One Chance

Five weeks ago, right after Supreme Court Justice Ruth Bader Ginsburg passed away, I once again wrote about the different options available to Democrats to save the ACA from a potentially disastrous SCOTUS ruling next spring...each of which would require them holding a trifecta in the House, the Senate and of course the Presidency:

  • 1. Pass a simple bill changing the federal mandate penalty to an amount higher than $0.00.
  • 2. Pass a simple bill clarifying that the mandate is separate from the rest of the ACA.
  • 3. Pass a simple bill striking out the underlying mandate language itself.

As I understand it, two of these would also require the newly-Dem controlled Senate to also kill the filibuster (or to somehow convince enough Republicans to agree to hit the 60-vote threshold), while the third (raising the penalty back over $0.00) could be done with just 50 votes (+ VP Kamala Harris as the tiebreaker) via the reconciliation process...which itself gets messy.

RE-UPPED 1/31/22: It was announced this morning that John James, who lost not one but two statewide U.S. Senate races back to back in 2018 & 2020, is taking a third swing at elected office in 2022. This time he's setting his sights lower, going for Michigan's new open 10th Congressional district, which is still competitive but which definitely has more of a GOP-tilt to it. In light of that, I decided to dust off this post again.

A month ago, incumbent Democratic Senator Gary Peters of Michigan and his Republican challenger John James were both interviewed as part of a Detroit Regional Chamber series on several issues, including healthcare policy and the ACA.

As I noted at the time:

"If you have a pre-existing condition...heart disease; diabetes; breast cancer...they're coming for you. If you love someone who has a pre-existing condition...they're coming for you. If you're under the age of 26 on your parents' coverage...they're coming for you."

Wednesday night's Vice-Presidential debate between Kamala Harris and Mike Pence wasn't as bad as last week's dumpster fire of a Presidential "debate" between Donald Trump and Joe Biden. The questions were mostly better, and neither Pence nor Harris screamed at each other. On the other hand, the moderator did a terrible job of cutting Pence off when he ran over his time limit or interrupted Harris, and just as importantly, Pence flat-out refused to answer most of the questions at all, often instantly changing the subject to whatever he happened to feel like talking about with zero pushback from moderator Susan Page.

Pennsylvania launches new state-based health insurance marketplace, Pennie

  • Pennie replaces Healthcare.Gov and will improve access to coverage and increase affordability

Harrisburg, PA – September 22, 2020 – Today, Pennsylvania announced, Pennie, the new state-based health insurance marketplace for 2021 coverage. Pennie is available to all Pennsylvanians and aims to improve the accessibility and affordability of individual market health coverage. It is also the only place that connects Pennsylvanians to financial assistance to reduce the cost of coverage and care.

Pennie was created by Act 42 of 2019, passed unanimously by both chambers of the General Assembly and signed into law by Governor Tom Wolf on July 2, 2019.

There's a lot to unpack in this press release from Covered California:

Covered California Hits Record Enrollment, Providing Important Lessons for the Nation on Meeting Americans’ Health Care Needs During the Pandemic and Major Economic Downturn

  • Covered California’s investments in marketing and outreach, along with consumer-first polices, helped it reach a record enrollment of 1.53 million people.
  • The record enrollment was bolstered by 289,000 people who signed up for coverage during the COVID-19 special-enrollment period, including 21 percent who were previously uninsured and likely ineligible to enroll under federal rules.

That's roughly 61,000 Californians who were able to enroll in ACA exchange policies specifically due to CA having an open SEP (that is, no requirement of coverage loss/etc. to do so).


This morning, U.S. Senator Gary Peters (D-MI) and his Republican opponent, John James, were interviewed online by Nolan Finley of the Detroit News and Stephen Henderson of DPTV & WDET. Here's the verbaitm transcripts of each of their healthcare/ACA Q&A sections, Peters first:

HENDERSON: "One of the things which has been made really manifest during the COVID-19 pandemic is the weakness of our healthcare system. We're now coming up on about a decade of life under the Affordable Care Act, which of course expanded access to insurance and made some other changes, but there are still obviously a lot of inefficincies...there are a lot of insufficiencies.

Give us an idea of what you would support in terms of changes to the healthcare system, changes to the Affordable Care Act, to get more people covered at lower costs and make the system work better."

Sunday, July 19th, 2020:

Wallace: "But you've been in office 3 1/2 years, you don't have a plan..."

Trump: "But we haven't had...uh...excuse heard me yesterday. We're signing a healthcare plan...within two weeks. A full and complete healthcare plan that the Supreme Court decision on DACA gave me the right to do. So we're gonna solve...we're gonna sign an immigration plan, a healthcare plan, and various other plans....and nobody will have done what I'm doing in the next four weeks.

It's been thirteen days.

Yesterday Donald Trump was interviewed by Chris Wallace on FOX News Sunday. It was full of the usual batcrap insane lies and babbling on Trump's part, but one exchange in particular caught my attention:

Wallace: "I want to talk to you about Obamacare. Since the pandemic hit, millions of people have lost their jobs, and thereby lost their health insurance. Almost a half million have signed up for Obamacare. Your administration just announced that you're signing onto a lawsuit to overturn Obamacare..."

Trump: "And replace it."

Wallace: "Why does it make sense to overturn Obamacare, which people are now relying on...Democrats are gonna say, the man who's wanted to kill Obamacare is gonna take it away...the protections for pre-existing conditions..."

Trump: "First of all, we got rid of the individual mandate, pre-existing conditions will always be taken care of by me and Republicans, 100%.."

Wallace: "But you've been in office 3 1/2 years, you don't have a plan..."

Yesterday, the Trump Administration formally submitted their official brief with the Supreme Court of the United States asking SCOTUS to completely and fully strike down the entire Patient Protection & Affordable Care Act. This is the latest development in the utterly insane "California vs. Texas" lawsuit (formerly "Texas vs. U.S.", "Texas vs. Azar", or as I prefer to label it, "Texas Fold'em", a name originally coined by U of M law professor Nicholas Bagley but which doesn't seem to have caught on with anyone other than me so far.

I've written about this completely absurd lawsuit more times than I care to remember, but as a reminder, here's what it comes down to.

The image below is the "3-legged stool" of the Affordable Care Act.

The blue leg represents the various patient protections which the ACA requires health insurance carriers to provide--guaranteed issue, community rating, essential health benefits and so on.