, it’s not a tax, and it is hence unconstitutional, and so therefore is the whole law."
This is a leap of logic I've never, ever understood. How can duly passed healthcare legislation ever be unconstititional, when prior Congresses passed Medicare, Medicaid, and CHIP?
What part of the ACA--even a weakened law, stripped of the mandate--violates the constitution?
Calling a healthcare program, a public good, an assault on the Constitution makes about much sense as calling corporate donations to political campaigns "free speech."
But Democrats should take this GOP gift and run with it. Comfy and cared for by their federal healthcare program, GOP representatives and senators want to deprive 20 million Americans access to care, simply because the law was passed by a black president.
That's just plain sick.
7
Literally nothing Mitch McConnell does benefits the citizens of Kentucky, but they vote for him anyway. Thus, they deserve to lose their healthcare insurance once the Republicans succeed in getting rid of the ACA.
1
If Trump supporters are forced to chose between access to health insurance and supporting Trump they will not abandon Trump. They will reject having access to affordable health care.
Apparently medical bankruptcy or premature death while waiting for Trump's big, beautiful but inconveniently non-existent health care plan is a small price to pay for never admitting that you were conned by a big-city career white collar criminal and his siren song of white nationalism.
Kentucky and West Virginia will vote for Trump no matter how many of his supporters are hurt by an AHCA repeal. There is no quick cure for partisan induced self-harm.
The fight will be in the purple states among independents not willing to follow the GOP into the Trumpian abyss.
1
Fox News and the like have poisoned our country with their half truths and lies. They play to fears and prejudice to sell their lies. We have an organized coordinated misinformation campaign aimed at brainwashing the masses to support policies that favor the very wealthy over the rest of us. It’s working. Can enough American become wise enough to overcome this assault on our country? Can the Democrats come up with a message that has overwhelming support? I’m not seeing it.
1
This should be a winning issue for Democrats.Why is it not stressed more? Of course allowing for ignorance and false and bad faith representation of the subject there is always the other problem:" that right-wing partisanship has already corrupted much of the judiciary." The author delicately refers to this as a 'possibility.' From here it seems much more than that.
2
You want to keep the President. Give up your health insurance.
One curious thing about the Republicans in Congress is that they are not only corrupt but incompetent. How else to explain their desire to get rid of Obamacare by hook or by court when a ruling against Obamacare would pretty much ensure a re-run of the 2018 elections in 2020.
1
Actually, there are THREE main implications of what we're seeing here. The third consists of the fact that anything proposed and/or implemented by Donald Trump's popularly-elected predecessor (and, most especially, anything that actually has his name on it) simply must be eradicated by the current administration. Twenty million people now have affordable health care for the very first time: so what? People with pre-existing conditions now have affordable insurance: big deal! Had President Obama invented a cure for cancer, his successor would have ruled it illegal. As for Osama bin-Laden, is it possible that Trump can have him brought back to life?
2
Obamacare was constitutional because it included a tax. So, if the tax is gone, killed by the GOP tax cut, it follows that the law itself is now unconstitutional. The GOP's argument about the law's unconstitutionality reminds me of the story of a young man standing before the judge pleading for mercy because although he was convicted of killing his parents, he is in fact now an orphan.
2
Yes, bad-faith, specious arguments can prevail. They have been prevailing for years now. They got Bush elected, gave us Citizens United, and made baking wedding cakes a matter of religious freedom. The non-lawmaking conservative judiciary makes lots of laws when they support right wing politics. This case will be no different.
The Republican party, led by Trump, wants nothing more than to erase anything and everything accomplished by Barack Obama. The ACA was his signature achievement. That's why they don't want to fix it. They must destroy Obama's legacy. Something to do with the color of his suits.
Knowing how Trump operates, he thinks the best way to get what he wants is to force the opposition to yield to his demands. I'll bet you Obama's tan suit that Trump thinks if he can demolish the ACA in one sudden fell swoop, that will force the Democrats to accept whatever lousy program the Republicans come up with. And that program will be pretty much the way things were before the ACA was developed.
His supporters will suffer mightily, but he will blame the Democrats for blocking his great non-plan. They, of course will believe him. Nancy and Chuck took away their healthcare.
So from Trump's perspective, he has nothing to lose and everything to win, as perverse as that sounds. The public, on the other hand, has nothing to win and everything to lose.
The folks that brought us supply side, trickle down economics are about to do the same to healthcare.
This nightmare of Trump never ends.
Obamacare saved my brother's life. His aggressive cancer surgery was made possible by his ACA coverage.
Trump and the Republicans are simultaneously collapsing this country, its principles, taxpayer programs that actually benefit the citizens, the environment, healthcare and the future of this country instead of pouring into the pockets of the rich.
At the same time, their poison spreads outwards. Bigotry and racism are now out in the open, and the norms of society are torn by constant lies and insults.
Destroying healthcare is just part of this whole. There is no longer an economic rationale for it: it works. It improved the economy. Tens of millions of Americans across the entire nation -- red and blue -- benefited. There was never a moral reason to destroy healthcare.
So what reason is left? The habit of hate?
3
I have been holding my breath for two and a half years waiting for the "better, cheaper, no pre existing conditions" Trump Care.
I am turning blue in the face.
The medicaid deniers are like the climate change deniers.
The medicaid denying states are red states that are bleeding red because of the trauma they inflict on their populations in the name of conservativism and ideological purity.
Oh well....Vietnam Vet
2
Ok, do away with the ACA. Go ahead. On one condition...
You also do away with whatever health insurance plan is covering our representatives in the House and Senate. No coverage for them or their families.
We'd have Medicare for All before the sun rises today.
4
Another absurd use of the law much like the 2010 SCOTUS (Citizens United" (AKA corporate personhood) that made corp[orations into people and defined money as free speech. The GOP is the servant slaves of special interests. And now the SCOTUS is a completely partisan owned corporate interest entity. This is why we need real reforms that get corporate money out of politics. Warren and Sanders have it in their platforms. Unless we do something about the bottomless greed of the 1% who cannot enjoy their wealth unless others suffer and die, America will be just another deformed Republic living under a kleptocracy of economic elites. 20 states have moved to amend the 2010 ruling. Wisconsin at 55% and pending. Others are building. This is the grass roots movement we need. ACA was a good start to help the uninsured of this nation. Rather than let it be destroyed by corporate greed and the elite's lust for power, we need to pull the plug on corporate totalitarianism starting with overturning the diabolical euphemism called "Citizens United."
2
When a political party uses the judiciary as a sledgehammer to enforce their minority and unconstitutional views using a partisan packed court you know that democracy is under fire.
The GOP under the abhorrent lead of Mitch "graveyard" McConnell has become the most cynical, scared, racist, corrupt and non-democratic political party of the USA.
They need to be voted out of office, all of them. Starting with McConnell who has done more damage to the country than Trump. It will take decades to undo some of that damage.
2
Up is down. Absurd arguments become norm and suggests Trump may successfully con some more voters, however, as Lincoln wisely said, "you can fool all the people some of the time and some of the people all the time, but you cannot fool all the people all the time."
The goodish news is I predict healthcare is the issue that's going to sink Trump and company, and very likely elect Biden, so let Republicans them keep working on killing Obamacare because it might mean even Kentucky will vote McConnell out!
if a legal argument has absurd implications, it’s an absurd argument.
3
The neoliberal orthodox economics is a construct to enrich the already wealthy and to insure their political power.
Politicians tell their voters what they want to hear but in the end they will do what their K Street lobbyists want them to do.
We are a plutocracy now. Get used to it. The 99% will be getting nothing, nothing.
It's unconscionable that the Red states in the lawsuit aren't satisfied with rejecting the ACA so their citizens could benefit from the expansion of Medicare; they actually want to take it away from other states. Politics over morality, or just basic human compassion. These are no followers of "love your neighbor as yourself."
The Republican party leadership (and their rich backers) are vile, but let's do acknowledge 2 Republicans who have helped save the ACA: John McCain (his last heroic moment: a big thumbs-down in prince of darkness Mitch McConnell's face) and Chief Justice Roberts (in the SCOTUS ruling you mentioned). Were it not for them, the ACA would have already gone away.
All we can do is hope the Dems take the Senate and presidency and retain the House, and then establish universal coverage (public option to start, please; medicare for all will lose the election). Let's just hope there's no one so in the insurance business's pocket, like Joe Lieberman was, who will prevent that from happening.
Eventually we'll have to get to medicare for all (but call it something else) to afford universal healthcare, but if the leading Dem candidates for the party nomination are smart they'll back off pushing it right away, and certainly back off from providing illegal immigrants with healthcare when not all American citizens have it...yet. Once everyone here legally is covered, then they can make the case for covering illegals.
1
It's unconscionable that the Red states in the lawsuit aren't satisfied with rejecting the ACA so their citizens could benefit from the expansion of Medicare; they actually want to take it away from other states. Politics over morality, or just basic human compassion. These are no followers of "love your neighbor as yourself."
The Republican party leadership (and their rich backers) are vile, but let's do acknowledge 2 Republicans who have helped save the ACA: John McCain (his last heroic moment: a big thumbs-down in prince of darkness Mitch McConnell's face) and Chief Justice Roberts (in the SCOTUS ruling you mentioned). Were it not for them, the ACA would have already gone away.
All we can do is hope the Dems take the Senate and presidency and retain the House, and then establish universal coverage (public option to start, please; medicare for all will lose the election). Let's just hope there's no one so in the insurance business's pocket, like Joe Lieberman was, who will prevent that from happening.
Eventually we'll have to get to medicare for all (but call it something else) to afford universal healthcare, but if the leading Dem candidates for the party nomination are smart they'll back off pushing it right away, and certainly back off from providing illegal immigrants with healthcare when not all American citizens have it...yet. Once everyone here legally is covered, then they can make the case for covering illegals.
1
I get that the GOP has been promising its base that it will repeal Obamacare because it's Obama's signature legislative achievement. Yet it seems that their sheer hatred for Obama may result in millions losing their healthcare just in time for the presidential election. How will they spin this to voters? Maybe Republicans are counting on more Russian interference (not like they're lifting a finger to stop it) or they think that red states are so brainwashed over the abortion issue that they will vote GOP even if they lose their health care. It remains to be seen. But either way, this is no way to govern a civilized society.
When it comes to Health Care, Republicans are unrelenting in their commitment to do harm to the American People. The damage Republicans seek to inflict on Americans by removing their Medicaid would be devastating. The real terror threat America faces is not in the Middle East but is Republicans in Congress who want to destroy the Health Care system. Republicans have been terrorizing Americans since Obamacare was enacted.
1
July 16th. That's the date Trump promised he'd deliver his "beautiful" new health care plan. 4 more days. Can't wait to see what he's got.
Wonder how many of the 20 million who may lose healthcare if the ACA goes away voted for Trump?
For those who didn't, my heart goes out to you.
1
And Trump and the GOP will argue that Democrats use the courts to write law...
Just because there are not enough Obama judges in the court for the left to get their way doesn't mean the judiciary has been corrupted. The law is wrong no matter what the implications of its repeal are. Obama isn't insurance anyway. It's a wealth transfer mechanism from the the working to the non-working and from Americans to illegal immigrants who use our emergency rooms and don't pay.
Once upon a time, not all that many years ago, the conservative side of the body politic would routinely froth at the mouth at "activist judges" who would legislate from the bench. They charged liberals with relying on the judiciary to accomplish what they couldn't make happen in the legislature. What goes around, comes around.
2
Two recent, personal examples of our "great" health care system:
1. My wife had her gallbladder removed a few months ago. She was at the hospital a total of 5 hours; no complications. Total cost: more than $30,000.
2. I recently had complications from an outpatient surgical procedure. The GI doc office that did the procedure, that said to call them immediately if I had symptoms of complications, told me to "just go to the ER." Docs use the ER as a dumping ground for problems that occur after office hours.
1
At the height of the final skirmishes before the ACA was a done deal- when the public option was still on the table- I went to a small protest organized by the Nurses union, 1199-C hospital workers, and a progressive doctors group. We were in front of a luxury hotel where the limos full of health insurance executives were rolling in, making sure they protected their bacon. Sure enough, no public option. Obama should not have started with a half-a- loaf strategy, which is one big reason I like Bernie Sanders’ approach. Medicare for All is the sane strategy. As Sanders says, healthcare should be a human right.
