Affordable Care Act Survives Latest Supreme Court Challenge
The
court sidestepped the larger issue in the case, whether the 2010 health
care law can stand without a provision that required most Americans to
obtain insurance or pay a penalty.
by Adam Liptak - June 17, 2021
WASHINGTON — The Affordable Care Act on Thursday survived a third major challenge as the Supreme Court, on a 7-to-2 vote, turned aside the latest effort by Republicans to kill the health care law.
The legislation, President Barack Obama’s defining domestic legacy,
has been the subject of relentless Republican hostility. But attempts
in Congress to repeal it failed, as did two earlier Supreme Court
challenges, in 2012 and 2015. With the passing years, the law gained popularity and became woven into the fabric of the health care system.
On
Thursday, in what Justice Samuel A. Alito Jr. called, in dissent, “the
third installment in our epic Affordable Care Act trilogy,” the Supreme
Court again sustained the law. Its future now seems secure and its
potency as a political issue for Republicans reduced.
The margin
of victory was wider than in the earlier cases, with six members of the
court joining Justice Stephen G. Breyer’s modest and technical majority
opinion, one that said only that the 18 Republican-led states and two
individuals who brought the case had not suffered the sort of direct
injury that gave them standing to sue.
Chief Justice
John G. Roberts Jr., who had cast the decisive vote to save the law in
2012, was in the majority. So was Justice Clarence Thomas, who had
dissented in the earlier decisions.
“Whatever the act’s dubious
history in this court,” Justice Thomas wrote in a concurring opinion,
“we must assess the current suit on its own terms. And, here, there is a
fundamental problem with the arguments advanced by the plaintiffs in
attacking the act — they have not identified any unlawful action that
has injured them.”
Justices Sonia Sotomayor, Elena Kagan, Brett M.
Kavanaugh and Amy Coney Barrett also joined Justice Breyer’s majority
opinion. At Justice Barrett’s confirmation hearings last year, Democrats
portrayed her as a grave threat to the health care law.
The
court did not touch the larger issues in the case: whether the bulk of
the law could stand without a provision that initially required most
Americans to obtain insurance or pay a penalty.
“This ruling reaffirms what we have long known to be true: the Affordable Care Act is here to stay,” Mr. Obama said on Twitter.
In
the 11 years since Mr. Obama signed the legislation into law,
Republicans have assailed the Affordable Care Act as a step toward
socialized medicine, government intrusion into health care decisions and
a costly boondoggle.
They challenged it on a variety of fronts in
the courts and made calls for its repeal a staple of their campaigns.
But some of its provisions, like coverage for pre-existing conditions
and for adult children up to age 26, proved popular across party lines.
Even when they controlled the Senate, the House and the White House,
Republicans failed to muster the votes to repeal the law — and despite
President Donald J. Trump’s promises to deliver a better alternative, he
never produced a detailed proposal of his own.
While health care
remains a potent political issue — and the Affordable Care Act has
shortcomings Democrats have acknowledged — the latest court ruling
suggests that Republican chances of winning a legal battle to kill it
are now much diminished.
“With millions of people relying on the Affordable Care Act for coverage, it remains, as ever, a BFD,” President Biden said on Twitter
after the ruling, alluding to his obscenity-punctuated comment to Mr.
Obama on the day in March 2010 the bill was signed into law that the
legislation was a big deal. Mr. Biden has signaled that he now wants to
build on the legislation through a series of steps to expand access to
health care.
Republicans were critical of the decision but suggested the battle would now focus on the policy fight in Congress.
“The failed Obamacare system will stagger on as a result of this decision,” said Senator John Barrasso, Republican of Wyoming.
“Every
American’s health care has been harmed by Obamacare,” he said.
“Republicans remain focused on making health care more affordable for
families in Wyoming and around the country. Democrats keep pouring money
into Obamacare instead of fixing the many problems facing patients and
health care providers.”
The challengers in the case sought to take
advantage of the 2012 ruling, in which Chief Justice Roberts upheld a
central provision of the law, its individual mandate requiring most
Americans to obtain health insurance or pay a penalty, saying it was
authorized by Congress’s power to levy taxes.
They argued that the mandate became unconstitutional after Congress in 2017 eliminated the penalty
for failing to obtain coverage because it could no longer be justified
as a tax. They went on to say that this meant the rest of the law must
also fall.
The challenge was largely successful in the lower courts. A federal judge in Texas ruled that the entire law was invalid,
but he postponed the effects of his ruling until the case could be
appealed. In 2019, the United States Court of Appeals for the Fifth
Circuit, in New Orleans, agreed that the mandate was unconstitutional
but declined to rule on the fate of the remainder of the health law, asking the lower court to reconsider the question in more detail.
Justice
Breyer did not address most of the arguments that were the basis of
those decisions, focusing instead on whether the plaintiffs were
entitled to sue at all.
The two individuals, he wrote, suffered no
harm from a toothless provision that in effect merely urged them to
obtain health insurance. Similarly, he wrote, the states did not sustain
injuries tied directly to the elimination of the penalty that had been
part of the individual mandate.
The states argued that the revised
mandate would cause more people to take advantage of state-sponsored
insurance programs. Justice Breyer rejected that theory.
“The
state plaintiffs have failed to show,” he wrote, “that the challenged
minimum essential coverage provision, without any prospect of penalty,
will harm them by leading more individuals to enroll in these programs.”
“Neither
logic nor intuition suggests that the presence of the minimum essential
coverage requirement would lead an individual to enroll in one of those
programs that its absence would lead them to ignore,” Justice Breyer
wrote. “A penalty might have led some inertia-bound individuals to
enroll. But without a penalty, what incentive could the provision
provide?”
