Obamacare

Obamacare is Headed to the Supreme Court Again. Republicans in Congress are Preparing for the Outcome. The Obama Administration Isn't.

A trio of Senate Republicans just released an updated plan to replace Obamacare.

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Whitehouse.gov

Obamacare is headed to the Supreme Court again this year in the case of King v. Burwell, which challenges the Obama administration's decision to allow insurance subsidies inside federal exchanges. One of the key differences between the way that Republicans and Democrats are preparing for the case is that Republicans are openly thinking about what comes next if the challengers win.

In an appearance before the Senate Finance Committee yesterday, The Hill reports, Sylvia Matthews Burwell, who runs the Department of Health and Human Services, refused to specify what, if any, contingency plans the administration was making for the possibility that it might lose in court. If the High Court sides with the challengers, the ruling would invalidate insurance subsidies in the 36 states where the federal government operates an exchange under Obamacare.

The administration and its allies have emphasized the disruption such a ruling would cause, but have been less forthcoming about how they would respond. Burwell refused to address those questions again yesterday morning, saying only that "my focus is on completing and implementing the law, which we believe is the law." Her question-dodging was aggressive enough that Sen. John Cornyn (R-Texas) suggested that she was "contemptuous of Congress's responsibilities," according to The Hill.

It's clear enough what the point of all this is; the administration wants the Court to believe that it would be maximally painful to side with the challengers. Any hint of a contingency plan would soften the blow.

Which is why, in contrast, multiple groups of Republicans in Congress are now working on readying health care alternatives should the Supreme Court rule in favor of the challengers.

The first of those, a joint plan from GOP Sens. Burr, Hatch, and Upton, was announced late last night. The proposal, dubbed the Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act, is an update of the Burr-Hatch-Coburn plan released last year. It's an Obamacare replacement plan that starts by wiping the Affordable Care Act from the books entirely, ditching its individual mandate and many of its restrictions and regulations.

In its place, the plan would implement a system of tax credits to help low-income individuals purchase coverage, prohibit lifetime limits on insurance plans, adopt looser age-rating restrictions than Obamacare, and seek to protect some individuals with preexisting conditions through a continuous coverage guarantee for individuals shifting between plans in different insurance markets.

It would also begin to limit the preferential tax treatment of employer-sponsored insurance by requiring workers to pay federal income tax, at whatever their rate already is, on health benefits valued at more than $12,000 for an individual or $30,000 for a family. The revenue raised would help offset the plan's tax credits. 

The plan is sure to generate controversy. Given the timing, with Obamacare once again up for a high-stakes Supreme Court review, it's sure to generate heated criticism on the left. It also plows into many of the right's competing notions about how to reform health care, particularly in its use of tax credits. Louisiana Gov. Bobby Jindal's op-ed this week warning the GOP against offering "Obamacare lite suggests some of the fault lines here. 

It's not a perfect plan, even for Republicans. But here's the thing: It's not intended to be.

Instead, the plan is better understood as an attempt to focus Republicans in Congress on health policy options and alternatives at a critical time. It's a starting point, one that ideally will exist on a continuum of plans and proposals—some more comprehensive, others more narrowly targeted—to be released between now and the Supreme Court's decision, which most observers expect at the end of June. The point of the proposal is not for it to be the plan, but for it to be a plan, hopefully one among many—making it something the administration refuses to say it has. 

Read the full Patient CARE blueprint below:

Final Patient Care Act Plan 

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86 responses to “Obamacare is Headed to the Supreme Court Again. Republicans in Congress are Preparing for the Outcome. The Obama Administration Isn't.

  1. “Hey, Roberts! Look, man, we have a backup plan….so you know…”

  2. The administration isn’t making plans for if it loses because…it doesn’t care about plans. Passing Obamacare was to buy off supporters and give Obama a legacy, not about actually providing a working health care plan (not that they could create one in the first place). If they win, his legacy continues for now, so all good. If they lose, they can point at the horrible Republicans and spur up the base. Plans don’t matter to the administration. Politics do.

    1. Exactly. If they lose, the plan is to point out how evil the Republicans are. That’s their go-to plan for everything else, why would it be different this time?

      1. I fucking KNEW it was Bush’s fault!

    2. ^^This.

      This administration has never actually responded to any crisis or major catastrophe with any kind of competency or action that would make one feel confident they were in charge.

      The reason why is that they don’t want to be in charge. Obama wants to be president, not do the stuff that makes a successful president. He wants to sign a bill so he can say that he gave people free healthcare, not do the work needed to make this happen legislatively. He never has.