2
While I would truly hate to see millions of Americans lose health care coverage, it might be the best path to a Democratic victory in 2020. The closer it happens to the election, the better. Then again, the Mitch & Co. corruption machine would likely see to it that the revocation is not implement until after the election! I also have little faith that the under-educated rural voters in W VA and KY, will suddenly have that "ah-ha" moment we all keep waiting for. It's like watching a toddler who keeps failing at a connect-the-dots coloring book.
7
For thirty five years my family had great coverage through my wife’s office plan, it covered 100% percent catastrophic coverage which came in handy when she had a stroke, it was a miracle she came out of a comma like state and miraculously recovered, after spending nearly a month in the hospital rehabilitating, a year at home before heading back to the office, if not for the health coverage there would have been no way to foot such a massive hospital stay and the following rehabilitation expenses. After my wife’s retirement I was able to take over the monthly payments of her insurance plan, there were yearly increases of averaging 3%, my wife eventually made the age of Medicare and my child was off on her own leaving only me on the family plan, until the ACA, a law not yet in effect the policy jumped a from $850.00 to $1100.00 monthly and then again in 2013 went up to $1800.00 a month, a little to rich for my pocket. My business partner found a state subsidized plan that cost as much as my original plan before the ACA, With high deductibles, and the catastrophic hospital coverage is only 80%. I lost my doctor, my pharmacist, and original healthcare plan as a result, but then again wouldn’t be able to find a policy if not for ACA. I still have some years to go before I’m eligible for Medicare, I can’t complain after all my wife is doing great, I am In good health and have health insurance I hope I never have to test the limits of. Time for a single payer with options.
2
@Glenn
If you believe outright overturn of the ACA will fix the problem you cite (and there are plenty of contrary testimonials), I have a bridge I want to sell you.
The cost of medical care is an enormous problem and going back to the past is neither possible nor sensible.
6
There is a reason most lawsuits brought by Democrats to overturn policy is brought in San Francisco. A judge there will inevitably issue a nationwide injunction against the policy. The Ninth Circuit will inevitably uphold the injunction and find the law unconstitutional. And the Supreme Court hears a tiny fraction of cases that are appealed to it. You don’t seem to care when the Democrats do it.
The 5th circuit court is very conservative, to the point that legal arguments could be twisted to allow established elements of the ACA to be overturned.
We can hope that there is enough understanding and sympathy, and that the judges find in favor of attempts to stabilize the health care system, but that remains to be seen. The judges know all these arguments--maybe political tribalism will not triumph (but I would not bet on it).
That the court could consider overturning something so important to the health of the nation on a tribal partisan basis does not bode well--but they could do just that, throwing the whole thing back to SCOTUS again.
1
The ONLY way to get the Affordable Care Act through Congress (at that time, even with a supposed Democratic super majority) was to guarantee profits to the insurance companies and pharmaceutical companies. Full stop.
What the goal was, and still is, is to cover tens of millions (as many as possible) Americans by subsidizing them to buy insurance, and to have the haves pay a lit more to the bottom. Simple enough.
Even though it was a conservative/republican plan to begin with, the republican party went off the deep end trying to reverse course via 50+ times voting to repeal, and almost the same amount of times going to court. In every state they controlled, they did not implement it, which is really why the costs are getting too high - there are not enough people within the system itself.
What is not talked about enough (or at all) was there was, and still is, a back door proviso (the REAL reason why republicans are apoplectic in trying to repeal) that any state can implement their own Single Payer systems (Vermont came closest) The original thinking was that state by state would indeed lead to Single Payer across the board at the federal level.
All that republicans/and the courts have done is to speed up that process, so that essentially the main plank of the Democratic party is now for Single Payer. (the country agrees)
Instead of happening in 20 years, I suspect that there will be a full Single Payer system in the U.S. within 10.
A good thing.
3
What's the point in being rich if you don't get stuff that ordinary people can't get? Like healthcare. Why should the rich have to stand in line with the poor to get their well deserved healthcare? If we give healthcare to everyone, the rich will all stop working.
4
I’m not rich by any means, but I manage my hard earned money well. There’s a case to be made that poor people are unhealthy because of their bad choices day in day out. I shouldn’t have to wait in line behind someone who smokes, drinks excessively, and is overweight because they eat fast food 7 days a week. I’m sure you’d call it victim shaming, but in reality it’s the result of government dependency that stems from progressive politics.
Mandatory single payer basically means that I’m going to be taxed heavily on income, be forced to wait in long lines for routine care, and basically fund the healthcare for the type of individual mentioned above. No thanks..
@Shay "Mandatory single payer basically means that I’m going to be taxed heavily on income, be forced to wait in long lines for routine care, and basically fund the healthcare for the type of individual mentioned above."
This is typical GOP talking points Shay. If the plan is patterned after other countries plans like Canada, Norway, Sweden, etc we can breath a sigh of relief. I had an office in Vancouver, BC for years and my friends there were very happy with their health care.
1
The judicial branch once determined the constitutionality of laws, something was determined to be constitutional or UN-constitutional. But the politicization of the courts by the GOP has introduced a third option, call it ANTI-constitutional. In numerous rulings the high courts (Appeals and SCOTUS) have made rulings against the Constitution. Hobby Lobby, Citizens United, The recent ruling on Gerrymandering, The partial overturn of the Voting Rights Act, this attempt at eliminating the ACA are all anti-constitutional. They (except the ACA question which is still pending) overturn settled law that has been in effect in some cases for centuries—principles like one man, one vote, Personhood reserved for people. If the ACA goes, Roe is next. I believe the solution for this kind of egregious behavior from the bench is impeachment and removal from office. We act as if impeachment is a drastic step that should only be used once in a great while but the evidence shows that political parties skate right up to the edge of constitutionality and sometimes over it because impeachment has become a dead letter. We need to change that and employ all features of the Constitution as needed.
7
And once you get to near the upper 50s or early 60s everyone has a preexisting condition. Why, why, do Republicans want to treat their own people so badly. Every other developed country has universal healthcare. I would think employers would get behind universal healthcare, it would save the money, distractions, staffing all kinds of hassle. Everyone please call your M of C about this issue. Our health is too important.
6
The key cost control component of the ACA was the "Independent Price Advisory Board." That component was eliminated, in a bipartisan effort, several years ago.
If the Republicans cannot show us their cheaper, better plan than the ACA, perhaps they can answer one question: how could anyone be expected to contribute to our nation's economy when they are struggling with unnecessary illness and who do they expect to pay for the services they will need in their prematurely final days having been already bankrupted with medical bills?
4
I cannot understand the reluctance to have healthcare for everyone. That mother who dies needlessly in childbirth, that person who dies because he couldn't afford to get a timely diagnosis, or the treatment that would have been started because of the diagnosis - they are all your fellow Americans.
Americans made a big deal about the 3,000 deaths from 9/11, and waged a three trillion dollar war as a result. But 20,000 to 45.000 people die every year from a lack of health coverage. Those people are just as dead as the victims of 9/11, but they die individually, scattered about the country. There is no outrage on their behalf.
20
The problem is libertarians. That political philosophy generally ignores reality and instead focuses on 'principals' without making any compromises for the real world and more importantly, real people.
7
I wouldn't say prices have stabilized. My daughter just got a notice that her premiums will go up by 19% next year. 19%!
3
Roberts was the only one to say it was a tax. Congress kept saying it wasn’t.
1
Republicans really need to rethink this.
It's one thing to never have health insurance.
But to take health insurance away from people?
That's completely different.
Voters who lose coverage will remember who took it from them.
And it won't be Democrats they blame.
It will be Trump and the GOP.
7
All of this just proves one point. Judges, including those on the Supreme Count, are just as political as the members of Congress. The symbol of our justice system, "lady justice" weighing evidence on the scale of justice while blindfolded, is hogwash. We need to start treating judges like politicians. Abolishing lifetime appointments would be a good start.
9
This is not really all that hard Mitch McConnell and Donald Trump do not care one tiny bit about you, unless that is you can do something for them. The vast majority of us simply don’t count in their world. Why that is not obvious to all is simply astounding to me but I guess PT Barnum had it figured out a long time ago.
7
Being insured does not mean that there are no limits to coverage, premiums that can be onerous, and deductibles. It's true in Medicare. Some have insurance with low premiums and deductibles to cover almost everything. Often, but not always, these plans are offered to government employees or those in the Health Care arena. Even these have restrictions. The central problem in health care is less insurance and more about cost. health needs are not so elastic (to use the economics term). Which means less price sensitive. And market dynamics (which the Republicans take as sacred) do not hold so well. This is made worse the more chronic and acute is the illness. Moreover this industry involves something like 16% of the economy. All of this is made worse by an aging population, lifestyle preferences (diet, sedentary living, etc.), and massively costly end of life technologies and practices. My point is that debating insurance coverages alone while relevant is an incomplete and deceptive sideline to what is truly at the core of the health care crisis in the country.
1
"Specious, bad faith legal arguments" no longer matter as the Republicans have been doing what they accused the Democrats of years ago; they have been packing the courts to "Legislate from the bench".
6
And, if you have good, employer-provided insurance, any democrat elected has already stated they will take that away...so they can give free health insurance to illegal aliens. Thus, the election will turn on this fact. Care to handicap the result, Mr. Press Panjandrum?
1
@Cari. Not so sure it is all or nothing
Nov 8, 2018 · On average, employers paid 82 percent of the premium, or $5,655 a year. Employees paid the remaining 18 percent, or $1,241 a year. For family coverage, the average policy totaled $19,616 a year with employers contributing, on average, 71 percent, or $13,927. Sorry, I would gladly pay an additional $5500 in taxes for guaranteed healthcare with no exemptions, no endless paperwork, and no denials of coverage. Why do you think it is that with few exceptions all people living in countries with universal healthcare systems support and appreciate said systems? The United States, the wealthiest society on the planet, remains the only one that does not provide it's citizens with the security of knowing that their health is a right and not a roll of the dice. Our healthcare system is broken--no one can even begin to argue that it is not. Big problems call for bold ideas to arrive at necessary solutions. If you are so wealthy or so healthy that this issue does not affect you, well then congratulations I suppose. But for the rest of us, the practice of medicine for profit is not only a failed failure, it is a disgrace. PS your lack of compassion for your fellow human beings is repugnant.
2
Why does the GOP hate the ACA so much? Is it just because people call it "Obamacare"?
5
.
@Matt,
.
Bc this era is one of the savage phases of the Class War,
and the GOP's hysterical hatred for the ACA is a crucial part of that :
wars need a villain against whom the cannon-fodder footsoldiers can be propagandized to sacrifice their lives,
hence the literally incredible opposition of many Red state voters to the Socialist ! Big Fed Govt ! ACA !
.
Just for spite, we should do away with all entitlements and live in a totally socialist free government where one picks themselves up by their own bootstraps. The first to complain about no Medicare, Social Security, food stamps, infant family leave benefits and no coverage for pre-existing conditions will be the same idiots believing the ACA is the bane of their existence - like they don't need healthcare.
2
On the legal front, here's a bit of background from Thomas Miller who was testifying before a congressional house committee in February: "The plaintiffs in Texas v. Azar constructed their arguments to, in effect, reverse engineer
and leverage the unusually contorted Supreme Court opinion of Chief Justice Roberts in NFIB v Sebelius. The Chief’s 'majority opinion of one' in the case had 'saved the ACA only by finding that the individual mandate provision could be found constitutional as a tax, rather than a regulatory penalty (despite how then-President Obama and the Congress that enacted preferred to describe it)."
The point ducked by Professor Krugman is that the constitutionality of the ACA rested on a bizarre ruling in the NFIB case, that Congress later chose, in effect, to target. Now, just what was intended by Congress in that targeting is open to question, but the root of this problem is with Chief Justice Roberts' odd logic in NFIB. The states challenging this law have good legal reason to make their case. Moreover, their ultimate goal is to permit a return to more state and private discretion with respect to healthcare, rather than to permit continued nationalization of a problematic system. Professor Krugman does not give proper credence to the legal background or the substantive problems with the ACA in operation that have left many states and their citizens with undesirable systems.