In a vigorous dissent, Justice Alito, joined by Justice
Neil M. Gorsuch, said the third installment of the court’s Affordable
Care Act trilogy “follows the same pattern as Installments 1 and 2.”
“In
all three episodes, with the Affordable Care Act facing a serious
threat,” he wrote, “the court has pulled off an improbable rescue.”
Justice
Alito wrote that the court has routinely found that states have
standing to challenge federal initiatives. “Just recently,” he wrote,
“New York and certain other states were permitted to challenge the
inclusion of a citizenship question in the 2020 census even though any
effect on them depended on a speculative chain of events.”
He said
there were “novel questions” about whether the individual plaintiffs
could sue. But “the states have standing for reasons that are
straightforward and meritorious,” he wrote. “The court’s contrary
holding is based on a fundamental distortion of our standing
jurisprudence.”
Unlike the majority, Justice Alito went on to address the larger issues in the case, California v. Texas, No. 19-840, saying the mandate was now unconstitutional and could not be severed from much of the rest of the law.
Had Justice Alito’s view prevailed, the nation’s health care system would have experienced an earthquake.
Striking down the Affordable Care Act
would have expanded the ranks of the uninsured in the United States by
about 21 million people — a nearly 70 percent increase — according to recent estimates from the Urban Institute.
The
biggest loss of coverage would have been among low-income adults who
became eligible for Medicaid under the law after most states expanded
the program to include them. But millions of Americans would also have
lost private insurance, including young adults whom the law allowed to
stay on their parents’ plans until they turned 26 and families whose
income was modest enough to qualify for subsidies that help pay their
monthly premiums.
A ruling against the law would also have doomed
its protections for Americans with past or current health problems. The
protections bans insurers from denying them coverage or charging them
more for pre-existing conditions.
“Today’s decision means that all
Americans continue to have a right to access affordable care, free of
discrimination,” said Xavier Becerra, the secretary of health and human
services, who in his previous job as California’s attorney general
helped defend the law in Thursday’s case.
Mr. Biden has said he
wants to build on the Affordable Care Act through steps like expanded
health insurance subsidies, and some Democrats are pushing for bigger
proposals like expanding Medicare coverage to more people.
Republicans
suggested on Thursday that their focus would now be less on seeking to
repeal the law than on the debate in Congress and on the campaign trail
for 2022 over how to address issues like the affordability of health
insurance.
“While the Supreme Court ruled today that
states do not have standing to challenge the mandate, the ruling does
not change the fact that Obamacare failed to meet its promises and is
hurting hard-working American families,” the three top Republicans in
the House, Representatives Kevin McCarthy, Steve Scalise and Elise
Stefanik, said in a statement. “Now, Congress must work together to
improve American health care.”
Obamacare Is Here to Stay. Brace for New Health Care Battles.
Republicans
in Congress have largely abandoned efforts to repeal the law. With the
latest Supreme Court ruling, health policy now shifts to new territory.
by Margot Sanger-Katz and Sarah Kliff - NYT - June 17, 2021
The era of existential fights over Obamacare has ended.
The Affordable Care Act has survived its third major Supreme Court challenge — what Justice Samuel Alito described in his dissenting opinion
as an “epic trilogy.” The law has gone from a 5-4 majority in its favor
in the first case to Thursday’s 7-2 split. The decision secures the
health law as a major legacy of the Obama era — the largest expansion of
health coverage in decades — after years of hard-fought and politically
painful battles.
Obamacare enjoys higher-than-ever public support, with most Americans now favoring the law. Enrollment in the health law’s programs is at a record high.
Democrats have moved from defending the 2010 law to expanding its
benefits. While Obamacare remains a dirty word in some Republican
circles, its repeal is no longer a focus of the party or a galvanizing
issue among its voters.
For nearly a decade, Republicans ran and
won many elections on the promise of ending Obamacare. But their failed
bid to do so in 2017 changed their political priorities. That effort
left them divided, bruised and on the wrong side of public opinion.
Though President Donald Trump periodically threatened to return to
repeal efforts, Mitch McConnell, the Senate minority leader, who once
called to eliminate the law “root and branch,” said in 2019
that he had no interest in revisiting the law before the next
presidential election. At the 2020 Republican National Convention, the
word Obamacare was not uttered onstage by any elected official.
The
most recent lawsuit was a holdover from an earlier era of Obamacare
politics. Filed by state attorneys general in 2018, it sought to
eliminate Obamacare entirely and has taken years to wend its way through the courts.
The
Supreme Court did not dive into the merits of the case, but instead
found that the plaintiffs did not experience any harms that would give
them standing to challenge the law.
The waning repeal effort has given Democrats their first chance in a decade to press forward on
a new campaign: moving the country toward a system of universal health
coverage. It seems the end of a period when Democrats played constant
defense, fighting back against legislative and legal challenges.
Their recent expansion of health insurance subsidies
had widespread support in the party. The stimulus package that
Democrats passed in January spent $34 billion to make coverage more
affordable for nearly all Americans who purchase their own health plans.
That change, however, was temporary and is currently set to expire at
the end of 2022.
Fights about health policy are sure to remain
heated, but they will be about what comes next. Democrats are still
divided over many leading proposals, even if they remain united in their
support of their past work.
“It’s our chance now to really build
now that three strikes and the opponents of health care are out,” said
Xavier Becerra, the secretary of Health and Human Services, and the
former attorney general of California, who stepped in with other
Democratic-led states to defend the law when the Trump administration
would not. “Now we know we survive, and now we build.”
Efforts
to move toward universal health coverage are complicated, with
potentially high costs, difficult policy trade-offs and the risks of
industry opposition.