      President Not My Fault, reporting for duty…..tomorrow maybe.

      1. President Not My Fault, reporting for duty…..tomorrow maybe.

        Depends on what the news cycle is like for the day.

      2. It’s pretty common behavior for a narcissist – actually.

        1. Narcissistic Personality Disorder does fit him to a tee.

      3. Obama wants to be president, not do the stuff that makes a successful president.

        Well, a “successful president” can mean two things. For me, it would be “president who does nothing but cut spending and repeal things”. But in the way you just used it, it sounds like “president who passes lots of legislation and does tons of mostly awful shit”. So in that case I’d hope he doesn’t want to do the stuff that makes him “successful”.

        Really, Obama wants all the prestige and adulation that goes with being a popular president, without having any responsibilities or having to do anything too arduous or annoying. Unfortunately that doesn’t translate into “do nothing”, it translates into “do things that are easy (but harmful) or go to the mat for a few things in order to create a legacy”.

        He’s the worst of both worlds: totally phoning it in, except for things that benefit him and that are inevitably terrible for the country.

        1. it sounds like “president who passes lots of legislation and does tons of mostly awful shit”.

          Yeah, I agree with you and I suppose I should have been more clear. I meant more along the lines of a President who doesn’t lie to get the things he wants, or one who appears to be in charge when catastrophe strikes, none of which describes President Not My Fault.

          It’s like he’s a freaking bystander.

      4. Are “Not Me” & “Ida Know” from Family Circus in President Not My Fault’s cabinet?

        1. Didn’t you see the cartoon that showed little Billy’s route around Benghazi during the riot? It was fucking hilarious.

      5. This administration has never actually responded to any crisis or major catastrophe with any kind of competency or action that would make one feel confident they were in charge.

        This is Obama’s Katrina.

  3. As we all know, all the groundbreaking Supreme Court cases have always hinged on how inconvenient it would be for each side, should they lose.

    1. Maybe in the past they didn’t care about “inconvenience,” but I can definitely see Roberts coming up with some bullshit.

  4. the administration wants the Court to believe that it would be maximally painful to side with the challengers.

    Because, that’s what’s important. How hard it would be for the government to fix it’s indiscretions rather than do the right thing. God they are pigs!

  5. Republicans in Congress are now working on readying health care alternatives should the Supreme Court rule in favor of the challengers.

    How about:

    Those who wish to purchase health insurance may do so, unimpeded, within the confines of the voluntary free market and the only role of government in the entire process is to ensure contracts are complied with?

    That would never work. CUZ TEH HELFCAIR IZ DIFFRENTZEZ!!!!!111tenplusone11

    All of them…all pigs!

    1. So how much of a pig are you for supporting the use of government guns to enforce contracts? Mildly piggish?

      1. Not at all. Tenet 2 for maximized liberty.

        2. The ONLY legitimate function of government is to protect the rights of its citizenry.

        1. Libertarian bullshit contradiction #1: Government is bad because it uses coercion and force. Ergo, government should only do those things that involve shooting and imprisoning people.

          1. Responding to initiations of force with force is perfectly moral. Yeah, I know; you think that a mugger and a mugging victim are morally equivalent.

            1. You’re talking to someone who doesn’t understand the differences between a minarchist and an an-cap, much less the difference between utilitarian, consequentialist, and deontological ethical frameworks. As such, it is impossible to have a fruitful conversation with him concerning this subject in the same way it is impossible to have a meaningful conversation with a toddler concerning empathy and compassion. In fact, his moral development has been so retarded that even as an adult, it is stuck at Kohlberg’s first stage of development.

              1. Your belief system is fundamentally incoherent and I’m hardly the first to say so.

                You cannot justify your system on a premise that your system immediately undermines.

                “Responding to initiations of force with force is perfectly moral” is vague bullshit. What’s an initiation? Breaching a contract? Pretty loose definition of force.

                1. Please don’t feed the troll.

                2. It’s generally seen as force or fraud. Robbery is fraud for sure, and may be force. Responding to it with force (or the threat of force) is perfectly justifiable. But I’m not surprised that you want to paint it as some sort of logical fail when it isn’t. The fact that you can’t grasp the argument is not a flaw in the argument, it’s you being intellectually flaccid.

                  1. So why can’t I define force any damn way I want to in order to justify my policy preferences, like you guys?

                    I say it’s force to let someone starve. Voila, we must have taxpayer funded food subsidies.

                    Just defend your policies on their merits please and stop trying to convince me that you’re the only people in the world to discover the correct set of political ethics.

