King vs. Burwell: How The Republican Beast is Feasting on Ignorance

by Madeleine Kando

The Affordable Care Act, also known as Obamacare, is once again under attack by Republicans. Since its birth in 2010, they have tried to dismantle it, either piecemeal or as a whole, and have taken every opportunity to badmouth it, without offering any significant alternatives.

They first derided the ACA by pointing to the many technical problems that the healthcare.gov website suffered from, which caused a bunch of delays. But when those problems got fixed and enrollment surpassed expectations, proving that Obamacare was a good thing, Republicans decided to challenge the constitutionality of the whole Act. When the United States Supreme Court upheld the Individual Mandate, they went after some of the provisions of the Act.

In Hobby Lobby vs. Burwell, the Supreme Court ruled that requiring family-owned corporations to pay for insurance coverage for certain forms of contraception under the Affordable Care Act violated a federal law protecting religious freedom. Obamacare lost on that front.
The current attack has to do with what Paul Krugman describes as 'an obvious typo' in one clause of the Affordable Care Act. In 'King vs. Burwell', the plaintiffs challenge the constitutionality of tax credits for premiums. As written, the law only allows exchanges "established by a state" to administer these subsidies. If the federal government set up the exchange (as it has done in most states), then it would not have the authority to administer a crucial part of the Affordable Care Act.

David King, one of the plaintiffs, is a 64 year old Vietnam veteran who makes $39,000 a year and if it weren't for the subsidies, he wouldn't be able to buy health insurance. Being a good Libertarian, he didn't want to be forced to buy health insurance in the first place, but had to because of the Individual Mandate. With a little help from two conservative think tanks, the Cato Institute and the American Enterprise Institute, a case was developed focusing on the phrase "established by the State”, in one of the clauses of the ACA.

Many states, mainly conservative ones, have refused to set up their own exchanges, and defaulted to exchanges run by the federal government. According to the lawsuit, the subsidies are lawful only in the states that decided to set up and operate their own exchanges. So, if you look at the specific language authorizing those subsidies, ‘it could be taken — by an incredibly hostile reader — to say that they’re available only to Americans using state-run exchanges, not to those using the federal exchanges.' (quoted from Paul Krugman's article).

But you don't have to be a genius to understands that the ACA did not mean to provide affordable health care only to those Americans who live in states that set up their own exchanges. The subtitle of the Affordable Care Act which contains the provision plaintiffs rely upon is titled “Affordable Coverage Choices for ALL Americans."

The irony is that if the Court declares the subsidies illegal in the states that have federally run exchanges, we could see a two-tiered system of health care develop: the states that have their own exchanges (mostly Democratic states) will keep their subsidies for middle income families, and the states with federal exchanges (mostly Republican states) will lose their subsidies and millions of Americans won't be able to afford health insurance. The mostly Republican constituency will become the victim of its own idiotic shenanigans. The states with the highest percentage of insured who qualify for subsidies would loose out. And those are Republican states.

The 3 legged stool that Obamacare is built on, (1) no denial of coverage for pre-existing conditions, (2) everyone has to have insurance, and (3) subsidies for those who cannot it, would suddenly miss one of its legs.

If subsidies are taken away from the newly insured in the 34 states that have federally run exchanges, most of them—especially the young and healthy ones—would drop coverage. A sicker pool of consumers results in higher premiums, which causes more people to drop out, which in turn results in a further increase in premiums, etc. The whole system collapses.

The stupidity of it all boggles the mind. It is also unbelievably mean spirited. To deny health insurance to people who need it the most because of a typo?

How does a rational person explain this latest development? The Affordable Care Act is one of the best things that has happened to this country for a long time and Americans are starting to realize this. It is imperfect, for sure, but dismantling it, especially without having anything to replace it, all in the name of liberty, is the most stupid thing we can do. If the Supreme Court upholds King vs. Burwell, it puts the engine in reverse, after 18 million previously uninsured people have signed up for Obamacare. It has become part of our reality. Would such a decision not cause enormous chaos?

According to a leading Market Research Company, 'Ipsos MORI', who created an Ignorance Index that compares 14 countries on how much citizens know about their country's social affairs, the United States is the second most ignorant country, behind Italy. Is that why we always vote against our own interests? Rather than waste taxpayer dollars on fighting Obamacare, we should spend our time on how best to use exchanges to improve insurance markets and health system performance.

Republicans should be careful what they wish for. If King vs. Burwell is upheld, it is sure to backfire. They will be blamed for injuring millions in their own states. Now that elections are not too far in the future, is this really what Republicans want?   leave comment here