Every developed nation does healthcare as a tax for about 9% of GDP per capita. We do it for roughly 18%.
Most of us by middle age has a preexisting condition the right wants to charge more for care.
The con movement will never provide for preexisting conditions. They will set up a high risk pool and underfund it so it won't work and claim success.
4
I sure hope those who didn't vote in 2016. voted for an alternative to Clinton because they didn't like her, or switched over to Trump believing that he was a working class hero are happy with the shape of the federal judiciary. Treating the election like an American Idol season and ignoring important consequences induces these absurd results. Many Republicans held their noses and voted for Trump just to assure a Conservative Court. The networks, of course, don't help since they treat the presidential election like American Idol, only peripherally dealing with issues and emphasizing the performance aspects of the candidate. Messaging has allowed the Republicans to control our control despite espousing policies that are abhorrent to the majority. Time to wake up.
3
Personally I am in favor of keeping Obamacare but find Krugman's criticism of Republican politicians a bit harsh. Republicans have for the most part been running on a platform of repealing Obamacare since it was passed. From their perspective, opposition to the program is a promise kept to voters, many not needing coverage or not being eligible for subsidies under the program or opposing the program on philosophical grounds as another step in the direction of government directing their lives. Years ago this debate would have been viewed differently, as Americans having different interests and opinions about the role of government. The discussion would have centered on pros and cons of policies from different perspectives. Now it's bad faith and self-serving on one side vs the good of us all on the other.
@Joe G
The criticism of Republicans was hardly "harsh." They were keeping a "promise" that 1) was not predicated on the welfare of all Americans, and 2) had no purpose other than Trump's disdain for Obama.
Furthermore, regardless of who their audience was, they'd had numerous opportunities to develop an alternative, but couldn't be bothered to do so.
So, yes, in fact it IS about bad faith and self serving actions by the GOP. And they deserve every bit of oppobrium that comes their way.
12
I now have little doubt that, if reelected, trump will simply do away with ACA by "executive order", aka fiat. That's clearly where this, and much else, is headed. This is a so-called democracy, only of money, and moneyed interests have made clear that they are not going to pay for healthcare for others, particularly The Other. November 2020 - it is likely our last chance. And without flipping the senate it won't much matter.
6
What boggles the mind is that the future of the ACA comes down to whether the mandate is a tax. If I told you that our present health care system was under review, i’m pretty sure you would assume that its effectiveness was being questioned. But no, the question is whether the mandate is a tax.
The mandate is a mandate and the lawyers should realize that that’s good enough.
1
I moved to some Western Europe some 26 years ago. Quite young at the time, and healthy, health insurance was the last thing on my mind. And now, in my 60s, if my body gives me a signal (an ache or pain), I can actually listen to my body and get access to preventative care without considering for a second whether I can afford the treatment or not. Thank God for that!
18
Hard to believe that healthcare in the US is such a political “hot potato”, don’t the US citizens see that the benefits of universal healthcare is a great benefit for everyone. Maybe that is the problem, the Republicans only want a select few to have it.
Here is Spain we see it as a human right and perhaps that is the difference.
16
@Rober González A benefit for my neighbor is a cost for me. I have enough costs.
The potential pitfall of building a political campaign around healthcare coverage for all is that much of the GOP base are old. They are already covered by medicare, or about to be. And sadly, if the environment, housing economy and decaying social security are any indications, aging boomers simply don't care about the plight of younger generations.
As long as they have their medicare and prescription drug coverage through retirement (which younger tax payers are essentially bank-rolling), they're not going to lift a finger to enact change or vote for candidates accordingly. Meanwhile, younger voters can vote all they want for candidates supporting medicare for all, but so long as the electoral collage is in place and they remain constrained to coastal cities for employment opportunities, their votes will be drowned out by the parasitic rural gerontocracy who couldn't care less.
13
@ab Terrific comment. "parasitic rural gerontocracy", what a great phrase. My friends would say it is uncharacteristic of me, but I am very optimistic, even about us geezers. The stock market will crash before the election. Unfortunately, the Democratic House, Senate, and President will have their hands full creating a recovery. Fortunately, we will end up with huge sustainable energy infrastructure projects and a generation of active citizens who will all get to vote again. 60% of them will be Democrats.
3
It's exaggerated to say ACA is a 'success story'. ACA would be rejected by millions of citizens in dozens of countries as inadequate in affordability and access--- depending on job status, and zip code, and it's support for insurance profits.
NY Times columnists and TV cable news commenters hardly discuss the concrete details of the HC financing issue and the alternative solutions to serve as role models.
The media people who discuss our heatlh care, all have excellent, secure insurance they can well afford. If that were taken away, how would they report and comment on US health care?
Millions of Americans are still uninsured or underinsured.
10
In the states where it was allowed to work, it works. The affordability issues are a direct result of Republican interference in the markets creating instability. I will never again vote for a Republican because of their inhumane policies and complete lack of respect and regard for the American worker. Why anyone votes for people so delighted to just let people die is beyond me.
3
Health insurance guarantees profits to the useless, cost-increasing private insurance companies, but it does not guarantee health care. Between deductibles, co-pays, coverage denials and limitations it is an illusion for many, even those who think they have great “coverage” in too many instances. The purpose of the right wing Republican think tank Obamacare was to stop single payer and real health care for all and preserve those private profits and unnecessary costs. Medicare for all is the real solution, but it will take a President with guts to fight for it and aCongrss not beholden to big money.
9
Obamacare should have been overturned because the federal government lacks the authority to run a national health plan. Read the tenth amendment, Dr. Krugman: a simple translation is “if is not specified, the federal government cannot do it.
Obamacare is patently redistributive, and as such also contravenes the fifth amendment’s equal protection clause.
No wonder the Obamacare case was plead so narrowly: to do otherwise would have brought up the thorny question of the constitutionality of social security, Medicare, Medicaid, and SSI, etc.
These are Constitutional, rather than ideological problems. If we are to remain a nation governed by law rather than by those with a social program wish list, we need carefully drawn amendments to sustain social insurance statues long supported by a majority of American citizens.
@J.Jones, if you've ever received health insurance through your employer, then you've participated in a redistributive system. Your insurance was heavily subsidized by your fellow taxpayers, which by your definition contravenes the equal protection clause.
The ACA simply levels the playing field by subsidizing Americans not covered by their employers.
The ACA isn't a national health plan--it's a law regulating the private health insurance industry. Medicare is a national health plan, but it's already been ruled constitutional (as has the ACA). But if your argument is that the federal government lacks the authority to run a national health plan, then Medicare would be much more vulnerable to being ruled unconstitutional than the ACA.
18
@SandraH. Two points: Employer-provided medical insurance is part of the employee’s compensation, as well as an employer business expense.
Two: Medicare should be ruled as unconstitutional, because its functions are not constitutionally allotted to the federal government. The remedy is a Constitutional Amendment.
I take issue with none of Krugman’s assertions in this piece, except the statement that Republicans oppose Obamacare because they “hate the idea” of affordable health care.
They may or may not hate the idea of affordable health care, but, in my opinion, that’s not why the Republicans repeatedly have threatened and tried to undo Obamacare.
My very strong sense is that they’ve tried to undo Obamacare for two interrelated reasons: 1. It’s Democratic legislation; 2. it’s Democratic legislation for which a dark-skinned man with curly, once-black hair is chiefly responsible and chiefly credited
Both of those historical facts gall them. They simply can’t stand either one of them.
I can sort of understand Krugman’s reluctance to say this, but, even so, he should have. This country doesn’t need anyone sweeping racism under the rug.
15
@David
I'm glad you said that. President Obama was approved of, revered - loved, almost, in Europe. I lost count of the number of times that family and friends pointed to our dreary, venal, hard hearted (if not cruel) leaders and said of Obama 'why can't we have HIM?'
The vindictiveness of Obama's political enemies, the subsequent savage, gleeful vandalism of his successes - regardless of consequences for people - is pretty astonishing and the frankly racist justification for it borders on the incredible coming from the (allegedly) most advanced nation in the world. I don't know how some of these people sleep at night.
3
So, if a small part of a Law’s unconstitutionality makes the entire law unconstitutional (I know; it doesn’t), then by extension, wouldn’t the whole law that contains the nullification of the ACA tax also be unconstitutional? Yes, you, corporate tax cut.
3
There are only three certainties in this life: 1) death; 2) taxes must be paid by working stiffs; and 3) republicans lose when they take away people's healthcare. So I'm all for letting republicans step in it again. It won't be successful, and the one issue alone will put a democrat back in the white house in 2020.
19
@markymark
One other certainty is that, eventually, everyone gets ill in one way or another, and it is horrible to have to choose whether to pay for that or the house, or food or whatever else is at stake at the time. Healthcare is a human right. There are no two ways about it and the only solution is a co-operative public matter not one of profit motivation.
12
We had a Democrat in the White House for eight years, and the Republican-controlled Senate simply made it their stated goal to obstruct him in every way they could. It was not their concern to help the people of this country, or even just of their states and districts, by proposing solutions, or coming up with better policies, or proper vetting of judicial nominees, or strengthening our diplomatic corps -- it was to get that Black man out of their White House.
1
The other important thing to remember is that Democrats must take control of the Senate - or else Republicans will install even more partisan hacks in the courts.
And they will be there for decades.
31
@Larry Roth
If half of the charismatic/intelligent Dems running for president who don't stand a chance to win would focus on the Senate instead, we'd have a much better chance.
23
If the appeals court rules against the ACA Trump can kiss his reelection goodbye, regardless of what the Supreme Court ultimately does. And so can a lot of Republicans down ballot.
13
Affordable and accessible healthcare and education for every American should be in our Constitution .
Save and improve ACA , it has a strong frame that can be strengthened.
Keeping coverage for pre existing conditions is a moral imperative.
Last but not least get anything related to healthcare out of Wall Street .
11
If the Supreme Court gets the ACA case, it will affirm the District Court-- as well as overrule Roe vs. Wade -- AFTER the election. Thomas, Gorsuch, Kavanaugh and Alito are wholly-owned subsidiaries of the Republican National Committee. They know the electoral consequences of throwing out the ACA and overruling Roe vs. Wade before the election. They also know that the average voter is low-information and has a short memory so there will be no such consequences in 2022.
7
I am over 65 years old. That means whether or not there is an ACA it has no impact on me personally. Still, I support the ACA - Obamacare - because it provides many of my fellow Americans who otherwise cannot afford healthcare even though based on my daughter's experience the "market place" healthcare has not done her any good - high premium and high deductible to the point of almost nothing is covered.
Nonetheless. I like - not support - the GOP's effort to repeal it, including the current let's go to the "activist GOP judges" route. The reason is, as stated in the column, "even though many of the beneficiaries are Republican voters — think about those numbers for Kentucky and West Virginia — Trump and his party are as determined as ever to destroy it."
As they say, election has consequences. Well they voted for Hump and the GOP against their own interest just so Hump can give the finger to the system (I heard an AFL-CIO poll in Wisconsin found that out) a system that fails them I concede. Well what about the other non Hump supporters who get hurt along the way? My point is: there is nothing I can do to effect the outcome one way or another so I might as well sit back and watch the Hump supporters find out how much what they did will come back to hurt them.
5
Well, nice that you can sit back and wait, but you may be waiting for the rest of your life, because these Hump supporters, even when given all of the evidence, will not see the reality or take the responsibility for what they have done to tear down everything this country used to stand for. They are like the dysfunctional family of an out-of-control and dangerous adulation-junkie -- their entire system is fixed on telling and believing lies, and shifting blame.
National health coverage has been part of U.S. political and policy discussion since 1912.
That 107 years is more time than *slavery* concerned U.S. lawmakers (just about 100 years if measured from Declaration of Independence to the formal end of Reconstruction).
The GOP is not introspective about this, let alone perceiving societal benefits.
Clearly the four Supreme Ct. justices who dissented when the Affordable Care Act first came before them saw no relationship between their own federally-provided health coverage and what they were discussing. There's no way a couple of them would have been able to get private insurance pre-ACA.