Even policies with widespread support in
Congress could face intense lobbying campaigns from opponents who fear
additional government intervention and loss of revenue. One example is a
proposal to eliminate surprise medical billing. It enjoyed bipartisan political support but faced an avalanche of industry opposition. Its success was not assured, but it passed in December.
Just this week, Senate leadership is considering a legislative package that could include an expansion of Medicare
to cover more middle-aged Americans and to provide dental, vision and
hearing benefits. The provision would be costly, and will probably face
resistance from health industries. Other ideas, like President Biden's
campaign proposal of a government-run “public option” that Americans would have the choice to purchase, are at the earliest stages of conception.
And
the post-Obamacare dream of many progressives, “Medicare for all,”
continues to divide the party. Such a policy would face fierce
opposition from hospitals, doctors and insurers, who already have an advocacy group to combat further government involvement in health care.
The
Affordable Care Act still has holes that have proved challenging to
fix. The 2012 Supreme Court decision that upheld the individual mandate
also made the law’s Medicaid expansion provisions optional. Twelve
states do not participate in that program, leaving millions of
low-income Americans without coverage. Generous incentive payments
included in the most recent stimulus package have not been enough to
convince any of the holdout states to join.
Some political voices
are still calling for the end of Obamacare, but they are growing rarer.
In 2012, nearly every leading Republican politician expressed
disappointment or anger at the first Supreme Court decision upholding
the core of the law. On Thursday, few commented.
Ted Cruz, the Texas senator who once helped drive a government shutdown
demanding an Obamacare repeal bill, issued a statement that reiterated
his objections to the law. Josh Hawley, a Republican senator from
Missouri who had helped bring the suit
as his state’s attorney general, said in response to a reporter’s
question that the Supreme Court had made its stance clear. (He did tweet about another Supreme Court case decided Thursday.)
Virginia
Foxx, the ranking member of the House Education and Labor Committee and
a Republican from North Carolina, was among those politicians who
criticized the decision Thursday.
“It’s a shame the highest court
in the country ruled today that Americans aren’t harmed by this broken
law,” she said in a statement. She cited a need for “workable solutions
that will bring down the cost of health care.”
Like Mr. Cruz and Mr. Hawley, she did not include a new call for Obamacare’s repeal.
Supreme Court’s pro-ACA decision spurs both parties to new strategies
By Amy Goldstein, Matt Viser and Mike DeBonis - Washington Post - June 17, 2021
The
decision by a conservative Supreme Court to uphold the Affordable Care
Act could usher in an end of a bitter, 11-year drive to get rid of the
law, as both parties immediately began scrambling to recalibrate their
strategies with a sense that the political reality of health care was
immutably altered.
Some
Republicans conceded Thursday that, after a decade of repeal votes,
political campaigns and legal challenges, their quest to nullify the
entire law probably is dead. Confronted with a 7-2 ruling that
marked the third time the high court has preserved the law, some GOP
members of Congress suggested that they would, instead, start plotting
legislatively to trim back parts of it.
President
Biden and his fellow Democrats, for their part, see in the court
decision a springboard to build on the 2,000-page statute. They and
outside analysts say the law’s survival also provides Democrats a chance
to seize on health care in the upcoming congressional elections,
portraying the party as protecting Americans’ coverage along with
defeating the coronavirus pandemic.
In
the hours after the ruling, the Biden administration did not lay out
specific elements of the president’s agenda that it will now pursue in
Congress. But potential goals include lowering the eligibility age for
Medicare and the relatively controversial idea of creating a public
alternative to private health plans sold through the ACA insurance
marketplaces.
“We’re working on it. Now
that we know the Affordable Care Act has passed this last test, we know
we’ve got our sea legs under us,” Health and Human Services Secretary
Xavier Becerra said in an interview. “Now we have an opportunity to talk
about where we can go. Until we had this decision, it would have been
folly to talk about those things.”
During
a June 17 news conference House Speaker Nancy Pelosi (D-Calif.) spoke
on the Supreme Court decision to dismiss a challenge to the Affordable
Care Act. (The Washington Post)
The
battle over the ACA has helped define the polarized political landscape
of the past decade. It boosted the tea party in 2010, propelled Donald
Trump’s campaign in 2016 and created a dramatic moment when Sen. John
McCain (R-Ariz.) blocked his party’s repeal push. More recently, the
ACA’s rise in popularity helped Biden’s cause in the 2020 election.
Now
Democrats hope to press their advantage. Sen. Patty Murray (D-Wash.),
chair of the Senate Health, Education, Labor and Pensions Committee,
said the court’s decision “is cause for celebration — but it must also
be a call to further action,” adding that Congress should allow Medicare
to negotiate drug prices with pharmaceutical companies, allow more
people join Medicare and create a “public option” for health coverage.
Becerra,
who as California attorney general led a Democratic coalition fighting
to preserve the ACA, noted that Biden’s budget seeks to make permanent a
temporary expansion this spring of ACA insurance subsidies, and he
said, “We will obviously tackle prescription drug prices.”
Republicans for years ran on a pledge to “repeal and replace”
the health-care law, only to fail dramatically when they won control of
Washington in 2016. After Thursday’s ruling, they began shifting to an
argument that the law needs to be changed but could not realistically be
scrapped.
“The ACA is still in place.
So I think what we’ve got to do now is think about what we can do in
terms of reforms . . . that will protect people with preexisting
conditions, but then also create new choices and options,” said Sen.
