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Statement by CMS Administrator Chiquita Brooks-LaSure On the U.S. Supreme Court’s Decision on Vaccine Requirements

“The Centers for Medicare & Medicaid Services (CMS) is extremely pleased the Supreme Court recognized CMS’ authority to set a consistent COVID-19 vaccination standard for workers in facilities that participate in Medicare and Medicaid. CMS’ vaccine rule will cover 10.4 million health care workers at 76,000 medical facilities. Giving patients assurance on the safety of their care is a critical responsibility of CMS and a key to combatting the pandemic.

“Vaccines are proven to reduce the risk of severe disease. The prevalence of the virus and its ever-evolving variants in health care settings continues to increase the risk of staff contracting and transmitting COVID-19, putting their patients, families, and our broader communities at risk. And health care staff being unable to work because of illness or exposure to COVID-19 further strains the health care system and limits patient access to safe and essential care.



Back in March, I wrote up an exhaustive history of the House v. Burwell court case, which has seen more twists and turns than a small intestine.

I'm not gonna recap the whole thing yet again today (click the first link above for that), but I concluded the most recent chapter by noting:

Simply appropriating CSR payments and killing off Silver Loading would pay for more than 40% of the cost of massively upgrading the ACA (perhaps $250 billion of the $600 billion or so total 10-yr cost).

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via Covered California:

U.S. Supreme Court Rejects Latest Challenge to the Affordable Care Act and Preserves the Landmark Health Care Law for a Third Time

SACRAMENTO, Calif. — Covered California Executive Director Peter V. Lee applauded today’s U.S. Supreme Court decision to dismiss challenges to the constitutionality of the Patient Protection and Affordable Care Act leaving the law intact to the benefit of millions of Americans.

“The Supreme Court – in rejecting claims challenging the constitutionality of the Affordable Care Act – has once again upheld the law that is helping millions of Americans benefit every day from health care coverage and broad consumer protections.  It is time to move on, focus on improving the law and reach true universal coverage. 

One Chance

UPDATE 5/17/21: (sigh) Never mind...again. There were several opinions announced this morning but the ACA case wasn't among them...again. The Sword of Damocles continues to dangle.

UPDATE 5/21/21: Annnnnnd the Supreme Court website now shows more decisions to be announced this Monday, May we go again (maybe)...

UPDATE: 5/24/21: (sigh) Never mind...again. There were two opinions announced this mroning but the ACA case wasn't among them...again. The Sword of Damocles continues to dangle.

UPDATE: 5/25/21: Annnnnnnd the Supreme Court website now shows more decisions to be announced this Thursday, May 27th...

UPDATE 5/26/21: Never mind.



I honestly thought that I had written the final chapter in this absurd saga, which started two administrations, two House Speakers, three HHS Secretaries and three U.S. Attorney Generals ago when the Federal Circuit Court issued their final ruling last August, but apparently not.

Since this insanity has been grinding away for nearly seven years now, I'm pretty much just reposting my entire August entry, with an important update tacked on at the end.

Here's a quick recap:

  • The ACA includes two types of financial subsidies for individual market enrollees through the ACA exchanges (HealthCare.Gov,, etc). One program is called Advance Premium Tax Credits (APTC), which reduces monthly premiums for low- and moderate-income. APTCs are the subsidies which have been substantially beefed up by the American Rescue Plan (the additional subsidies will be available starting in April in most states, soon thereafter in most other states).
  • The other type of subsidies are called Cost Sharing Reductions (CSR), which reduce deductibles, co-pays and other out-of-pocket expenses for low-income enrollees.
  • In 2014, then-Speaker of the House John Boehner filed a lawsuit on behalf of Congressional Republicans against the Obama Administration. They had several beefs with the ACA (shocker!), including a claim that the CSR payments were unconstitutional because they weren't explicitly appropriated by Congress in the text of the Affordable Care Act (even though the program itself was described in detail, including the payment mechanism/etc.)

UPDATE 4/03/21: I've confirmed with a highly-trusted source that this isn't least not before the Supreme Court issues their ruling, anyway.

As noted below (scroll all the way down), it appears that a $1.00 penalty would be too small to make the reconciliation cut, which means the only way to #MootTheSuit via reconciliation would be to change the mandate back to an amount large enough to have a significant impact on the budget...which presumably means several hundred dollars.

I mean, if they're gonna do that, they might as well just restore it to the original $695/2.5% of income while they're at it.

I suppose this was inevitable, but it's grating nonetheless, and especially so given that we're in the middle of a pandemic which has caused tens of millions of Americans to lose their jobs:

The Supreme Court agreed Friday to consider a Trump administration plan to let states impose work requirements on some who receive health-care benefits under the Medicaid program for the poor.

Arkansas and New Hampshire want to continue programs halted by lower courts, and more than a dozen other states say they want to impose similar requirements.

But despite the Supreme Court’s willingness to take up the issue, the incoming Biden administration might have other ideas, and opponents called on it to reverse endorsement of the work requirements.

So, the idiotic, asinine and otherwise absurd GOP-brought, Trump-supported lawsuit to strike down the Patient Protection & Affordable Care Act finally had its (presumably final) day in court today...the United States Supreme Court, that is.

Here's my live-tweeting of the proceedings. I missed the first ten minutes of it and didn't tweet out everything, but this captures most of the Q&A.

Defending the ACA were California Solicitor General Michael Mongan and Donald Verrilli, who is the former U.S. Solicitor General, and who was working on behalf of the House Democrats, I believe. For the plaintiffs, you had the Texas Solicitor General, Kyle Hawkins and Acting U.S. Solicitor General Jeffrey Wall (note the "acting" descriptor...Trump has tons of unconfirmed appointees...)

Remember, there are three main questions for the SCOTUS to consider about the lawsuit:

9:22am Nov. 6th: See updates at end


There's still millions of ballots left to count, and no doubt some legal battles gearing up, but as of 11:00am on November 4th, the most likely scenario going into 2021 will be:

  • Joe Biden will be sworn in as the 46th President of the United States.
  • Democrats will continue to control the U.S. House of Representatives, albeit with a smaller margin than they have today.
  • Republicans will continue to control the U.S. Senate, albeit with a smaller margin than today (either 52-48 or possilbly 51-49 depending on an upcoming runoff election in Georgia).

The Texas Fold'em lawsuit (official name: CA v. TX, formerly TX v. Azar) is scheduled to be heard by the U.S. Supreme Court (6-3 conservative) just 6 days from today, on November 10th.

Keep in mind, however, that while the hearing will happen next week, their actual decision isn't expected to be announced until next spring...most likely between April and June.

When I was in college at Michigan State in the early 1990's, there was a kid on my dorm floor who signed up for the old Columbia House CD* Club. For those of you too young to remember, here's how it worked:

Any music fan eager to bulk up their collection in the ’90s knew where to go to grab a ton of music on the cheap: Columbia House. Started in 1955 as a way for the record label Columbia to sell vinyl records via mail order, the club had continually adapted to and changed with the times, as new formats such as 8-tracks, cassettes, and CDs emerged and influenced how consumers listened to music. Through it all, the company’s hook remained enticing: Get a sizable stack of albums for just a penny, with no money owed up front, and then just buy a few more at regular price over time to fulfill the membership agreement. Special offers along the way, like snagging discounted bonus albums after buying one at full price, made the premise even sweeter.