Even more cement-brained is the inability to see a connection between the implementation of Medicare in the '60s and estate taxes starting in the '80s. Without Medicare, health bills would have eaten many more estates long before the tax threshold.
9
Nancy Pelosi should include a provision in the combined debt ceiling/budget bill reinstating the penalty tax in the ACA. It could be for less than before, but something meaningful. That would put an end to the litigation and retain medical coverage for some twenty million people. If the Republicans refused to pass the bill or Trump vetoed it, or they shut down the government because of it, the true venality of the Republican party would be again be brought home to the American public. It seemingly could only help the Democrats.
12
I've commented on this before and I'll do it again: We have to figure out a new way to appoint Federal Judges at all levels and make it time limited. No more lifetime appointments. Why not have both Houses vote on Federal Judges? So we won't have one man from a State that should not be a State in these modern times dictate who gets picked? Outlaw all external groups that are picking these judges, conservative or liberal.
My other hobby horse is to question Statehood. Again, in these modern times we need a flexible political system that dictates what makes a State and how many Senators each one gets. Why give outsize power to a State that is smaller in population to my County?
If, somehow, the ACA gets disbanded, the Republican/ Trumplican Party will forever become a minority party. They are playing with fire.
8
The problem is that the current argument is a perfectly logical offshoot of Roberts’ tortured route to finding the ACA constitutional. If the ACA is constitutional because the mandate was a tax, then eliminate the tax and it follows that the ACA is not constitutional. In fact, the ACA is obviously constitutional as a valid exercise of Congressional power under the Commerce Clause. Health care is something like 17% of our economy and crosses all state lines. Of course Congress can regulate it. Right-wing judicial acolytes of the Federalist Society, like Roberts and the rest, however, want to decimate the Commerce Clause and return us to pre-New Deal days when our federal government could raise an army, enforce the fugitive slave laws and not much else. If they succeed they will have completed their inexplicable mission to destroy any authority our government has to keep the forces of Organized Money and Plutocracy in check. Although health care is an important issue, the underlying constitutional battle is crucial to our system of government and our modern society.
9
The lawsuit against the ACA that was upheld by the Supreme Court argued the individual mandate was unconstitutional. The court ruled the mandate a tax and therefore constitutional. If Congress passed the ACA with no mandate in 2009, it could be argued fiscally reckless but there would have been no grounds for an unconstitutional finding. To the contrary, time has shown the law durable even without the mandate. Bottom line is there is no rational reason to throw out the current health care system and drive it into chaos. Democrats, and me included, that if there is a better solution presented to make quality, affordable health care available to all Americans, I would enthusiastically support it. The current effort in the courts is an example of republicans being mean spirited and will do huge damage to their brand if their misguided effort is upheld.
7
@Mark Wyo Agreed, but we’re dealing with lots of right-wing activist judges now, including on the SCOTUS, who don’t hesitate to legislate from the bench and impose their personal views on everyone else. Judicial restraint has fallen by the wayside.
2
@Mark Wyo
“Chief Justice Roberts concluded: The Affordable Care Act is constitutional in part and unconstitutional in part. The individual mandate cannot be upheld as an exercise of Congress's power under the Commerce Clause. ... The Federal Government does have the power to impose a tax on those without health insurance.”
2
Instead of battling each other to see who can offer the most comprehensive (and complex) "Medicare for All" proposal, which the GOP will demagogue, I wish the leading Democratic candidates would simply say something like:
"If elected, I will defend and strengthen the affordable care act, increasing subsidies, lowering its deductibles and spreading its reach. If my opponent is elected, he will eliminate the AFA the day after the election and the coverage for your children will be stripped away, you will lose pre-existing conditions protection, you won't be able to buy insurance on the open market, rural hospitals will close. He tried and failed in 2017 and again in 2019, in 2021 he will succeed."
11
I’d rather stop cutting huge checks to dead weight insurance companies. I want my doctors, hospitals and nurses to have that money. Not some underwriter.
13
Well, it's obvious the Republicans have been packing the courts to legislate from the bench, and their voters that elected them actually voted against their own well being. We need education mandatory.
2
@SHAKINSPEAR
I totally agree that education is a must. But how do you educate people that believe there were talking snakes in an imaginary garden of Eden? I am referring to Dixie. I am thankful I was born and raised on the Canadian border, not the snake oil south.
1
If the Republican Attorneys General and the administration succeed at throwing out the A.C.A., what's the plan? Would they return to the conditions that existed prior to the A.C.A.? Just what the insurance markets, health care providers and patients need, unpredictability and destabilization. Yet in all of this and the amount of time Republicans have been trying to deep six the A.C.A., they have not provided any specifics of what they would replace the A.C.A with. Just a lot of vague marble-mouth nothings. From the President we get the you-just-wait-and-see the glorious health care that's coming.
Lawmakers need an intervention on this issue. Time to come up with a plan that is a hybrid of private insurance and a public option where private insurance fails to provide service. You know, something like the A.C.A. only new and improved. Prove to the voters that a public option is viable and move on from there.
3
Louisiana, Mississippi and Virginia, as well as New Jersey which is Democratically controlled, all have their state legislatures up for election this year. For Governor, Kentucky and Mississippi's Republican Governors and Louisiana's Democrat are up for election. Some or all of these are included in the states suing to kill the ACA.
Let's see the referendum on health care continue this year as well.
4
@Kim, to be fair, Gov. John Bel Edwards of Louisiana opposed joining the GOP lawsuit against the ACA. It was Louisiana AG Jeff Landry who decided to join the suit. The governor didn't have the authority under Louisiana law to make that decision.
Governor John Bel Edwards should be reelected, and AG Jeff Landry should be retired.
2
Obamacare is not fair for all the people and that is the problem. Cover everyone and or make premiums and deductibles fair across the board. The ins companies are taking advantage of corporate plans and employees. Everyone deserves healthcare.
3
@Comeuppance, I'm not clear on your meaning, but you seem to be saying that people who get insurance from their employers are seeing their premiums go up because of the ACA. That's not true. The ACA has slowed the rise in health care inflation. While it taxed so-called Cadillac plans, that tax hasn't been implemented and won't affect most employees.
That doesn't mean that insurance companies aren't raising premiums on their own because a) medical inflation is still happening and b) private insurance companies take a 20 percent cut of the premium. It's one reason that a public option for everyone is much more efficient than any private plan.
3
"The plaintiffs’ arguments are clearly specious and made in obvious bad faith . . . I’m pretty sure that if a legal argument has absurd implications, it’s an absurd argument."
Whether a legal argument is made in bad faith or has absurd implications doesn't matter. We need look no further than the Citizens United decision to see an example of that. For judges intent on implementing political decisions, rather than upholding justice, sophistry prevails. If this lawsuit does make it to the Supreme Court, it would once again come down to Chief Justice Roberts's vote.
8
"The Affordable Care Act was an imperfect and incomplete reform. The political compromises needed to get it through Congress created a complex system in which too many people fall through the holes."
In the end, though, were those compromises truly "required" in order to get the ACA through Congress? As I recall, it was enacted without a single Republican vote. Once it became apparent that that would be the case, why didn't Democrats go back to the drawing board and simply walk back the compromises that allowed so many of us (my family included) to fall through the cracks? Arguably, that could have made all the difference in the Rust Belt, where middle-class white Americans who had voted for Barack Obama *twice* withheld their support from his perceived-to-be-annointed successor.
5
@Frank F, unfortunately the compromises were necessary to get anything passed. Joe Lieberman was still a senator. He killed the public option.
I'm 62 years old, my wife is 61 (sorry for the disclosure) and we buy health insurance on the open market, but fortunately we have enough resources that we're not eligible for subsidies. Living in Mass., we greatly benefitted from "Romneycare" when it was passed several years before Obama's election. We had a wealth of choices, the premiums were quite manageable, and the yearly increases were never more than 5%.
We have no "issue" with the ACA. Our two sons, one living in Calif. and the other in NY, are self-employed and fortunately are able to benefit greatly from having this health coverage where in the past they would have been shut out of the market. However, here in Mass., our ACA coverage is significantly worse for us than it was under Romneycare. Our premiums have increased by over 10% per year, the degree of coverage has lessened, our co-pays and deductibles have greatly increased and we are also restricted in the doctors we can see and the hospitals we can use.
It is hard to say what would have happened if we still had Romneycare. Fortunately, we have fairly decent coverage, but it isn't nearly as broad and affordable as it was before. We don't look forward to getting older....but we're not that far from Medicare. It is time for Medicare, true coverage for all.
586
@marty
Massachusetts has an over 95% insured rate, so that means all of the money necessary to fund a Medicare for All program (M4A) is currently being spent on health care in your state. That is correct, Senator Warren could get to work tomorrow just like Ted Kennedy did with Governor Romney and provide the leadership to start a M4A program...and yet she doesn’t. The fact she doesn’t tells me providers have no interest in M4A and so it is DOA.
8
@Sebastian Cremmington
I googled your assertion that Warren is not for "M4A" or Medicare for All and it's incorrect.
Axios and other web pages say she is but that she hasn't built a hard plan yet. Her web site wouldn't load so I couldn't look at it. I'm using the wireless signal from a big grocery store chain...
Even so there's Mitch McConnell and the Republican opposition to a universal health plan, and the statement that Romney and Kennedy worked together (I'm paraphrasing you) was from a bygone era if that's what happened. I know Kennedy was for health care as well as Romney so is your post a red herring?
56
@lightscientist66
Actually if the goal is no private health insurance then it makes more sense to start at the state level. M4A is cheaper and better so all the money to fund it is currently being spent on health care in Massachusetts. The federal government is only necessary if one wants a public option which was rejected in 2010.
5
My young adult son's life was saved because he was insured under the exchange. He had quit his job in order to focus on his health - months of doctors visits had not generated a diagnosis. Fortunately, he bought a great policy with a low deductible on the exchange. A few months later, as his health had deteriorated with no answers, I insisted he go to the ER because his doctor would not give him a same day appointment. None of us thought he was near death (which he was), and I am 100% certain he would not have gone to the ER if he did not have the insurance. Upon arrival at the ER, he was immediately seen by a doctor, because professionals could see his distress. A few hours later an emergency procedure on his heart saved his life. The cost of his emergency care and his ongoing medical treatment since would have bankrupted him had he not had the insurance.
I will forever be grateful that "Obamacare" together with great ER work saved my son's life and that he can continue to be a productive member of society. Without the preexisting conditions coverage requirement, he could not afford the expensive medicine he must take for the rest of his life. Sometimes I lay awake at night in fear that the pre-existing conditions mandate will be repealed and our world will come crashing down.
1439
@NEW
Even though I am 68 shortly will be 69 and retired I fully understand your fears. I got married to the love of my life at 23 years of age, we got married after my better half was baptized by the minister who performed the baptism. We never got a marriage license and after a couple of years my love was diagnosed with terminal illnesses. The life expectancy was to around 1993. We couldn't get healthcare as of the diagnosis had been made and at the dinner table I was informed that if we formally established our marriage I still could got get coverage for my love. So we fought and fought I paid for a lot of the medical care. It took 10 years for disability benefits to be awarded then the laws changed we looked at what was available and it was better to leave things alone disability benefits were better that any healthcare insurance. Those 10 years I worked 2-3 jobs in order to provide for us. I have been a widower for over 10 years now and I truly wish the ACA had been there when we needed it.
I am thrilled that your son has received the necessary medical support and meds he needs. It makes me happy for him and your family I also understand your fears.
I wish for only good things for you your son and all of your family and the future.
Alec
165
@Alecfinn
Twice in the past three years the VA has saved my life. Kidney stones and kidney failure and advanced pneumonia and bronchitis.
I was seen my highly qualified doctors. Immediately hospitalized and treated.
I am so thankful for the VA.
I have TRICARE for Life and I love my VA doctors.
I just wonder at republicans who deny children health care.
Please note that the republicans in congress are covered by the Federal Employee Health Benefits Plan and not one of those "conservatives" has resigned from the plan.
You would be shocked at how low their payments are and you would be howling for Congress Care. haha
Vietnam Vet
157
@Alecfinn
I too have a story, the only significant part of it being that if not for Obamacare, someone I know would surely have died. I'm betting there are a lot of these stories.