Josh Hawley (R-Mo.). “Hopefully this will be a spur for some new ideas
and new proposals, because pretty much all that’s been on ice since I’ve
been here, because everybody said, ‘Well, let’s see what happens with
the court decision.’ ”
Asked whether he
saw any need for further constitutional questions to be litigated,
Hawley, a former Supreme Court clerk, said, “I think this court has made
pretty clear that they’re not going to entertain a constitutional
challenge to the ACA.”
Sen. Roy Blunt
(R-Mo.) added, “The Affordable Care Act gets constantly woven deeper and
deeper into the system. It’s eventually going to be pretty hard to
unravel from the system. The court had a chance to do that today and
didn’t do it.”
Sen. Mitt Romney (R-Utah)
said that it was unclear where the politics would head next on health
care but that any changes probably would have to come through
legislation rather than litigation. “At this stage, it looks like that’s
the most immediate course of any change,” he said.
Joseph
Antos, a longtime health-care scholar at the conservative American
Enterprise Institute, said that Republican rhetoric against the ACA may
outlast substantive attempts to dismantle it.
Sen.
Ted Cruz (R-Tex.) issued a statement Thursday excoriating Democratic
health policies, as well as the court’s reasoning, but he did not
propose any specific alternatives. Cruz branded the law a “stepping
stone toward a single-payer public option system, which would eliminate
private health insurance.”
Antos noted
that Republicans, in the minority by narrow margins in both chambers of
Congress, are not in a position to pass legislation curtailing the law
this year or next. And even if they win control of the House or Senate
in the midterm elections, Biden would refuse to sign any such bills for
two years after that.
Even so, Antos
said, anti-ACA rhetoric could prove useful to the campaigns of House
members from pro-Trump districts. “But they should stop talking about it
in Washington,” Antos said.
Celinda
Lake, a veteran Democratic political strategist, said recent polling and
focus groups suggest that health-care could be a substantial midterm
issue, with voters eager to improve affordability and keep their medical
care stable, especially after the disruptions to people’s lives caused
by the coronavirus pandemic.
The court’s
basis for upholding the ACA — that the Republican attorneys general and
other plaintiffs who brought the suit lacked legal standing — “is such a
definitive rejection,” Lake said. “I think this will be very energizing
for Democrats.”
The Supreme Court has
more conservative justices than it did when it ruled in favor of the law
in 2012 and 2015, Lake noted, making Thursday’s decision “the last nail
in the Republicans’ coffin in terms of getting rid of the ACA.” Two of
the three Trump-appointed justices, Amy Coney Barrett and Brett M.
Kavanaugh, voted to uphold the law.
Larry
Levitt, executive vice president for health policy at the Kaiser Family
Foundation, said that while “there will always be legal skirmishes,
there are no existential threats [to the ACA] remaining on the horizon.”
As
then-President Barack Obama and congressional Democrats sought
legislation that would move the country closer to universal coverage,
the strategy was to expand private and government insurance alike.
In
2014, the ACA exchanges opened, selling private health plans to people
who could not get affordable health benefits through their jobs. That
year, some states began to expand Medicaid, the insurance system for
low-income residents run jointly by the federal government and states,
opening it to people with slightly higher incomes and to adults without
dependent children at home.
The number
of Americans who have gained insurance under the law has never been as
large as originally forecast. But it always has been in the millions, and the Biden administration this year has been pressing to drive the number higher, creating a six-month special enrollment period for the ACA marketplaces that runs through mid-August.
The
law, Obama’s signature domestic achievement, was adopted without a
single Republican vote in 2010. And in the following few years, it
ushered in the most profound changes to health coverage — and care —
since the creation of Medicaid and Medicare in the mid-1960s.
At
the same time, the ACA has remained a source of profound political
polarization. Conservatives have depicted it as a tyrannical government
takeover of health care, with former Alaska governor Sarah Palin even making false claims
that the law would establish “death panels.” Liberals saw it as a
long-overdue, if insufficient, effort to expand insurance coverage,
control health costs and help protect vulnerable Americans.
Public
sentiment has been divided, hovering slightly on either side of 50
percent support, according to years of tracking polls by the Kaiser
Family Foundation, a health-policy research group. Support has increased
slightly during the past few years, with 54 percent of U.S. adults
viewing it favorably this winter, the Kaiser polling shows.
From the time it was enacted, Republicans began trying to dismantle the law through Congress and the courts.
House
Republicans tried more than five dozen times to repeal all or part of
the ACA. The closest the GOP came was in 2017, when Obama’s presidency
ended and Trump moved into the White House after campaigning on a pledge
to get rid of the health-care law.
House
Republicans passed legislation that year to dismantle major parts of
the ACA, but the effort narrowly failed months later in the Senate
during a vote that culminated with McCain giving a dramatic thumbs down
on the floor of the chamber. Health care also has been an animating
issue among Democrats. It was one of the most robustly debated issues
during the 2020 presidential primary, with Biden defending the current
health-care law and Sen. Bernie Sanders (I-Vt.) and others pressing for a
broader system, Medicare-for-all.
Sanders
said Thursday that although he was pleased with the Supreme Court’s
decision, he would continue working for more extensive reforms.
“The
current American health-care system is completely dysfunctional,”
Sanders said. “We’ve gained a lot of momentum. Taking on the insurance
industry and the drug companies and the whole medical establishment is
not easy, but we’re making progress and we are going to win.”
Biden, however, signaled no more receptivity to a single-payer system than he did as a candidate.
“After
more than a decade of attacks on the Affordable Care Act through the
Congress and the courts,” the president said in a statement, “today’s
decision — the third major challenge to the law that the U.S. Supreme
Court has rejected — [means] it is time [to] move forward and keep
building on this landmark law.”
