Five really important ACA/KvB stories which I don't have room in the headline for.

There was a time when I thought that ACA-related news would quiet down after the Open Enrollment Period ended. That day may come at some point, but with the King v. Burwell decision bearing down on everyone, forget about it.

In addition to this morning's release of the big CDC National Health Interview Survey, here's not one, not two, but five major pieces out today. Unfortunately I don't have time for lengthy write-ups for each, but they're all pretty important in different ways:

As the U.S. Supreme Court prepares to issue a ruling that could impact the Affordable Care Act, 47 percent of Americans now approve of the health care law, the highest in CBS News and New York Times polling (although support is still short of a majority). For the first time, more Americans now approve than disapprove of the ACA, but by a narrow margin.

Nothing in the results are particularly surprising (GOP: Obamacare bad!; Dems: Obamacare good!), but they come to one rather silly conclusion in my opinion:

Most Republicans (72 percent) continue to oppose the law, while most Democrats (70 percent) support it. Independents are split. Still, few Americans (just 9 percent) think the health care law is working well and should be kept as it is, and 31 percent want the law repealed entirely. Most - 55 percent - think that there are some good things in the law, though changes are needed to make it work better.

Some anti-ACA pundits and politicians are pouncing all over that 9% figure, of course ("See??? Only 9% think Obamacare is working!!), but that's an absurd simplification, especially given KvB breathing down our throats. Here's the actual question as asked and the allowed responses:

It seems to me that "there are some good things but some changes are needed" can mean any number of things. "Some changes" could mean anything from "tweak the wording of the King v. Burwell language slightly", "add pregnancy to the list of qualifying life changes" (as New York and California may be about to do) or even "increase the subsidy threshold" or "put more limits on deductibles". None of those is damning of the law in any way; the question doesn't ask what type of changes people want.

Republicans for months have been planning to use a fast-track budget procedure to extend Obamacare subsidies if the Supreme Court strikes them down — all while completely gutting the underlying law.

But just days before the court’s ruling, the party is still grappling with the question of how much of the law to repeal, in part because of its exorbitant cost.

The plan to use the expedited procedure — called reconciliation — is in flux as lawmakers realize they would have to come up with hundreds of billions in spending cuts to pay for a full repeal of Obamacare. And some Republicans aren’t sure they want to go there.

No offense to Ms. Blade; the story is fine...but this still kind of falls under the category of "You don't say?? Really??" Plus, bonus points to her for using the word "vexes". Haven't seen that in quite awhile.

A Republican lifer in Wranglers and cowboy boots, Pierce is his party’s old school ideal: a self-sufficient small business owner living off the land, growing steaks for people who can afford them. He’s also a prominent Arizona state senator, formerly president of the senate and majority whip.

So it’s somewhat surprising that he has invited me to his home district in order to sell me on the benefits of Obamacare.

...Ideologically, Pierce is opposed to federally subsidized health care, which he believes is a government “intrusion” and part of a “huge overreach in federal power” under Obama. But in 2013 when Brewer introduced her plan to expand Medicaid with ACA funds, Pierce seems to have taken a surprising tack: He gauged his constituency. His was an aging district with a retiree town for a county seat—the median age in Prescott is around 54—with a financially failing community hospital and a jail overrun with the mentally ill. He says he decided that voting for Medicaid expansion was “the right thing to do. I don’t represent the people on the far right, or the Republicans. I represent everybody who lives out here.”

This is actually a pretty positive piece, and welcome news. Of course, the "Die Hard" in the headline reminds me that "Gruber" is back in the news. Where's Bruce Willis when you need him?

At the New York Times, Michael Shear has a story about the impact of an adverse King v. Burwell ruling on President Obama's legacy...which includes this rather repulsive look into the minds of Congressional Republicans:

Republicans, who control Congress, say they are aware that Americans may look to them for a solution, and could blame them if bickering and gridlock get in the way. But many say they are gleeful that the court may do with a single decision what Republican lawmakers could not accomplish in five years: strike a devastating blow to one of Mr. Obama’s signature achievements.

“This is the beginning of the end of the Affordable Care Act,” Representative Paul Ryan of Wisconsin, the chairman of the House Ways and Means Committee, said in an interview.

Woo-hoo!!! Millions of people's lives ruined!! Thousands of unnecessary deaths!! Yee-hah!!! (not to mention most of them are likely Republicans.)

Finally, over at Politico, Peter Suderman has an important piece laying out the fundamentals of why the Republican Party just can't seem to get their act together when it comes to healthcare:

Obamacare, in other words, was ClintonCare’s second act—the culmination of more than 15 years of work and consensus building. To put it another way: Republicans never started working on health policy; Democrats never stopped.

Of course, the NY Times story above about how many GOP Congressmen are "gleeful" about the prospect of winning King v. Burwell might lend a bit of insight as well.

Here's the thing:

  • 1. You either accept that everyone is entitled to decent healthcare without breaking them financially, or you don't.
  • 2. IF you accept that they are (which Republicans claim to), then you have to accept that healthcare costs a lot of money.
  • 3. IF you accept #1 and #2, you also have to accept that a substantial number of people can't afford to pay that money.
  • 4. IF you accept #1, 2 and 3, you then have to accept that someone will have to pay that money.
  • 5. Under the pre-ACA system, that "someone" was a combination of a) taxpayers (Medicaid, Medicare), b) employers (ESI), c) individuals (OOP costs) and d) Hospitals (ER Uncompensated Care)...but it left out some 40-50 million people.
  • 6. Under the ACA, that "someone" is still a combination of a, b, c & d, but it's shifted around and has cut those left out down to around 30-35 million.
  • 7. Any "replacement" for the ACA which claims to still address #1 would still require a lot of money. It's just a question of where that money would come from.
  • Since very little of it would come from the poor/low-income, it would have to come from some combination of everyone else (middle class, the rich, corporations, etc).

Since the Republican Party can't accept rich people or corporations paying higher taxes under any circumstances, they're in quite a bind. Wash, rinse, repeat.