Local governments need to respond to ACA ruling


I try to stay pretty focused on local politics on this site, but federal policies invariably intersect with local government. The ruling from a federal judge in Texas that the Affordable Care Act is unconstitutional presents a serious threat to American communities.

This ruling didn’t come out of thin air: it was engineered by none other than our indicted Attorney General Ken Paxton, cheered on by Greg Abbott, Dan Patrick and pretty much every other elected Republican in Texas.

Obamacare could be a lot better, thanks in large part to Republican attempts to sabotage it. But it has undoubtedly been a huge success. Millions of poor Americans have free or low-cost access health care through Medicaid. Millions more can buy heavily-subsidized health plans in the individual market. To undo that progress is insane.

There is no valid moral or ethical justification for repealing Obamacare. It’s an imperfect government program that delivers tremendous good. There are ways to strengthen it. Re-instating the individual mandate, which Congress repealed, could help drive down premiums for those whose incomes are too high to qualify for subsidies, who represent a relatively small piece of the ACA marketplace. In Texas, it would really help if we’d just take the federal dollars to expand Medicaid. But every GOP plan to repeal Obamacare has simply taken away all of the subsidies. That’s all it is. It’s not a “reform,” it’s simply taking away a good thing and returning things to the even worse way they were before.

Ending Obamacare isn’t only senselessly cruel, it’s not in line with what voters believe or politicians say about health care. Even as the GOP has shifted further into crazytown these last few years, almost every elected Republican accepts the fundamental role that government plays in our communities. Indeed, Trump even campaigned on the promise that he was going to “cover everyone.” Republicans insist that they will make sure to keep in place protections for preexisting conditions.

The ruling itself is ridiculous. The most charitable view of the judge’s reasoning is that he didn’t understand the law he was asked to rule on. The less charitable view is that he is a partisan, pure and simple.

When the Supreme Court upheld the mandate as constitutional in 2012, it was based on Congress’s taxing power. Congress, the court said, could legally impose a tax penalty on people who do not have health insurance.

But in the new case, the 20 plaintiff states, led by Texas, argued that with the penalty zeroed out, the individual mandate had become unconstitutional — and that the rest of the law could not be severed from it.

Ridiculous. The individual mandate was one part of the law aimed at one segment of the population. The Republicans got rid of the mandate and in doing so helped to harm one of the focuses of the law. But the rest of the law is working fine. The Medicaid expansion has nothing to do with the individual mandate.

The marketplace could likely be strengthened by the reintroduction of the mandate, but it’s functioning nonetheless. Those who receive subsidies (the vast majority) are shielded from the premium rates that we hear so much about.

The increases in subsidies necessary to cover the rising premium rates (due to the Republicans trying to push as many healthy people out of the marketplace as possible) has resulted in increased government spending. So I guess that’s one rationale for opposing the law. Of course, Republicans making an argument for fiscal restraint is rich.

Anyway, after all of that bad news, the good news is that this will likely be a drawn-out legal process, not harming the ACA immediately. Even the Wall Street Journal editorial board chides Greg Abbott et al for bothering with this lawsuit, and predicts that the ruling will be overturned and backfire politically on Republicans.

This is an opportunity for Democrats as well as state and local governments stand up to make clear to people what is at stake. The ACA is popular and people are justifiably outraged at the prospect of tossing millions off of health care plans. Local elected officials should sound the alarm to get people engaged locally in calling their members of Congress, organizing rallies, etc. City Council’s now 100% Democratic membership should pass a resolution in favor of defending Obamacare and instruct its law department to file an amicus brief.  It’s up to Democrats to make sure every voter in this increasingly purple state knows that Republicans have done everything in their power to keep people from having health care.

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