Obama,
the president most associated with the law that is often called
Obamacare, commented via Twitter. “Today, the Supreme Court upheld the
Affordable Care Act. Again,” Obama wrote. “This ruling reaffirms what we
have long known to be true: the Affordable Care Act is here to stay.
Echoing earlier demands from progressive groups and lawmakers,
over 100 labor unions and their allies on Wednesday called on the Biden
administration and Democratic congressional leaders to include expanded
Medicare eligibility and prescription drug pricing reform in the $1.8
trillion American Families Plan, part of President Joe Biden's three-part Build Back Better economic and infrastructure proposal.
"The Biden administration and Congress have a chance to deliver important progress at a crucial time." —Dan Bauer, CWA
In a letter
(pdf) to Senate Majority Leader Chuck Schumer (D-N.Y.) and House
Speaker Nancy Pelosi (D-Calif.), 103 labor, faith, healthcare, racial
justice, and other allied groups urged Biden and Congress "to include
robust Medicare drug price negotiation in the American Families Plan
package and to reinvest significant savings from negotiations [in] the
Medicare program, alongside other critical investments in health equity,
coverage, and affordability."
"By using the savings to improve
dental, vision, and hearing services, capping out-of-pocket costs,
lowering the Medicare eligibility age, and taking other bold steps to
improve our nation's health, the Biden administration and Congress would
be delivering on key promises and improving the lives of millions," the
letter states. Currently, Americans are eligible for Medicare benefits
at age 65.
"The American Families Plan must center the needs and
priorities of BIPOC communities and expanding Medicare would help to
increase coverage and access to care for communities of color who are
disproportionately uninsured or under-insured," it says.
The letter continues:
The
United States spends far more than any other country for prescription
pharmaceuticals, and the largest purchaser in the world is the Medicare
Part D program. High U.S. drug spending is driven by excessive prices
charged by prescription drug corporations, which lead to treatment
rationing and preventable negative health outcomes, including death.
Enacting a robust system of direct government drug price negotiation and
price spike protections that provides relief to patients regardless of
medical condition, insurance provider, or status will save lives and
prevent suffering and financial hardship for families across the nation.
"Bold
drug pricing reform will support building a healthier America, as well
as produce hundreds of billions of dollars in savings to reinvest in
bolstering coverage," the letter asserts. "With these significant
estimated savings, upwards of $450 billion over 10 years, it is a crucial time to address other needs of Medicare enrollees."
"In
addition, by expanding access to Medicare to Americans 50 and older,
the Biden administration and Congress could deliver crucial progress on
expanding healthcare," the letter continues.
The signers explain:
Medicare
has achieved universal coverage for Americans 65 and older, while the
uninsured rate for adults 50–64 is 10.5%. Americans approaching
retirement age have faced significant job loss as a result of the
recession brought on by the pandemic and are at a particular
disadvantage in states that have refused to expand Medicaid, leaving
low-income Americans in those states particularly at risk of going
without coverage and needed care. And given that most people experience
increased medical needs as they age, lacking insurance at such a crucial
time can mean financial ruin.
"Far too many
Americans continue to struggle to get the care and medicine they need
when they need it. Establishing government drug price negotiations and
price spike protections will provide countless Americans with relief and
put an end to treatment rationing," the letter says.
"Bold drug
pricing reform will support building a healthier America, as well as
produce hundreds of billions of dollars in savings to reinvest in
bolstering coverage." —Letter from 103 groups
"Expanding
Medicare to those 50 and older would mean giving the peace of mind that
Medicare enrollees already have to 63 million additional Americans,
while expanding it to only adults 60 and older would expand eligibility
for Medicare to an additional 20 million Americans," it concludes. "Now
is the time for action to lower drug prices and improve access to care
for millions."
The groups' demand follows similar calls from 17 Democratic senators in an April letter
that argued Medicare, which was signed into law by President Lyndon
Johnson in 1965, is "one of the most successful and popular federal
programs in our nation's history."
"The time is long overdue for
us to expand and improve this program so that millions of older
Americans can receive the healthcare they need, including eyeglasses,
hearing aids, and dental care," the senators asserted.
The
lawmakers also said that lowering the Medicare eligibility age to as
young as 50 would be a way to expand coverage, save lives, and implement
a popular reform to a program that is already favored by a majority of
the American people across the political spectrum.
Indeed, an April 2021 Data for Progress survey
found that 86% of Americans—including 82% of Republicans—support adding
dental, hearing, and vision benefits to Medicare.Three-quarters of
Democrats, a majority of Independents, and nearly half of Republicans
also favor lowering the Medicare eligibility age to 55.
"We have a
unique opportunity to finally address the exploding cost of
prescription drugs," said Dan Bauer, director of government affairs at
the Communication Workers of America (CWA), in an statement
Wednesday. "These rising costs have put necessary and lifesaving
treatments out of reach for working families and retirees and bold
action is needed."
"Pursuing bold reform will also create
substantial savings that can be used to expand Medicare to more seniors
and cover important treatments for seniors like vision, hearing, and
dental care," Bauer added. "These are important steps to ensure
affordable care for working families and retirees throughout the
country."
Eagan Kemp, health policy advocate for Public Citizen,
added that "lowering the Medicare eligibility age to 50, capping
out-of-pocket costs, and expanding benefits to include dental, hearing,
and vision would improve access to care for millions of Americans."
"Far
too many Americans have lost their insurance or put off needed care due
to the Covid-19 crisis," said Kemp. "The Biden administration and
Congress have a chance to deliver important progress at a crucial time."