100
There is one statistic that tells it all: The US is the only advanced country in which the life expectancy has gone down.
If this statistic were shown by economic class, there would be a revolution in this country.
1248
@MS
No, even economic stats don't seem to sink in. Too many people won't attack the in-equality problem because they think the are one lotto ticket from being rich. On the health care angle they just don't realize the freedom that a country wide healthcare plan would give for job mobility and the long term savings it would produce just from the point of preventive care.
119
@MS
I understand your statement but I think you probably are wrong. Taking the southern tier of states as an example, voters in that area consistently vote to keep things as they are, with the lowest educational attainment, the highest numbers in financial difficulty, draconian laws that allow banks and other mortgage companies to take a house away without judicial process, the lowest minimum wages and the freest conditions for payday lenders and predatory debt collection practices to continue. Economic freedom and social equality are not on the radar screen of desired results.
In fact, if you were to ask around, you could even find people in the bottom third of income status who would argue that the rich deserve better medical care. During the pumped up, raging controversy about Obamacare, a news item even reported that a man in Kentucky who had his life saved by the program was voting to have it ended. People had been so thoroughly propagandized about how "evil" Obamacare was they preferred ending even if it meant they, or someone close to them, would die.
159
@MS
A country that can elect someone like Trump isn't interested in facts, statistics or common sense.
The only thing that will change health and healthcare for the better in the US is a brave new regime that has the interests of Americans at heart.
240
People should be aware, corporations are shifting more and more of the costs to the employee. Corporations are slowly shifting out of providing heath benefits to employee's, by calling employees "contract employees", by doing that they don't have to extend any of the benefits extended to "permanent" employees, this includes paid time off.
The law is abused in Seattle for example, a "contract" employee is hired, but the law says that a contract employee can't work over a specific amount of time, because contract employees are usually "project"employees. The law stipulates, anyone termed "Contract" or "Temporary" employees, can only work up to 6 months, employers simply send that employee home, on the last day, because there has to be a break in "service" essentially resetting the clock.
I worked for the largest healthcare system in Seattle, they routinely keep contract employees for much longer than 6 months, in many cases it was for years, telling them a FT job would be offered, rarely did that happen, they were just stringing along that temp worker to keep them there, just resetting the clock every 6 months, many times we would have more temporary workers than FTE.
As this trend becomes the norm, more and more of the population will become uninsured, If the republicans can't see the forest through the trees, in terms of healthcare, then they are doomed to lose congress and the White House. They have chosen corporations over constituents.
559
@James
This is my professional world, the project contract and FTE that will never come.
My contract firm is obliged to let me buy insurance, which is expensive but decent. I'm grateful for the work. But we deserve better.
29
@James The public needs to hear more and more of these stories but the Democrats seem to be sucked into the immigration crisis. I think they should emphasize health care and climate change. Make America and our planet healthy again.
42
@James
They can't see the forest for the trees but man they can sure see that lobbying money and campaign contributions and cushy lobbying or corporate position as soon as they leave "public service" which for them was serving their masters, as they explained before enacting the 2017 Republican Regressive Repressive Reactionary Tax Obscenity
37
The passing line about how our representatives don't listen to the will of the people is the most disturbing aspect of this column. I don't understand how the very fabric of our country can be shredded & no one can do anything about it - except SCOTUS who has helped it along - viz, the gerrymandering decision.
461
@RKD Sadly, most American campaigns are negative and the Republicans have had great success in running against things. I see no reason why that would change.
8
@RKD See yesterday's Times Opinion page for a study that supports this: https://www.nytimes.com/2019/07/11/opinion/politicians-voters.html?fbclid=IwAR1HJ_WhlpGFDyH91ic3qPm1CL1zSqau5Qlt67N-Mczz9S_kExp66McAI-s
2
@RKD and all.
You should read this article about politicians listening to their constituents.
https://www.nytimes.com/2019/07/11/opinion/politicians-voters.html
Dr. Krugman:
What we need in this country is LBJ back from the dead. Yes he failed miserably in Vietnam, but his legislation has saved the lives of tens of millions and improved the lives of hundreds of millions since he left office 50 years ago. He championed and signed Medicare (which was denounced by almost every Republican politician as "socialized medicine"), Medicaid, Foodstamps, Headstart, the civil rights act, the voting rights act and the fair housing act, among dozens of other important social programs. He was in the words of his principal biographer, Robert Caro, a truly "compassionate" man and a "political genius." Instead of looking for another Obama, the Democratic Party needs to find a candidate with the vision, skill and political genius of LBJ. The Democrats face very dark forces today and no ordinary candidate will do. I suggest you read LBJ's 1964 commencement speech at U of Michigan if you want to understand what I am saying.
840
@James Ricciardi Although I need to learn more about LBJ, I agree with you about needing another LBJ rather than Obama. Obama is indeed squeaky clean, but he also was an extremely ineffective president, who largely wasted 8 years of having a Democrat in the White House. The combination of compassion and toughness is rare I think, as demonstrated by our current and previous president, each of whom embodies one or the other of these traits, but certainly not both.
20
To be fair to Obama, he was up against unprecedented political obstruction on the part of the House and later Senate that resulted in 100’s of open federal judgeships, including one on the Supreme Court, dozens of meaningless repeal votes, and endless investigation of the presumptive 2016 nominee. The Koch funded Tea Party combined with a surge in Fox News attacks was incredibly, and unfortunately, effective at blocking an otherwise good President at every possible move.
Think about it: By many commenters here, Obama gets blamed for Iraq, the financial crisis, the pull out in Iraq, the bailout of the financial crisis, and the GOP’s brainchild ACA being too socialist (but not effective) just to name a few.
112
@CB I agree. He was a good president, but even his ACA, passed without a Republican vote, would have been impossible without LBJ's Medicare and Medicaid. Indeed, even his presidency would have been unthinkable without LBJ's civil rights and voting rights acts.
69
Republicans were against the ACA when it was being debated in Congress (remember John Boehner saying 'let's back up and start over again?') yet they had no alternative. After trump was elected, the Republican-led Senate tried to kill the law, but failed, and they still had no alternative. Now they are pursuing dubious attempts in the courts to eliminate it, and they still have no alternative. With the large number of people who have benefitted from the law, contrasted with the small number of people who still complain about having to purchase insurance (my wife works in a rehab hospital, and she comes home daily with stories about patients and their families who demand expensive care after they have neglected to get insurance) it should be clear to most people which party is actually looking out for their health. Republicans offer nothing, and cry 'socialism!' about every plan to expand access to health care. We should be moving forward on this and on controlling costs, not moving backward.
572
@eandbee
I am convinced that they want to destroy education the EPA, Consumer Protection, the Dodd-Frank law and anything else that lets anyone else improve their lives.
55
@eandbee. Ironically, the ACA was patterned after a right wing think tank proposal and was why it got implemented first in MA which had a Republican Governor. Leave it to Republicans to trash their own babies!
10
@eandbee
So for 10 years the GOP has been shouting the litany of "repeal and replace" and still has not put forth a plan. Trump ran on the promise of a big, beautiful cheap and better healthcare plan and after 2 years in office where is it? He said he wanted to repeal the ACA as soon as he was inaugurated. What Happened? Oh yeah, "healthcare is really hard".
I almost hope that the ACA is struck down by the court and ordered terminated immediately in toto so we can watch the GOP stumble,fumble and self destruct. I am curious as to how fast public support for the GOP would fall when 20 or so million people lose or cannot afford coverage. What's the plan if that happens - status quo ante?
Also Dr. K, just an aside. You wrote "But Republicans still hate the idea of helping Americans get the health care they need." You should have stopped after Americans.
12
Here's what the GOP doesn't want us to know or keep in mind when we are listening to them.
1. Every person in this country will need medical care at some point in their lives. Some will need ongoing medical care for their entire lives due to chronic illnesses.
2. Lifestyle choices are made by every person. Therefore, no matter what choices anyone makes there will be some bad side effects from them and denying people medical care because they have a "lifestyle" disease won't change things.
3. Other countries manage to provide better medical care for their residents and citizens at far less than the USA does for better results. Unless we're incapable of learning from them we could borrow from their systems.
4. Sure most people love their health insurance; until they really have to use it and then they learn exactly what it doesn't cover.
5. Other countries, some far less developed than the USA, consider access to health care a human right. Why don't we?
6. We have death panels in America: they're called health insurance companies that set the standards and have switched to offering narrow network high deductible plans that drop doctors and medications on a dime.
7. If we want real choices our system is not providing them now. It is giving all of us a good reason not to go for needed care.
7/11/2019 8:11pm
1047
@Patrick Campbell.Health care is a human right because health care exists. It's one of those things people need to stay like water and food. Working is a fact of life and health care is one of those things people work for. We work for food, water, shelter, healthcare. The human chain of work means we depend on one another. The person who picks your food needs healthcare just like you need food.
117
@Patrick Campbell,
This country was founded upon the principle of forming a country and government that allows people to pursue "life, liberty and ... happiness" free from government interference, and that government was to assure all Americans have equal rights (i.e., rights cannot be limited to some to advantage them over other citizens).
How can you have "liberty" if you have a untreated or under-treated disease or medical condition that prevents you from having gainful employment? How "free" are you to exercise your rights if you're constantly fatigued, sick, in pain or contagious, but can't get treatment? How can you exercise your Constitutional rights to self-government if your too sick or infirm due to lack of medical treatment. Is this the "freedom"?
112
I remember reading papers from John Madison and his contemporaries who built this country and I don’t remember any mention of health care. I’ll leave the heavy lifting for the founders. As for what is best for society, I’m not responsible for society’s success or failure. That is for the elected and the caring which I am neither.
1
I know the ACA has allowed people to get care who wouldn’t otherwise, but I also know that in many cases people do receive care they can’t afford but need——- after they have depleted their resources. Is there any information regarding the bankruptcies avoided by having the ACA? Sick, can’t work, can’t afford insurance- going in debt. that is our apparently uniquely American experience. Work hard, save up a bit, fall off a ladder, end up in debt 100k.
Mr Krugman refers to getting needed care but I wish avoiding financial ruin was similarly referenced. Any wonder despair, hopelessness and suicide are growing?
People can endure hard times. What makes us feel so hopeless is enduring hard times in a country that has the resources to care but doesn’t.
335
@A Fan Of The Imperfect ACA The ACA saved my life - but the prior system forced me into bankruptcy. In 2006, I relocated to Texas from California to improve the quality of my life - I was able to buy a house for $146,000 but unable to purchase health insurance because of my pre-existing condition - Type II Diabetes. I had been insured by Kaiser Permanente for more than 20 years starting as a member of a group plan then an "individual Plan" that pre-dated COBRA. Since Kaiser Permanente did not provide medical care in Texas, my continuous coverage had no value. No insurance company would sell me health insurance. The only option for me was the Texas High Risk Plan (no longer needed since the ACA) at $800/month. When the premium became $1,400/month, I joined the ranks of millions of Texans who were uninsured. I found a local non-profit health clinic that provided services on a sliding scale. Because I was uninsured, they also helped me get mammograms and my prescriptions. But they could not help me when I arrived in an ambulance at a nearby for-profit hospital. Denton County, Texas does not have a "public" hospital like Dallas and Tarrant Counties. As an uninsured patient, the hospital could charge me any price for services. The hospital was willing to reduce their charges but the doctors and providers of ancillary services would not negotiate. I did not lose my home but it has been a long way back financially.
31
@Linda
My husband and I also had to file for bankruptcy before the ACA, when we each had a pre-existing condition. In addition to the high costs of the high risk pools, they (and the state assistance in MN) also required going 6 months with no insurance before even applying.
In addition to the many other problems with bankruptcy, we had to liquidate the retirement savings that we had contributed to for years.
I am lucky to actually like living in a low cost area of a low cost state where my SS benefits are enough to live on.
12
@A Fan Of The Imperfect ACA In Minnesota, Republicans passed a $350,000,000 bill that funded a high risk pool that removed the 5000 or so highest cost patients into a separate category that removed them from the 'pool' allowing huge premium increases to ease.
Not that anyone ever gives credit, but it seems like Republicans are always having to clean up Democrat caused messes.