                    1. So why can’t I define force any damn way I want

                      Because words have meanings, moron.

                      AND

                      The force you “define” infringes on the rights of others (i.e. the bad kind of government force).

          2. All government is is force, moron. Government is bad when it uses that force to infringe upon rights of the people. Government is good when it uses that force to protect rights.

            But, of course, you are too stupid to see the difference.

            1. Like the right to healthcare?

              1. There is no right to health care. Your positive rights are limited to the powers granted the government in the Constitution. The government has no power to provide you with health care. Doing so, infringes upon the right of people to do as they wish with their own property.

                For the 10,000th time.

  6. If anything, SCOTUS crippling the law and forcing Democrats and Republicans to craft a solution would be a good thing, politically, for Obama and the Democratic Party.

    They could henceforth point to problems with the law and say “See? It was working just fine until our corporate-owned Supreme Court gutted the law and the Republicans altered it!”

    But I strongly suspect Obama doesn’t give two shits about the Democratic Party.

    1. Or they could let Hillary run on it for 2016.

      The Republicans want to take away your healthcare! Hillary wants to give you the subsidies you were promised!

      The pressure to pass a fix will be overwhelming.

  7. I can’t tell how Jindal’s proposal is any less “Obamacare-lite” as he defines it. But it’s hard to tell through all the lame, fatuous sloganeering and preaching to the choir of the religion of The Poor Are Icky Slobs, Fuck Them.

    How about we simply take the idea that a social safety net is about giving free stuff to undeserving brown people and shoot it in the fucking face until it’s dead? People need healthcare, not everyone can afford it, we’re rich enough to provide it to everyone, and it’s cheaper to do it that way anyway, and nobody has any data to suggest that bullshit half-measures including these Republican proposals and Obamacare are better for any reason.

    1. People need healthcare, not everyone can afford it, we’re rich enough to provide it to everyone

      We’re rich enough to provide everyone with all the healthcare they could possibly need? Are you sure about that?
      Resources are finite …

      1. Then perhaps we should stop squandering trillions of dollars worth of them on welfare for billionaires.

        1. Such as?

          1. Such as all of the following things which Tony supports:

            – Corporate subsidies
            – Corporate bailouts
            – Beach house subsidies

            1. Good point. I wonder if Tony would be in favor of not spending billions of dollars on “green energy” subsidies, if it meant more free healthcare.

              1. I’m for universal healthcare, in part, because it will prove to cost the country less money. But I’m just going by literally all the evidence in the world.

                Don’t get me started on what I want to spend money on. It’s a long list. We’ve been spending it on tax cuts for a long time and have some catching up to do with the advanced human civilization we used to spearhead.

                1. spending it on tax cuts

                  We all knew it was coming. Say it with me now: NOT GIVING IS TAKING AND NOT TAKING IS GIVING.

                  1. Economies cannot be run on platitudes alone.

                    1. Economies don’t need TOP MEN to run.

                    2. Says the guy emoting about healthcare.

                2. As usual you demonstrate a complete inability to rationally allocate scarce resources.

                  If is a well established fact that markets allocate resources more efficiently. “Tax cuts” are a means of letting the market allocate resources instead of the government. That’s cheaper for everyone all around.

          2. The money that’s sitting in their accounts doing no good for anybody. It didn’t get there through hard work and ingenuity, it got there through wealthy-favoring tax policy drawn up to be such, so it shouldn’t be a problem. The point is the country has the resources, it’s just deciding to use them all for pointless things.

            1. What accounts? Their investment accounts? You mean the money they have loaned out to businesses all over America? I didn’t realize that wasn’t doing any good.

              1. Or the offshore kind. I realize one needs to be delicate around you guys, as touchy as you are about the precious sanctity of the wealth of billionaires, but put very simply there is too much wealth at the top and it needs to be taken and put to better use.

                1. it needs to be taken

                  I appreciate your honesty.

                2. Right, so, if I get you correctly, not having a wealth tax on money held in offshore account is “trillions of dollars of welfare for billionaires”.

                  I dispute both your logic and your math.

                3. And who decides what the better uses are for their money. Let me guess: you. I can come up with great uses for your money, so I’m sure you wouldn’t mind me coming to take it. Especially since I’m sure compared to many in this country, you’re wealthy. What the hell gives you the special wisdom needed to decide to what use someone else’s money needs to be put?

