Oops – make that 56 and 0

My apologies if this is similar to yesterday’s post. The potential destruction of the ACA by an unelected body is an issue of monumental consequence.

There is about a month before the Supreme Court (SCOTUS) will be hearing arguments concerning whether or not a drafting error in the Affordable Care Act would render the very fabric of the law moot. Did Congress really mean to make the ACA only offer subsidies to states that had their own exchanges (note: Iowa does not)? Or was there simply an error in drafting the law that was not by congress? Even as major of an opponent of the ACA and one of the senators most involved in writing the law as our own Chuck Grassley said such a challenge is “ridiculous.”

So what happens if SCOTUS rules in favor of the challengers? Simply stated, millions of Americans (including around 40,000 Iowans) would lose their subsidy and thus health care would most likely be unaffordable. Therefore, the affordable part of ACA changes and most likely millions will need to drop their health care. Not sure what that would do to the requirement that all Americans carry health insurance. If the subsidy is not available, then is the requirement therefore no longer in effect except in states that have their own exchanges? That is one of the possibilities.

An almost certain effect will earlier deaths for those who will lose their insurance. Joan McCarter at dailykos took a brief look at what how many might be given an early death sentence should the SCOTUS decide to rule in favor of the challenge in this case. In her article she quotes the American Public Health Association estimates that as many as 10,000 will die early.

Not that this is any big deal to the right. In a editorial for the Washington Post, American Enterprise Institute(AEI) “scholar” Michael Strain claimed that more Americans dying is OK in service to achieving certain ends. That is the old “ends justify the means” argument that is a never ending controversy. Allowing people to suffer and die to achieve some undefinable goal of freedom seems like a strange concept.

With John Roberts having been the swing vote on the SCOTUS’ previous decisions on the ACA we may expect that he would once more be in that position once again. With the criticism he took last time over his decision to let at least part of the ACA to go into effect one might think Roberts would feel some need to make amends to the Republican base on the ACA with this decision. With this as a background it is not hard to feel very concerned when the SCOTUS hears this case in March and rules on it in June.

This is where John Boehner comes in. Boehner has led his chamber in some 56 assaults on the ACA without ever having any hope of success. He has continued his crusade while in place of doing any work on what he apparently believes are much lesser issues such as jobs, infrastructure, outrageous student loans, immigration and many other pressing issues. Should the SCOTUS rule that suddenly a major portion of the ACA is no longer valid, then it should fall into Boehner’s lap to lead his colleagues to deal with the problem.

As anyone who has followed Republicans (actually Tea Baggers) in congress recently knows that party is really split 3 ways. One of the issues they are split on is health care. Therefore Republicans have never articulated any plan to replace the ACA despite their constant attempts to get rid of it. Their focus is on killing the ACA only. The SCOTUS may fulfill Boehner’s fondest dream without him having to even getting his hands dirty. Since they have been preaching “repeal and replace” for years and with the SCOTUS doing the repeal portion for them, what will Republicans do to replace?

Since Joni Ernst used that trite phrase over and over in her campaign, I called her office for some enlightenment a couple of weeks ago. There is nothing being worked on.

It is looking more and more that if a portion is repealed then the emphasis will be on killing the rest of it as quickly as possible, not replacing anything. I expect that the replacement pieces they will offer will be the two old standbys that they have floated for decades:

1) limit awards in torts which they claim will lower liability insurance costs and thus lower charges to patients. This has been shown over and over again to be false. Here is one such study.

2) Allow people in one state to buy health insurance across state lines. What this will do is allow states with few regulations to sell essentially worthless policies for low prices. While there are some guarantees of payment in the ACA, those would no doubt be attacked through the court system also.

If the SCOTUS rules for the challenge in King vs. Burwell it could surely be a really bad day not just for poor Americans who will probably lose their health insurance, it will be a bad day for all Americans who will still be depending on a ridiculous insurance system to ameliorate medical costs.

Single payer, single payer single payer. I can’t say it enough.