2
Your examples of American citizens benefiting from Obamacare—in West Virginia and Kentucky—two deeply red states, is instructive. From 21% to nine in the former and from 21% to seven in the latter, both, by the way, dinosaur-like fossil fuel states where coal miners are born to die, one guesses that affordable healthcare is a premium. Right, Joe Manchin and Mitch McConnell?
But the ACA is marketed by the right as a black man’s Kenyan, Socialist plot to balkanize America. The appellate court system is now awash with ideologues who once fought “activist judges “— because they were Democrats. No such scruples obtain today.
It will ultimately fall to the Roberts Court to define what’s a tax and what’s a mandate. This unwanted (by Republicans) baby will be, when it arrives on the doorstep of the Court in the fall, the defining decision of our time. It’s impossible to ask for a unanimous verdict as the Courts rendered in 1954 (Brown vs. Topeka) and 1974 (United States vs. Nixon). For the sake of the public good, can this Court break ranks with Big Insurance and Big Pharma?
Is it too much to ask?
696
@Red Sox, ‘04, ‘07, ‘13, ‘18
Yes, it is a great deal to ask. The majority of the Supreme Court justices were appointed precisely because the conservative Republicans who knew them best believed they would stand shoulder to shoulder with Big Pharma, Big Insurance and every oligarch to come before the Supreme Court. Those conservative Republicans have proved to be pretty astute.
65
@Red Sox, ‘04, ‘07, ‘13, ‘18
I’ve been reading your comments for a while now, and I’d like to take the opportunity to commend you on providing some of the most insightful comments on this message board week after week, month after month.
I’m a MA native, and if you don’t mind me asking - what do you do for a living? I’ve always been curious about that.
Oh, and thank God for MA, where our priorities still lie with education, science, environment, healthcare and watching out for our families and fellow citizens.
71
@Red Sox, ‘04, ‘07, ‘13, ‘18 I agree with what you are saying here. Say Obamacare and any GOP supporter foams at the mouth. Say ACA and what Trump and the GOP want to do and they get angry and want to keep it or see something better replace it. What a difference a name makes.
25
ACA failed to stop healthcare cost inflation and people who pay for it, don't get any benefits from this program. If you have pre-existing condition, you dont need an insurance you need a payment plan. Insurance is for random event outside our control that did not happen yet. You cant buy a car insurance after you crashed the car. Why the healthcare is different. Medicare for all ("all" without asterisk) is much better alternative to ACA.
5
@Alice
The ACA was revised by the GOP and their donors so the increasing costs were built in hopefully for exactly what your comment stated.
1
Who knows what the Supreme Court will do this time around? But, you know, Bernie is right. If tens of millions of people scream loud enough, and create enough disruption in society, then we'll get some kind of socialized medicine. Without that movement, it's never going to happen.
10
@Eric
Yes! But Paul is as against that as probably judge Clarence Thomas is.
Bernie 2020
Warren 2020
In whatever combination.
Or bust.
2
Americans support social or public programs/institutions from public schools to public parks and public libraries to public sewer systems/water systems to mass transportation and public services (road maintenance, etc). It is incomprehensible that health care which every person needs should be available only to some. A public option needs to be available and all need to participate in a legitimate (not simply catastrophic insurance) health plan whether public or private.
The CEOs for Veteran's Health Care and Medicare are not paid multi-million salaries as with many private insurance companies. More funds are used to pay better salaries to all, assist with pension programs, etc offering more employees living wages. Indeed, more health care funds are applied to direct services. And the overall health insurance costs are less. Why most companies that pay all or some of the health insurance for their employees wouldn't prefer a public single-payer system that cut company costs while providing quality insurance is also incomprehensible.
Yes, improve the ACA, but killing the program will be a travesty for millions, upon millions with pre-existing conditions, for those in their early 20's and millions more who simply can't afford any insurance. Incomprehensible.
14
We all knew repealing the Affordable Heath Care Act was never of the table, especially since Donald Trump couldn't deliver on the Wall in Mexico and keeping the citizenship question off the 2020 Census.
It obviously makes no difference to him and the Republican Senate that MILLIONS of Americans stand to lose whatever they might now have if he gets his way, even though it will disproportionately effect those in the Red states who voted for him thinking he would make America great again.
There also seems to be no progress on his promise to deliver a better and more viable replacement for it, even though that didn't stop him from raiding the federal coffers for a bombastic show of faux-patriotism on the 4th of July.
Granted Obamacare wasn't perfect, but it was certainly better than nothing.
And that's just what Americans are going to get under Trump.
16
Obamacare was great for issuing insurance cards, not so great at making sure those premiums went to doctors and nurses. No they were kept by insurance companies who continue to deny care and prescriptions coverage and to pharmaceutical companies who can charge whatever they want and create drug shortages at will. Actually it bankrupted many medical providers who could not get paid enough by insurance to pay the rent, malpractice, office staff, and doctor salary so of course we love working for free and that’s why so many of us quit.
6
@Doctor X
I guess in 2010 Dems should have gone with Medicare for All instead of the Heritage Foundation/GOP ACA plan.
31
@Doctor X, to be fair, the ACA isn't the source of these problems--insurers were demanding that doctors join their networks at reduced fees long before the ACA. Most young doctors can no longer afford to open their own practices.
4
@CB
Yes sir!
Where was Paul then?
Where was Paul in 2016? Not on the side of Bernie who had it right then as he has it now.
1
"The New Plot" is the correct characterization of the latest GOP effort but it is more than just a plot to kill the ACA. I strongly believe this issue is a way for the GOP to milk private insurer "donor cows" and sympathetic industries like pharma, medical instruments, clinics, etc. to fill the coffers of the GOP that can be used to finance the campaigns of their candidates and the messaging that government and one size fits all will destroy free enterprise, move our government one step closer to socialism, and bring an end to the American capitalism system.
To the GOP political power is everything and money is required to keep this oligarchy rolling. No one appears to care about the welfare and health of the American people.
I must admit that the GOP "plot" strategy is successful. I have been close to the Bob Dole, Clinton, and Obama efforts to improve health care delivery and health insurance systems and Obama came as close as any Administration with the ACA but it cost him his Congressional majority in 2010.
So it was one shining time for about 2 years before the Congress and his Presidency fizzled beginning with the GOP obstruction of Merrick Garland that essentially made permanent a politicized judicial system.
Even though we have experience in government Medicare insurance for everyone who works, the VA system, the Military Tricare insurance, the GOP and the private insurers insist that government insurance is an ineffective insurance system. This is not correct.
24
@james jordan
I am optimistic that when the Congress and the White House becomes a Democratic majority in 2020, By July 4th 2021, the U.S. can assure every American of every income level that they are insured and then with the data can begin to develop a better healthcare to the American people.
There are some well off people who can't bear to be mixed with the common folk so they can, of course, pay for their own special services and special insurance but they must also continue to contribute to the universal health insurance program. Some will say this is unfair but I explain that we do that now with our Medicare program and it is not starving our society.
The following is true:
#1 The diagnosis and treatment of serious health conditions is not for amateurs or robots so the expertise and knowledge to assure a possible good outcome does not involve a choice of the consumer -- it is a "natural monopoly".
#2 Insurance actuarial laws state that the larger the risk pool the lower the risk to each participant.
3
If the args. before the 5th Circuit gain traction, there is an argument in reserve, to be made to preserve at least expanded Medicaid under the ACA. A passage from the 2012 USSC dec.:
“We have repeatedly characterized...Spending Clause legislation as ‘much in the nature of a contract.’” The legitimacy of Congress’s exercise of the spending power “thus rests on whether the State voluntarily and knowingly accepts the terms of the ‘contract.’” Respecting this limitation is critical to ensuring that Spending Clause legislation does not undermine the status of the States as independent sovereigns in our federal system. 132 S. Ct. at 2602 (cits. omit.)
The USSC gave all States an opt-out of the ACA’s Medicaid expansion.This concept of a contract between a State and the Fed. Gov’t could be used by States that opted into the ACA’s Medicaid expansion (such as CA, NY, LA, KY) to challenge any impending judicial repeal of the ACA. After all, in the ACA, the Fed. Gov't promised to “pay 100 percent of the costs of covering these newly eligible individuals through 2016 [and] In the following years, the federal payment level gradually decreases, to a minimum [certainly not repeal] of 90 percent.” Id. at 2601. In exchange for and in reliance upon these promises, the opting-in States changed their healthcare systems, their health care public funding, their ins. systems and markets, as the deal required.
It may be time to prepare such a challenge, to judicial repeal, by opting-in States.
8
This is what happens when you allow litigation to dictate policy prerogatives. We live in a world of endless bad faith lawsuits initiated by interest groups of all stripes and resolved in many cases by Judges who find making social policy a rather more dignified calling than processing discovery motions and presiding over preliminary hearings in criminal cases along with the rest of the dull minutiae that Federal judges in the litigation age are overwhelmed with. This situation is really an underrated and uniquely American achievement.
11
I used to be wild free market believer until I was laid off and had no coverage from an employer and Obamacare paid for my cancer treatments. No unregulated profit seeking insurance company would cover someone with pre existing conditions.
104
If the 5th Circuit sustains the lower court's decision invalidating the entire ACA, the chaos and damage to the US economy would be extensive. [There are articles here and the Washington Post delving in-depth as to the chaos that would erupt not only to the health insurance markets and the medical segment of our economy, but to the many aspects of the ACA that were not directly related to healthcare, like caloric content labels, food content labeling, etc.]
There is, however, one sliver of a silver lining in this scenario.
Imagine the backlash against the GOP just before the 202 election? Without both chambers firmly under GOP control, McConnell would have to negotiate with Pelosi's Democratic House - and they'd driver a very hard bargain. Most likely, a bargain that McConnell won't swallow (let alone Trump).
30+ million thrown out of the healthcare system right before a major election, with the White House and 34 seats up in 2020, of which 22 are held by the GOP. Democrats will need to gain 3 or 4 seats to take control (with a simple majority), or 13-14 seats to take a 60-seat effective control.
If this seems impossible, consider the 2018 off-election. The
pundits, on average, predicted the Democrats would take between 16 -20 seats. Instead, they won 40.
24
@John: "If this seems impossible, consider the 2018 off-election. The pundits, on average, predicted the Democrats would take between 16 -20 seats. Instead, they won 40."
One of the reasons for such a huge swing was the number of Republicans who decided not to run for re-election in 2018: over 40.
Just bashing Trump/GOP on HC distracts from the very real problems of ACA. Sure, we're thankful for ACA! But our liberal columnists and politicians avoid the truth---premium costs have gone way up. ACA subsidizes instead of regulates insurance premiums. Big insurance with campaign donations regulates our govt.
'Improve' Obamacare? How specifically? We the People deserve real life data---who pays, how much and who benefits?
Why are profits of big insurance/pharma so prioritized in US politics, that whatever puts public interests 1st is just labeled left wing radica? Our media is afraid to go there.
Why does Krugman keep avoiding comparative data, as an economist, from the dozens of nations who for generations have funded affordable HC for all---as centrist policy-- well supported by citizens and all parties?
If they tried to change to high profit US style HC, their populations would march in the streets endlessly in every color vest of the rainbow.
Countries with insurance mandates like ACA have consistent national policies on this, not varying per states, and their govts regulate insurance costs for their citizens. That's showing respect for the citizens who elect them. That's the whole purpose of democracy.
We're tired of hearing excuses---that ACA is 'imperfect' but it improved many people's lives. This obfuscates. Our low standards are obvious. Millions of citizens in dozens of countries since the 20th Century have had better than than that.
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@Meredith
Don't let the perfect be the enemy of the good. Of course ACA has serious flaws. The authors had to include many to get buy-ins from Republican legislators and the healthcare industry itself. Now that ACA is established and accepted but the public, congress can correct the flaws. That is, if they can get control of both chambers and the presidency.
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@Charles Tiege...tired of that constant phrase as an excuse. We're generations behind decent. Need decent, not perfect.
@Meredith
People used to die. Push people back to free markets, they will start dying again. Insurance companies don’t give a shirt about people with pre-existing ,conditions. They must be told what to charge and what to do. Whip and a chair!!