Include Bold Drug Pricing Reform and Medicare Improvement and Expansion in
American Families Plan
June 16, 2021
Dear Majority Leader Schumer and Speaker Pelosi,
The time has come to deliver for America’s seniors, people with disabilities and people
approaching retirement. The undersigned organizations representing diverse interests,
including consumer safety, public health, business, faith-based, racial justice and labor
organizations, are calling on the Biden Administration and Congress to include robust
Medicare drug price negotiation in the American Families Plan package and to reinvest
significant savings from negotiations the Medicare program, alongside other critical
investments in health equity, coverage, and affordability. By using the savings to improve
dental, vision, and hearing services, capping out-of-pocket costs, lowering the Medicare
eligibility age, and taking other bold steps to improve our nation’s health, the Biden
administration and Congress would be delivering on key promises and improving the lives of
millions. The American Families Plan must center the needs and priorities of BIPOC
communities and expanding Medicare would help to increase coverage and access to care
for communities of color who are disproportionately uninsured or underinsured.
The United States spends far more than any other country for pharmaceuticals, and the
largest purchaser in the world is the Medicare Part D program. High U.S. drug spending is
driven by excessive prices charged by prescription drug corporations, which lead to
treatment rationing and preventable negative health outcomes, including death. Enacting a
robust system of direct government drug price negotiation and price spike protections that
provides relief to patients regardless of medical condition, insurance provider or status will
save lives and prevent suffering and financial hardship for families across the nation.
Advancing the strongest reform possible is not only the right thing to do in its own right, but
stronger reform also has potential to provide greater savings for reinvestment. Conversely,
any weakening of drug pricing reform would reduce savings. Bold drug pricing reform will
support building a healthier America, as well as produce hundreds of billions of dollars in
savings to reinvest in bolstering coverage.
With these significant estimated savings, upwards of $450 billion over 10 years, it is a crucial
time to address other needs of Medicare enrollees. Given the challenges seniors faced
during the COVID-19 pandemic, it is time to deliver the relief they need. Coming out of the
crisis, many seniors will need additional services. Adding an out-of-pocket cap for medical
expenses and expanding access to dental, hearing and vision services in the American
Families Plan would go a long way in improving access to needed care. CBO has already
estimated that adding dental, hearing, and vision to Medicare would cost less than $360
billion over ten years.
In addition, by expanding access to Medicare to Americans 50 and older, the Biden
administration and Congress could deliver crucial progress on expanding health care.
Medicare has achieved universal coverage for Americans 65 and older, while the uninsured
rate for adults 50-64 is 10.5 percent. Americans approaching retirement age have faced
significant job loss as a result of the recession brought on by the pandemic and are at a
particular disadvantage in states that have refused to expand Medicaid, leaving low-income
Americans in those states particularly at risk of going without coverage and needed care.
And given that most people experience increased medical needs as they age, lacking
insurance at such a crucial time can mean financial ruin.
Far too many Americans continue to struggle to get the care and medicine they need when
they need it. Establishing government drug price negotiations and price spike protections will
provide countless Americans with relief and put an end to treatment rationing. Expanding
Medicare to those 50 and older would mean giving the peace of mind that Medicare enrollees
already have to 63 million additional Americans, while expanding it to only adults 60 and
older would expand eligibility for Medicare to an additional 20 million Americans. Now is the
time for action to lower drug prices and improve access to care for millions.
We thank you for your attention on this crucial issue.
Signed,
ACA Consumer Advocacy
African American Health Alliance
AIDS Healthcare Foundation
Allergy & Asthma Network
American Indian Health Commission for WA State
American Postal Workers Union, AFL-CIO
American-Arab Anti-Discrimination Committee (ADC)
Americans for Democratic Action, Southern California Chapter
Association of Flight Attendants-CWA
Bayard Rustin Liberation Initiative
Be A Hero Action Fund
Blue Future
Business Leaders for Health Care Transformation
California Alliance for Retired Americans
Center for Independence of the Disabled, NY
Center for LGBTQ Economic Advancement & Research (CLEAR)
Center for Popular Democracy
Church World Service
Citizen Action of Wisconsin
Coalition of Labor Union Women, AFL-CIO
Coalition on Human Needs
Communications Workers of America
Communities United (MD)
Congregation of Our Lady of Charity of the the Good Shepherd, US Provinces
Consumer Action
Doctors for America
Empowering Pacific Islander Communities (EPIC)
Faith Action Network - Washington State
Families USA
Health & Medicine Policy Research Group
Health Care Is a Human Right WA
Health Care Voter
Healthcare-NOW
Hometown Action
Hoosier Action
In the Public Interest
Indivisible
Indivisible Georgia Coalition
Indivisible MN03
International Community Health Services
International Federation of Professional and Technical Engineers (IFPTE)
International Union, United Automobile, Aerospace & Agricultural Implement Workers of
America (UAW)
Iowa Citizens for Community Improvement
Jane Addams Senior Caucus
Justice Democrats
Maine People's Alliance
Marked By COVID
Metro New York Health Care for All
Midwives for Universal Health Care
MomsRising
MoveOn
Nashville Indivisible
NASTAD
National Advocacy Center of the Sisters of the Good Shepherd
National Equality Action Team (NEAT)
National Nurses United
National Organization for Women
National Resource Center on Domestic Violence
National Union of Healthcare Workers
National Women's Health Network
NETWORK Lobby for Catholic Social Justice
North Seattle Progressives
ONE Northside
Our Maryland
Our Revolution
Partners for Dignity & Rights
Partners In Health
People's Action
Physicians for a National Health Program - Washington
Plymouth Area Indivisible (MN)
Progressive Democrats of America
Protect Our Care
PSARA (Puget Sound Advocates for Retirement Action)
Public Advocacy for Kids (PAK)
Public Citizen
R2H Action (Right to Health)
Retired Public Employees Council of WA
Rights & Democracy NH & VT
RootsAction.org
San Francisco AIDS Foundation
Seattle King County-NAACP
Service Employees Intternational Union (SEIU)
Social Security Works
South Carolina AFL-CIO
Sunrise Movement
TakeAction Minnesota
Tennessee Health Care Campaign
The Episcopal Church
The Latino Medical Student Association
Treatment Action Group
UNITE HERE Local 11
United Church of Christ, Justice and Witness Ministries
United Electrical, Radio & Machine Workers of America
United Vision for Idaho
Universal Health Care Foundation of Connecticut
Virginia Organizing
Voices for Progress
Washington Community Action Network
Washington State Alliance for Retired Americans
West Virginia Citizen Action
Western Front Indivisible
cc: Rep. Frank Pallone (Chair, Energy and Commerce Committee, U.S. House of
Representatives), Rep. Ritchie Neal (Chair, Ways and Means Committee, U.S. House of
Representatives), Sen. Ron Wyden (Chair, Finance Committee, U.S. Senate), and Sen. Patty
Murray (Chair, Health, Education, Labor and Pensions Committee, U.S. Senate)
What the Rich Don’t Want to Admit About the Poor
by Ezra Klein - NYT - June 13, 2021
I’m not going to pretend that I know
how to interpret the jobs and inflation data of the past few months. My
view is that this is still an economy warped by the pandemic, and that
the dynamics are so strange and so unstable that it will be some time
before we know its true state. But the reaction to the early numbers and
anecdotes has revealed something deeper and more constant in our
politics.