                  1. Any economic system is defined by the rules that implement it, usually by governments. You can’t have your laissez-faire capitalism version without rules for ownership and contracting. The minute you have an economy that is worth a shit, you have government deciding things. So government truly ends up deciding the allocation, even if it means leaving the status quo in place or repealing all regulations or whatever. It’s all making choices and seeing what happens. You’re assuming that all the wealth in the hands of the wealthy got there by legitimate and virtuous means, but you certainly wouldn’t say we live in a pure free market with no corruption. You might as well be saying that pirates have a right to whatever loot they take, once they have it.

                    1. Whereas you get to assert that any wealth that somebody managed to obtain was obtained illegitimately without offering any evidence.

    2. Tell the people who are dying waiting for healthcare from the VA how we’re so rich we can afford healthcare for everyone.

      1. Tell them what? “Wouldn’t it be better if you simply fucked off and died? We lack the resources.”

        1. So we’re supposed to spend resources we don’t have because we’re too pussy to say “no” to anyone?

          1. Actually, we’re supposed to hold the bureaucrats who so badly mismanaged the resources allocated to the VA accountable for their incompetence and venality.

            1. But in general, Tony seems to think that nobody, anywhere, ever, should ever be told “no, we don’t have the resurces” when it comes to healthcare.

              We can’t let stupid things like facts of reality can’t get in the way of the “right” to healthcare.

              1. Well, that’s because the elements of healthcare are magic. Medicines and surgical procedures are merely potions and rituals performed by a white-robed priesthood. You can never run out of magic.

              2. That’s what we call rationing (or death panels). What if we could afford to provide a minimum level of care to everyone, but beyond a certain amount people had to pay? Would it be possible to approach this subject with that kind of rationality, or are we stuck with bullshit excuses that are all really a distraction from your real concern, that a well-functioning socialized healthcare system would undermine your precious dogma?

                1. What if we could afford to provide a minimum level of care to everyone, but beyond a certain amount people had to pay?

                  Then we’d start this whole bullshit discussion all over again because you and your ilk would bitch about how unfair it was that certain people could get treatment that others could not.

                  1. The entire civilized world provides quality healthcare universally, except us, which means we are less civilized than we could be. If you’re not up for at least experimenting with what has worked elsewhere, you’re being a pig-headed dogmatist.

                    1. The entire civilized world

                      Citation needed.

                      provides

                      Citation needed.

                      quality healthcare

                      Citation really needed.

                      universally

                      I can’t wait to hear yet another reading from the Gospel of NHS, a parable about how everyone’s happy and healthy and no one dies waiting for treatment.

                      Evangelicals in the Bible Belt don’t have as much faith in Christ as Tony has in the Government.

                    2. Here’s the WHO’s ranking of countries’ healthcare systems. You’re welcome to read about how they each work.

                    3. The WHO rankings have been subject to many and varied criticisms since its publication. Concerns raised over the five factors considered, data sets used and comparison methodologies have led health bodies and political commentators in most of the countries on the list to question the efficacy of its results and validity of any conclusions drawn. Such criticisms of a broad endeavour by the WHO to rank all the world’s healthcare systems must also however be understood in the context of a predisposition to analytical bias commensurate with an individual nation’s demographics, socio-economics and politics. In considering such a disparate global spectrum, ranking criteria, methodology, results and conclusions will always be an area for contention.

                      In over a decade of discussion and controversy over the WHO Ranking of 2000, there is still no consensus about how an objective world health system ranking should be compiled. Indeed, the 2000 results have proved so controversial that the WHO declined to rank countries in their World Health Reports since 2010, but the debate still rages on.

                      From your own link. They relied on life expectancy, which is heavily influenced by lifestyle and cultural factors. Meanwhile, the U.S. tops the world in cancer survival rates.

                    4. Being a person who lives in that ‘civilized world’ who apparently has quality healthcare universally I wonder why my grandfather died on a waiting list for heart surgery and I had to engage in medical tourism in the U.S. when my intestines almost melted (inflammatory bowel diseases aren’t fun guys).

                2. What if we could afford to provide a minimum level of care to everyone, but beyond a certain amount people had to pay?

                  You mean, like Medicaid?

              3. The Tony approach to healthcare:

                1) Use government to make healthcare “better” and “safer” with laws, regulations, taxes, subsidies, bureaucracies, and cartels.

                2) When #1 doesn’t work as planned, complain about the high cost and poor efficiency of healthcare and demand more of other people’s money.

        2. Tell the people who are dying waiting for healthcare from the VA how we’re so rich we can afford healthcare for everyone.

          Sorry, I forget that English is not your first language.