1
Obama and designers stated many selling points about ACA, some proved false. The very poor benefited to a degree if they could find a Dr. accepting new patients especially children. A single working parent not receiving subsidies had to pay $1400/mo. premium with high deductibles and co-pays .. same as the mortgage payment on the starter home..even then finding a Dr was challenging...as was keeping your Dr for many.
"disingenuous Republicans" aside Krugmans piece doesn't reflect on these unintended consequences. Flaws in ACA are glaring, 1. the federal government , larded up with political motives is 3rd party in doctors office, 2. ACA is much to broad mandating medical procedures beyond basic injury and diseases driving premiums so high...3. no reward for those practticing healthy life styles.
.. issues the Swedish national healthcare system solved mostly. issues Democrats use for political machination.
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@Lane
Lane, the very first paragraph of this opinion piece notes that the A.C.A. was incomplete and imperfect. More so now that the mandate has been ended. That does not mean that the law has not improved many lives, or that the law might be revised to remove some of its imperfections. If Americans want good health care for all, they can either remove the insurance industry from the equation, or keep it with some kind of system such as we have now. But it is hard to improve a system when a president and senate wish to end it, and have not suggested a good system to replace it. After all, protecting those with preexisting conditions is hugely expensive without some form of taxation to spread the cost for caring for such people (who are many people and most senior citizens).
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@BDS one way or another payment to Dr must come through patients hand to work. The trick is to eliminate politics and perverse incentive
in getting vouchers to those needing subsidies...impossible in this politically weaponized enviorment.
Thank you for making it clear that insurance empowered by the ACA covers more than the indigent. It’s the only insurance available for anyone who has no access to group plans, either through employment or marriage. It’s amazing to me how many educated, newspaper-reading people don’t know this, and how many newspaper stories don’t make this clear. In some states there are already no policies available outside of the state exchanges. If the ACA goes, individual insurance goes—it barely matters what the rules are pertaining to pre-existing conditions then.
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Many years ago, as an attorney in the Tax Division of the Department of Justice, I argued a case before a Fifth Circuit Court of Appeals panel headed by John Minor Wisdom. Judge Wisdom was a Republican from Louisiana who served during the 1950's and 1960's and was one of "the gang of four" known for issuing a series of crucial decisions advancing the civil rights of African-Americans. Back then that court was nationally respected for its legal ability and courage. Sadly, the current court (and the district courts whose decisions it reviews) have been deluged with Republican party hacks whose only interest appears to be advancing the party line.
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Paul, if the ACA were to be overturned by the courts, it will only put us on the path to Medicare for All that much more surely (inasmuch as there will be no functional national system in the way to hinder it).
It will also make it that more likely that Republican Senators will become an endangered species in November 2020. Given how popular the ACA is in a state like Kentucky, even the Grim Reaper himself (McConnell) might be put out of his misery if the current law were overturned.
While some ordinary Americans may temporarily suffer if this law is overturned, it is the Republican Party that will suffer most before all is said and done.
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@Matthew Carnicelli Are you sure voters will punish the GOP for kicking said voters to the curb ... yet again? Having observed American voting (and not-voting) patterns for a few decades now, I am convinced the Republican Party could shoot someone on 5th avenue and still win elections.
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Plaintiffs apparently argued before the appeals court that by repealing the penalty, Congress intended to repeal the entire ACA. At least one of the judges - the Trump appointee, shocker - seemed to buy that argument. Yet in 2017, Congress tried but failed to repeal the ACA. Bills passed the House but not the Senate, because even though Republicans used budget reconciliation to get around the filibuster, they couldn't get a simple majority of the votes in the upper chamber. Whatever other arguments there are, the fact that a Trump-appointed appellate judge is willing to entertain, let alone agree with, the plaintiffs' arguments in that regard is truly frightening.
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Dr. Krugman, Thank you for this informative article. The number of previously uninsured residents of West Virginia and Kentucky who've gained health care coverage under the ACA is stunning.
As a gig worker, without the ACA, I wouldn't be able to afford health insurance. I have a deductible and copays, yes, but it's nothing compared to the catastrophic debt I'd incur without this lifesaving plan. Whatever it takes, we simply must attain universal health care coverage in this country.
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California recently strengthened ACA by adding back the mandate which resulted in a tiny 0.8% increase in premiums this year with more insurance players returning to the system. It has also recently begun covering undocumented immigrants under 26. For small business California Care (utilizing the ACA exchange) has enabled my business to cover my remote employees in multiple states at business rates.
When states work on it, people get covered. Then we can go from emergency care to improving people's lives.
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Funny how liberals like Krugman talk about the need for respect of the judiciary when judges rule against Republicans but speak derisively of "republican" judges when they rule against democrats.
And please, I don't know how this will come out, but use some common sense. If the only thing that made Obamacare constitutional was the mandate being labeled a tax by Roberts and the mandate is gone, how is it still viable constitutionally? That doesn't seem like a "specious" argument.
@Chris: Affordable universal healthcare benefits all Americans, not just Democrats. What do you propose as an alternative to the ACA, or as improvements to the ACA? Without the mandate, the ACA is constitutional. The claim of Republicans was that the mandate made the ACA unconstitutional, but the SC reasoned the penalty was a tax, and therefore not unconstitutional.
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Before common sense can kick in you have to have your facts straight. The prior argument was that the mandate made the ACA unconstitutional. Roberts, et al said, 'no the penalty for violating the mandate is a tax, and that makes the mandate OK, thus the law remains constitutional'. So, obviously, if you remove the penalty entirely, you don't really have a mandate, and there's nothing to complain about.
The 2020 election may be a referendum on health care, but it will not solve the underlying problem with out political system unless Democrats with more intestinal fortitude than Schumer and Obama take charge. This situation with the Federal courts, and with the Supreme Court, are not going away in any of our lifetimes unless the majority in the US seize control of our political system. That will mean eliminating the right-wing bias in our courts, starting with undoing the McConnell takeover by adding 2 seats - which can, speaking of the intestinal fortitude mentioned above, only take place if a Democratic Senate ends the filibuster. It will be a power play, pure and simple, but one on behalf of ordinary Americans, the majority who voted for Clinton and twice elected Obama. The last time Democrats controlled the Congress and Presidency, weak-willed leadership blew the opportunity to end big-money twisting our politics and gerrymandering twisting our democracy.
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I think the Democrats would be wise to unite behind the idea of improving Obamacare. How it would be improved going forward is of course open to discussion and debate, but I believe both moderates and progressives can agree that the ACA is a good place to begin.
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Given the scenario that the Senate is run by Republicans for another 6 years, then it doesn't matter who is president. Nothing proposed by any Democratic candidate will ever get past Mitch McConnell. It's likely the house will stay Democratic for 4 years. So Trump is effectively limited to military operations, state visits with lots of sword dances, and filling empty seats in the Judiciary. I hope the economy continues to run nicely because you can't tax cut your way out of a recession. We'll blow our interest rate cuts to re-elect Trump then have no tools to deal with the global meltdown looming.
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Yes. The ACA's foundation does not rest upon a tax. It rests upon provding affordable and reasonably comprehensive healthcare.
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@pietrovsky, but the ACA insurers do rely on the ‘law of large numbers—‘ the foundation of all viable insurance plans. The mandate simply compelled younger, and presumably healthier people to buy health insurance. Just like we do with our home and car insurance: we buy those products when our home hasn’t burned down and our car hasn’t been involved in a crash. I personally found the most fault with the low amount of the penalty. After all if you’re really looking to change someone’s behavior, the penalty has got to be great enough to provoke this change in behavior. $500 was apparently a high enough amount to provoke indignation, but I’m not certain a real change in behavior. One thing I do know is, any healthy person who suddenly gets sick wants health insurance, and drops their argument that having health insurance is a personal choice, and what their insurance covers should be optional. As if we know the services we’ll need if we get sick.
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@Lynn Yes, but the ACA relied upon a huge web of funding mechanisms, including the expansion of Medicaid, and savings to make health insurance affordable, not simply the mandate. It has continued to cover millions who previously were unable to afford or obtain coverage, notwithstanding the effective elimination of the penalty. The mandate would make it more effective and was a large part of holding down costs, but the ACA was really about providing coverage to more people, prohibiting plans from rejecting people or charging prohibitive rates for pre-existing conditions, and prohibiting bogus plans, which were abundant prior to its passage. If you read the Act, it is mainly about expanding and improving coverage. But whatever,
I am a former Republican whose family is greatly benefitting from Obamacare. If Trump succeeds in undermining it we are up a river without a paddle. No profit seeking insurance company would insure my family that has pre existing conditions.
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I'm 62 now, and for about 30 years now, I've known the structure of our health insurance system, and saw that it would be trouble.
I've had to move a lot to make sure reasonable health insurance would be available.
ACA with fixes, Medicare for All, will it all get fixed? At times it looks pretty hopeless. Will people in their early 30s now, who see the problems with the system, be struggling for their next 30 years?
Some problems are slow to fix, for social and political reasons. Slavery and Jim Crow took about 300 years to stop. I'm not sure this country will do any better with health care.
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My state attorney general and his predecessor are two of the Republicans who have tried their hardest to take healthcare away from us. I hope he has an opponent next year who uses that against him to knock him out of office.
I've noticed that judges can invent rationalizations for any decision they wish to make. An order to completely dismantle complex legislation issued by three judges who have no particular expertise in healthcare policy would cause chaos in all areas of our society. I don't know how they can live with themselves if they take this destructive action. Moreover, they do not have constitutional authority to do this. The Constitution clearly assigns legislative power to Congress, not judges.
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Since the day Obamacare became law, Republicans have been singularly determined to undo the legislation. Dozens of attempted repeals in vain, with absolutely no viable alternative. It would even be darkly funny to watch Trump now declare that there will be a terrific new plan unveiled, and McConnell reply that he too looks forward to seeing what Trump has to offer, were the implications not so deadly serious. Republicans simply don’t care about the life and death implications of killing the ACA. And to give themselves cover for not having a solution of their own, they will happily let courts do their dirty work for them.
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@NM -- esteemed daughter,
the "something terrific" that the president promised Americans isn't even on the GOP agenda anymore. Healthcare is the one issue Republicans hope won't be a factor in next year's elections. They hate the ACA because they hate Barack Obama. It's as simple as that.
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@silver vibes
I agree. I think it’s not so much about the ACA, it’s about undoing everything Obama, our first black president, did. I didn’t believe that race entered into this Obama hatred for a long time, but now I do. Sad.
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Thank for not omitting the problems of the current ACA.
"imperfect and incomplete reform. The political compromises needed to get it through Congress created a complex system in which too many people fall through the holes."
Hopefully, the challenge will fail, and we can fix the ACA, or move on to a Medicare for all.
My own favorite defects of the ACA, not well publicized, are:
1)There is an estate clawback on ACA Medicaid and expanded Medicaid for people 55 and older. This can be for all medical expenses, and not just an actuarial premium.
Two states that I know of, CA and MN, have amended laws not to allow the clawback. In a prior post in a PK column, a person stated no state would ever do the clawback, and he got a lot of "recommends", indicating reader agreement.
However, MN was doing the clawbacks. (It provoked an outrage and was stopped.)
I also note my own state of MA has, on its current ACA application:
"To the extent permitted by law, and unless exceptions apply, for any eligible person age 55 or older, or any eligible person for whom MassHealth [MA Medicaid] helps pay for care in a nursing home, MassHealth will seek money from the eligible person’s estate after death."
The clawback has to be taken seriously.
2)The division in 2 parts, expanded Medicaid vs on Exchange, is well beyond the capabilities of most state governments to manage. (I've had 5 continuity of coverage problems in the last year in MA, because my income is near the 138% FPL cutpoint.)
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@Norm Spier
The AHCA would have fixed your predicament forgoing expanded Medicaid for 100% premium subsidies. The AHCA also would have spent more than the ACA because of how the CBO scored the individual mandate. Unfortunately Democrats refused to work with the Republicans to improve the ACA.
@Sebastian Cremmington
I see your AHCA, which must be referring to one of the Republican "alternatives" they they offered at some point.
And I see "forgoing expanded Medicaid for 100% premium subsidies".