The American economy runs on poverty, or at least the
constant threat of it. Americans like their goods cheap and their
services plentiful and the two of them, together, require a sprawling
labor force willing to work tough jobs at crummy wages. On the right,
the barest glimmer of worker power is treated as a policy emergency, and
the whip of poverty, not the lure of higher wages, is the appropriate
response.
Reports that low-wage employers were having trouble
filling open jobs sent Republican policymakers into a tizzy and led at
least 25 Republican governors — and one Democratic governor
— to announce plans to cut off expanded unemployment benefits early.
Chipotle said that it would increase prices by about 4 percent to cover
the cost of higher wages, prompting the National Republican
Congressional Committee to issue a blistering response:
“Democrats’ socialist stimulus bill caused a labor shortage, and now
burrito lovers everywhere are footing the bill.” The Trumpist outlet The
Federalist complained,
“Restaurants have had to bribe current and prospective workers with
fatter paychecks to lure them off their backsides and back to work.”
But
it’s not just the right. The financial press, the cable news squawkers
and even many on the center-left greet news of labor shortages and price
increases with an alarm they rarely bring to the ongoing agonies of
poverty or low-wage toil.
As it happened, just as I was
watching Republican governors try to immiserate low-wage workers who
weren’t yet jumping at the chance to return to poorly ventilated
kitchens for $9 an hour, I was sent “A Guaranteed Income for the 21st
Century,” a plan that seeks to make poverty a thing of the past. The
proposal, developed by Naomi Zewde, Kyle Strickland, Kelly Capatosto,
Ari Glogower and Darrick Hamilton for the New School’s Institute on Race
and Political Economy, would guarantee a $12,500 annual income for
every adult and a $4,500 allowance for every child. It’s what wonks call
a “negative income tax” plan — unlike a universal basic income, it
phases out as households rise into the middle class.
“With
poverty, to address it, you just eliminate it,” Hamilton told me. “You
give people enough resources so they’re not poor.” Simple, but not
cheap. The team estimates that its proposal would cost $876 billion
annually. To give a sense of scale, total federal spending in
2019 was about $4.4 trillion, with $1 trillion of that financing Social
Security payments and another $1.1 trillion supporting Medicaid,
Medicare, the Affordable Care Act and the Children’s Health Insurance
Program.
I suspect the real
political problem for a guaranteed income isn’t the costs, but the
benefits. A policy like this would give workers the power to make real
choices. They could say no to a job they didn’t want, or quit one that
exploited them. They could, and would, demand better wages, or take time
off to attend school or simply to rest. When we spoke, Hamilton tried
to sell it to me as a truer form of capitalism. “People can’t reap the
returns of their effort without some baseline level of resources,” he
said. “If you lack basic necessities with regards to economic
well-being, you have no agency. You’re dictated to by others or live in a
miserable state.”
But those in the economy with the power to do
the dictating profit from the desperation of low-wage workers. One man’s
misery is another man’s quick and affordable at-home lunch delivery.
“It is a fact that when we pay workers less and don’t have social
insurance programs that, say, cover Uber and Lyft drivers, we are able
to consume goods and services at lower prices,” Hilary Hoynes, an
economist at the University of California at Berkeley, where she also
co-directs the Opportunity Lab, told me.
This is the
conversation about poverty that we don’t like to have: We discuss the
poor as a pity or a blight, but we rarely admit that America’s high rate
of poverty is a policy choice, and there are reasons we choose it over
and over again. We typically frame those reasons as questions of
fairness (“Why should I have to pay for someone else’s laziness?”) or
tough-minded paternalism (“Work is good for people, and if they can live
on the dole, they would”). But there’s more to it than that.
It
is true, of course, that some might use a guaranteed income to play
video games or melt into Netflix. But why are they the center of this
conversation? We know full well that America is full of hardworking
people who are kept poor by very low wages and harsh circumstance. We
know many who want a job can’t find one, and many of the jobs people can
find are cruel in ways that would appall anyone sitting comfortably
behind a desk. We know the absence of child care and affordable housing
and decent public transit makes work, to say nothing of advancement,
impossible for many. We know people lose jobs they value because of
mental illness or physical disability or other factors beyond their
control. We are not so naïve as to believe near-poverty and joblessness
to be a comfortable condition or an attractive choice.
