Once again the U.S. Supreme Court, even this Trump-soiled one, saved Obamacare. In the process it spared the Republican Party.
You might have been thinking that Republicans oppose the Affordable Care Act. They say they do. That's called talking points. It's called pandering to the base.
But it doesn't mean Republicans have anything to put in its place. And it doesn't mean Republicans would want to run in the midterms after having taken away and not replaced health insurance for millions of cancer victims and poor people.
By a 7-to-2 vote, the Supreme Court said that the appellants seeking to have the act thrown out lacked standing to bring the appeal. The majority-conservative court saw no reason to bother with the appeal's total lack of merit.
The anemic legal argument was that, since a few words of the massive legislation had been ordered deleted by the courts--the ones presuming to mandate that people have health insurance--the rest of the many-pronged law had to collapse as well.
Donald Trump nominees to the high court--two of the three, in this case--rejected his wishes just as they did on his attempt to whine his way to a bogus victory in the last presidential race.
It may be that responsibly conservative judges applying law and logic may not be politically and culturally doctrinaire after all, though an abortion case or two will address that point more clearly.
Republican officeholders issued their perfunctory lamentations that such a supposedly dubious act of government overreach would live on. But you could hardly hear those perfunctory Republican lamentations for the mass Republican sighs of relief.
If the Supreme Court had struck down the Affordable Care Act, millions of Americans with pre-existing conditions would have lost their statutory assurances of comprehensive and normally priced insurance. Young adults below the age of 26 would have been susceptible to being kicked off their parents' plans. Dozens of states would have lost federal billions with the abrupt elimination of Medicaid expansion.
No state would have been hit harder than Arkansas. Our state would have lost the money to buy private insurance for 300,000 poor people, which stabilizes private premiums for everyone, fortifies the state government budget and keeps rural hospitals and much of the state's health-care infrastructure viable.
Yet there was Gov. Asa Hutchinson, term-limited but interested in maintaining a national Republican profile after 2022, putting out a statement of regret that the court had upheld the ACA on procedural grounds and not addressed broader supposed concerns. But I don't think he really was all that peeved.
Hutchinson had to know as well as anyone that this evenly divided Congress almost assuredly would not have been able to pass anything on health care, much less anything better, especially this close to the midterms. You'd have had Republicans arguing for state-by-state solutions and a Medicaid work requirement. You'd have had the Democratic left arguing for going all-in on Medicare for everyone. And we'd have had midterm elections mostly about the new and vast void in health care, a Democratic advantage, especially since Obamacare became much more widely used during the pandemic.
Hutchinson revealed his real interest when he pivoted to say it's time for the state to turn its attention to its application for a new waiver to keep Medicaid expansion going past Dec. 31.
The state won a waiver to use its expansion money not for direct Medicaid, but to buy private insurance for those people. We called it the private option, and it was a stirring success.
Hutchinson got in office and felt obliged to re-brand the program something Republican-y, like Arkansas Works. Then he imposed a kind of work requirement by which recipients were supposed to report that they were working or looking for work or doing volunteer work. That was an administrative debacle that took health insurance from thousands and found employment for none. The federal courts threw it out because Medicaid, by statute, is for health insurance, not work programs, which are wonderful, but separate.
Health care is not a punishment stick. It's the humanity of civilized people.
Now the original private-option waiver is soon to expire and the state is re-branding the program again--as ARHOME, standing for something or other--and planning finesses that seem good in part and dubious in part. Recipients would get new wellness incentives. They'd also get some vague version of work incentives. Some recipients would face higher premium responsibilities and co-pays.
I could see the Biden administration embracing some of it and balking at some.
Hutchinson tells me he isn't worried because he finds the proposal sound and in line with Biden administration aims, and, anyway, the state and federal governments can negotiate solutions on disputed elements of the waiver request, heading off any abrupt cancellation.
It's almost as if we can assume that the Affordable Care Act, like Social Security and Medicare, is here to say, never mind Republican talking points and base-feeding.
John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, is a member of the Arkansas Writers' Hall of Fame. Email him at [email protected]. Read his @johnbrummett Twitter feed.