If it were the ACA, with just the replacement "all medical Medicaid with 100% premium subsidies", that would seem to work. (Up to you'd also need other fixes, one of which is maybe a 12% of MAGI cap on any on-exchange premium, the rest being subsidies.)
Knocking out all of Medicaid, and everyone without an employer plan below 65 would have an affordable on-exchange plan.
However, I was following all of the Republican "substitutes" at the various times they were being offered, in multiple sources, including the NY Times, and the very good, detailed Tim Jost columns on the Health Affairs Blog.
There was nothing from the Republicans that didn't open up numerous gaps in coverage for some people. Besides my own eyes, a lot of people and economists looked at those proposals, and would have brought to our attention anything adequate from the Republicans.
Note that I'm thinking of not just solving "my predicament" that you indicated. I'm thinking of everyone's predicaments.
So, I guess, basically, I don't believe you.
Can you find a link to one or two detailed expositions on this AHCA and post them here, for me and the other readers so inclined to evaluate?
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@Norm Spier - Why shouldn't the state be allowed to 'Clawback' money used for nursing home care. I suppose you want other taxpayers in your state to pay for your parents care so you can inherit more money? My wife & I helped care for her mom & dad and her mom & dad's estate paid for their care for the last 10 years of their life, we didn't expect the state to pay for their care.
2
This is the one thing everyone including Congress and the White House should support. Heaven help anyone who tries to make it go away. Folks don’t want to lose their homes to pay a family member's medical costs. If that happens, we could risk truly serious reactions with unintended consequences.
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It is clear that our current delivery of healthcare in the US is dysfunctional. It is profit based and not outcome based which is how the rest of the industrial world functions. We have chosen profit over sanity.
The Republicans who still want to thwart the ACA found that voters want to be able to live their lives without fear of bankruptcy due to a medical condition. 2018 made that case.
We can only hope that their quest to destroy the ACA will seal their fate in 2020. The propaganda machine will be working overtime on Fox et al to make voters believe that the Democrats want to move them to "socialism." It is up to us to write letters to the editor and talk to our friends to make the case that healthcare is a right and not an option only available to the very rich in this country.
Keep fighting for our citizens. Improve the ACA, don't repeal it. It is our only hope for a humane healthcare system in America. We are the richest country in the history of the world. We can afford to pay for healthcare for our people.
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@Doctor No....yes, agree. But we can write letters to editor, and comments, and tell our friends that HC is a right---spread the word, from now 'til doomsday!
But it won't change policy until we get rid of big money financing our elections and setting the limits of policy, and media commentary.
Some of our biggest donors are big insurance & pharma. Our medical care and our elections are the world's most expensive and profitable.
Other capitalist democracies don't turn over their elections to the biggest donors, and they've had HC for all as a citizen's right for generations. The contrast in how they finance this is conspicuously avoided by our medi, Krugman, and others. Much easier to bash GOP/Trump, and explaining the positive role models in the world, to put pressure on our politicians.
No reform in health care or drug costs, without reform of campaign finance. Hardly mentioned in our news media, which makes big profits from our system.
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First, we always need to keep in mind that the GOP (Greed Over People) Party is ALWAYS searching for ways to increase the wealth of the people they work for - the 1%. Most always this means figuring out ways to take the money from the 99%, or eliminate/reduce any tax money spent on social programs. This isn't even debatable. This is the GOP's sole mission. That the working and middle class who vote for them either don't realize this, or ignore it because they despite Democrats, doesn't make this any less true.
What the Democrats - and those who support them in the media - need to do is to begin publishing the actual impact of the Republican budgets and proposals. They need to show the voters in specifics areas what will happen to them and their loved ones when health care is eliminated - either by ending the ACA or Medicaid; when funding that goes to their states is drastically cut; when Social Security benefits are cut or even eliminated; when federal funding for disaster relief - wildfires, floods, hurricanes - is slashed or eliminated. In short, Republican voters need to see the actual cost to them for their voting record. It will be eye-opening.
Finally, we can only wonder what would've happened if Obama and the Dems had the resolve to implement Single Payer instead of this platypus of a health care system. t may well have been an improvement over what we had, but it's a poor substitute for what we need - MFA.
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@Kingfish52...yes we the people who stand in long lines to vote, can only wonder---what WOULD single payer have been like? Suppose Obama and the Dems and their supportive columnists had really explained it, and promoted it? Or Medicare for All, whatever that means?
Or like some other countries, insurance mandates, but with the crucial factor of our govt regulating insurance prices for the people that elect it. Too radical for Obama and Krugman?
This is painted by HC profiteers as too left wing for 21st C America. So our cautious media won't give us the facts on the ground, using real people/real societies that we can use for comparisons to our system. Our HC politics have been stuck, while big insurance profits go up, as do our premiums.
I'm tired of hearing ACA is 'imperfect' but a big improvement---the slogan of cautious centrists masquerading as real progressives. It's gone on too long.
Most modern countries wouldn't put up with ACA---they're used to better, for generations already. But then they don't turn over their election financing to big insurance and big pharma either.
But keep that dark, Krugman. Just bash the Gop/Trump on and on, to much approval.
4
Everyone has a pre-existing condition or knows someone with one. Mine is a mild problem involving one disc in my neck. Pre-ACA, my insurance company expressly provided that it would not cover anything related to my neck or spine due to that pre-existing condition. I asked a hypothetical: if I were hit by a bus and my spine were injured as a result of that, wouldn’t they cover any of my treatment; the company said, “no.” Without the ACA, we are all an accident or catastrophic occurrence away from lifetime and annual caps, pre-existing condition exclusions, and bankruptcy.
Having lived overseas and enjoyed the benefits of universal health care, including excellent doctors, no bills, and no fighting with insurance companies, I am sad that most Americans don’t realize how bad we have it and how needless this all is. The ACA isn’t perfect, but it is a step in the right direction. The Republican Party is very good at tearing things down, but doesn’t seem to know how to build anything, including a better healthcare system to benefit all Americans.
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@J.
I had an operation at age 17 for a deviated septum. Since that time and until the ACA, each and every health insurance policy I had refused to provide coverage for any illness I incurred in my ears, nose or throat. I had to fight my own insurance company every time I had a ear or throat infection. After some years I became adept at arguing the "fine line" distinction between infections that started in the ear or throat (covered) from infections that started in the nose, then spread to my ears or throat (not covered).
What always got me was that, in the grand scheme of things, my "pre-existing condition" rarely leads to frequent, expensive or fatal illness, unlike your condition or most other peoples' conditions. Yet the health insurers went out of their way to save precious few dollars - but surcharged my premium because of my "pre-existing condition." The pettiness is just astounding.
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If we are covered now, none of us would have preexisting conditions, correct? I’m more concerned with lifetime caps.
4
Remember the line,”being a woman is a preexisting condition”?
14
We have one party that wants to destroy every aspect of government sponsored collective based action. They believe that only people who can do it for themselves deserve it. The exceptionalism of America is limited to the fact that this party, this self centered kleptocratic party, is supported most zealously by those who will be left behind as a result of its ascendence.
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@Doug
Yes.
Can you spell C-A-L-V-I-N-I-S-M?
I've been writing for a long time how it is impossible to understand the attitude much of this nation has about those of lesser resources, and what they "deserve" and are "entitled to", without an understanding of how so much of our individualistic ethos and our Social Darwinism stem from the Calvinist philosophy, even if many have forgotten the religious underpinnings.
But many of our oligarchs do believe that if you are smart, if you are "worthy", you will be rich. Therefore, if you aren't, you aren't worthy--it's your own fault and redistributed resources would only be wasted on you. (The idea of systemic structural unfairness is unheard of in their mindset, although their lobbying and politician-buying creates and perpetuates just such a system.)
Most of other nations have gotten around to the idea that human beings have certain inalienable rights. Despite our independence declaration, a lot of our power brokers do not believe that, unless you prove you "deserve" them through capitalist accumulation.
11
@Doug: "We have one party that wants to destroy every aspect of government sponsored collective based action."
And we have another party that wants to destroy every aspect of individualism through government sponsored collective based action.
There has to be a better way than these two versions of government. I suggest both Democrats and Republicans read the Constitution. It's neither long nor difficult.
Even if you have your own insurance, if you live in a small community that has a small hospital and emergency clinic, the ACA has made it possible for them to remain open.
The law requires that emergency clinics treat all emergencies, not just those with insurance. Many small town hospitals were closing due to the number of uninsured patients. They were losing too much money, and the doctors were going to clinics that could pay them.
Without these clinics, those who needed emergency services had to wait for transport and in many cases travel long distances when they needed faster treatment. As far as we can tell,it is the big medical insurance companies that want to eliminate the ACA, they make their money by insuring those who need it least. Anyone who may cost them money is not wanted. Just look up the incomes of the HMO executives, and ask how can they justify incomes in the tens of $millions, or even hundreds of $millions, how can they profit that much from insuring medical access? It is obvious the payees are not getting their moneys worth, this is the business model of the insurance industry.
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@David Underwood Thank you for writing about this. Many aspects of the ACA can be flipped on and off like a lightswitch. People who have no insurance one day can be covered the next, and vice versa (which is not a minor concern).
When the medical clinics and hospitals close, particularly in those states that chose not to expand Medicaid, it's a years- or decade-long decision to find and re-open a replacement.
30
Maybe Obamacare doesn't have quite the support Krugman thinks it does.
The Vice President in the administration that championed Obamacare doesn't think enough of it to pay the tax that was specifically enacted to help fund it, the additional employment tax. Instead, Biden creates a legal fiction with an S-Corp to shield his speaking and book income from employment tax saving himself a half-million dollars.
2
@M Wood,
Sorry that's not how the "penalty" works. First, Biden has health insurance, so there's no penalty. Even if he didn't have any insurance, any income from an S corporation is reported on Form 1120S and Schedule K-1. Any income or loss from S corporation operations is reported (via Schedule K-1) on the shareholder personal income tax return. At that time, the penalty would be added to any income tax liability due the government.
As it is, under the Tax Cut for Billionaires and Corporations Act of 2017 - um, I mean the tax reform act of 2017 - the penalty amount was set to zero - $0.00.
17
@M Wood
Thank you for this comment. If that is true, then please post it to an article about Joe Biden's campaign.
1
@M Wood
What is your source for this statement? Lemme' guess, Rush/Hannity FOX News. Just enough technical terms to make it believable. The taxes you speak of are not related to the ACA.
6
Although I think the Supreme Court actually ruled that the individual mandate, reasonably characterized as a tax, was within the congress's constitutional power to tax, but not within its power to regulate interstate commerce, the Supreme Court is likely to uphold the constitutionality of the ACA again even if the individual mandate is disapplied.
8
@James F. Clarity IV
According to the IRS, in 2018, the mandate and tax penalty is still in place. I paid over $3000 on last year's return for not having insurance.
West Virginia, the state with the highest proportion of its citizens on Medicaid because of expansion under the ACA, was the state with the second highest percentage of its voters to vote for Trump over Clinton. Only one party had threatened the ACA at the time. How does America reconcile these facts? Voters in states all over America have sacrificed their own interests. Despite the midterm results, I am not convinced that voters on the right will change parties, even if it means their health care is at stake. And that’s sad.
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@Shane W,
There's a story told allegedly by George McGovern years ago about his ill-fated 1972. He recalled an incident at a campaign stop in his home state of ND where he gave a campaign speech to seniors. Apparently, they were having none of it - many voiced support for Nixon.
"I knew I was going to lose," said McGovern, "when I overheard some of the seniors leaving at the end of the speech, talking about their support for Nixon, then discussing their Social Security checks, food stamp allotments, and navigating Medicare - all programs I had sponsored or co-sponsored to make their senior years easier."
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@Shane W
You don’t have the privilege of assigning people their interests. I have had people question my sanity and my intelligence when I walked away from money. Money isn’t very important to me compared to some other values. Their judgements of me were rooted in their own close-minded towards and intolerance of other values systems. Everyone does not worship the same Gods.
7
Actually, it’s called suffering the consequences of your bad decisions, as those who both support the GOP, and benefit from the ACA, so richly deserve to do. Trying to protect people from their own stupidity is getting old.
25