    3. How about we simply take the idea that a social safety net is about giving free stuff to undeserving brown people and shoot it in the fucking face until it’s dead?

      This kind of imagery is violent hate speech, similar to Sarah Palin’s “targets”. I expect nothing less from racist teabaggers.

  8. But I have been told over and over and over and over, the Rethuglitards have never offered up an alternative to the Obamacare, because they hate poor people and want them to die on bus stop benches while waiting for buses which have been cancelled to take them to free clinics which have been shut down.

    1. Correct, however you forgot “and then turn them into Soylent Green, after pulling their gold teeth fillings and stealing their eyeglasses.”

      1. Fuck yeah! Each pair of eyeglasses can be easily converted into 2 monocles in the orphanarium for the new class of Robber Barons.

  9. I’m carefully and purposefully not thinking about this case too much until outcome is announced. Because it is painfully obvious that they fucked and wrote an opt-out clause where they meant to write a coerce-in clause, and now they want the law to be something besides what was actually passed. But plain reading of English has never been our court systems strong suit, so I don’t want to get emotionally invested in this.

  10. “IF YOU KIDS DON’T STOP SQUABBLING, I’M GOING TO JUST DRIVE THIS CAR RIGHT OVER A CLIFF!”

  11. and seek to protect some individuals with preexisting conditions through a continuous coverage guarantee for individuals shifting between plans in different insurance markets

    Yeah, whatever that means. Either you allow insurance companies to base their premiums on the client’s condition, or you don’t. If you do, everyone including most Republicans will scream bloody murder. If you don’t, then you’ve just outlawed insurance.

  12. “The price of a successful attack is a constructive alternative.” Never let the enemy score points because you’re caught without a solution to the problem.

    Are the Repubs now Alinskyites?

  13. Hatch is another Republican who wants to use the tax code against workers who are not under the code. Obamacare and his proposal all depend on workers earning INCOME. Income has been defined by courts as profit or gain. Workers do not profit from their labor, they exchange their labor for tangible property of equal value, money. Only federal workers earn wages. The withholding statute does not mention workers in the private sector unless they are government contractors. The federal register,in which the feds have to publish any laws that effect the population at large, does not have any entries that include the private worker. Until libertarians get it, we will continue to lose these battles to creeping socialism. “Workers” did not pay income tax until the VOLUNTARY VICTORY TAX of WWII. NOT because the personal exemption was high, because records show that most workers earned more than the personal exemption. It was because it was commonly understood the income tax is a classical liberal tax on public offices. It cannot be a general tax on labor. That is the black letter law, if anyone cares to read it.

  14. Personally, I am of the opinion that it won’t actually matter THAT MUCH, if the challangers win. The reason is that even IF the subsidies are struck down the pressure will be enormous to pass legislation that makes them available anyways.

    The administration will direct the IRS to try to “claw back” the subsidies and the screaming from the electorate will be impossible to ignore. They will literally be trying to yank hundreds of dollars out of the pockets of millions of people. There is NO WAY there isn’t going to be a legislative fix.

    The real question is: What ELSE can the Republicans get into the legislative fix? The subsidies are going to be there, along with repeal of the medical device tax, but maybe a repeal of the mandates? Maybe deregulation of the exchange plans? Maybe make catestrophic-only coverage qualifying? Maybe get rid of the tax deduction for employer sponsored plans?

    If the challengers win it is not a death knell for the ACA. It really just forces congress to “fix” the ACA in the near term.

  15. Obama wants all the prestige and adulation that goes with being a popular president, without having any responsibilities or having to do anything too arduous or annoying.

    ‘Way back in business school, in Organizational Behavior, the professor talked about people who seek “authority without responsibility”. That fits O’Dummy perfectly.

    1. “authority without responsibility”.

      So… politicians.

  16. It’s like he’s a freaking bystander.

    “When the going gets tough, the tough go golfing.”

  17. “For those who may be uninsured when our proposal is adopted, we envision a one-time open enrollment period in which individuals would be able to purchase coverage regardless of their health status or pre-existing conditions. This would provide a path for all individuals to obtain affordable coverage immediately. This enrollment period would make certain that an uninsured American facing health issues could purchase at the same premium as a healthy individual.”

    In other words, Obamacare.

    1. Along with its own special definition of “affordable.”

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  19. Tax credits for people with low incomes, unless they extend into a negative income tax, will be minuscule. They will not enable those people to buy meaningful medical insurance. For the poor, coverage with a high deductible may as well be no coverage. Thus, these Republican plans will not provide the poor with medical care. They will be a sham replacement for Obama’s health care plan.

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