Most
Americans don’t think of themselves as benefiting from the poverty of
others, and I don’t think objections to a guaranteed income would
manifest as arguments in favor of impoverishment. Instead, we would see
much of what we’re seeing now, only magnified: Fears of inflation,
lectures about how the government is subsidizing indolence, paeans to
the character-building qualities of low-wage labor, worries that the
economy will be strangled by taxes or deficits, anger that Uber and Lyft
rides have gotten more expensive, sympathy for the struggling employers
who can’t fill open roles rather than for the workers who had good
reason not to take those jobs. These would reflect not America’s love of
poverty but opposition to the inconveniences that would accompany its
elimination.
Nor would these costs be merely imagined. Inflation
would be a real risk, as prices often rise when wages rise, and some
small businesses would shutter if they had to pay their workers more.
There are services many of us enjoy now that would become rarer or
costlier if workers had more bargaining power. We’d see more investments
in automation and possibly in outsourcing. The truth of our politics
lies in the risks we refuse to accept, and it is rising worker power,
not continued poverty, that we treat as intolerable. You can see it
happening right now, driven by policies far smaller and with effects far
more modest than a guaranteed income.
Hamilton, to his credit,
was honest about these trade-offs. “Progressives don’t like to talk
about this,” he told me. “They want this kumbaya moment. They want to
say equity is great for everyone when it’s not. We need to shift our
values. The capitalist class stands to lose from this policy, that’s
unambiguous. They will have better resourced workers they can’t exploit
through wages. Their consumer products and services would be more
expensive.”
For the most part, America finds the money to pay for
the things it values. In recent decades, and despite deep gridlock in
Washington, we have spent trillions of dollars on wars in the Middle
East and tax cuts for the wealthy. We have also spent trillions of
dollars on health insurance subsidies and coronavirus relief. It is in
our power to wipe out poverty. It simply isn’t among our priorities.
“Ultimately,
it’s about us as a society saying these privileges and luxuries and
comforts that folks in the middle class — or however we describe these
economic classes — have, how much are they worth to us?” Jamila
Michener, co-director of the Cornell Center for Health Equity, told me.
“And are they worth certain levels of deprivation or suffering or even
just inequality among people who are living often very different lives
from us? That’s a question we often don’t even ask ourselves.”
To Fix America's Broken Health Care System, We Must Rethink Who Counts as an Expert
by S.E. Smith - Time Magazine - June 10, 2021
Americans are emerging from the COVID-19 pandemic like
survivors of a wildfire surveying an unfamiliar landscape. As we take
stock of what’s left, we are forced to rebuild, but we need not simply
restore what was taken in a hollow echo of what we knew before. We can
make health care and the infrastructure that supports it better,
stronger, more resilient. To do that, as we learned at great cost over
the past 15 months, we must value all
the stakeholders in the system: not just insurance executives and
hospital CEOs, but patients, disabled people, older adults, low-income
people, people of color who have faced historic health care
discrimination, and health care workers and supporters, from home health
aides to hospital registrars.
Millions of Americans interact with the health care system
every year—if and when they can afford it. But discussions about health
care reform often leave out some of these voices. Policy-makers,
industry executives, hospital officials and others in high-status
positions hear from others in similar roles, or from prominent members
of the health care community like sought-after specialists who bring in
high-value patients. Under-represented in these conversations are those
who know the system at its worst, like ambulance crews making minimum
wage, nurses in underfunded community health clinics and uninsured
patients who know what it’s like to halve their insulin dose to stretch
to the next paycheck. The devaluation of these members of the health
care community is paradoxically what makes their voices so important:
those who are considered lowest in status often have the best
observations about the systems they are trapped in.
Two
groups of stakeholders were particularly vocal and active during the
pandemic: nurses and disabled people. While communities banged pots and
cheered, hospitals hung heroes work here banners and the media trumpeted
about “essential workers,” many nurses were laboring in conditions that
didn’t have to be so dangerous. Nurses are on the front line of patient
care, on shift for hours with their assigned patients, unlike
physicians, technicians and other providers who typically see patients
briefly for tests or assessments. Nursing work can be grinding and
emotionally exhausting, and nurses often know their patients and their
families best, seeing elements of the health care system that others may
be oblivious to. Yet these medical professionals are often not afforded
the respect given to doctors.
During the pandemic, though, the nation had no choice but to hear the collective voice of nurses everywhere.
Hospital by hospital, nurses worked together to make themselves and
their patients safer, even if it meant wearing garbage bags as PPE, as
some had to do in New York City—forcing those in charge to confront the
reality that we were ill-prepared for a national public-health
catastrophe. And as nurses rapidly adopted technology to allow for
remote patient visits, too many of which ended with families saying
goodbye via video chat, they reminded the health care community that
patient care isn’t just about physical health.
The
disability community, including a broad swath of people from those with
chronic illnesses to wheelchair users to mentally ill people, makes up
roughly 26% of the U.S. population. While the term professional patient
is sometimes used in a derogatory way, it accurately describes many
people who regularly interact with the health care system. They are, by
nature of their health care needs, extremely familiar with the ins and
outs of the system, including the problematic elements. During the
pandemic, some organized around hashtags like #HighRiskCA, which was
used to call out the way California’s vaccine-distribution
system, in the first phase of the rollout, left out disabled people who
did not meet its 65-plus age requirement but were highly vulnerable to
COVID-19. Furthermore, through a partnership between the Johns Hopkins
Disability Health Research Center and the Center for Dignity in
Healthcare for People With Disabilities, a team that included disabled
researchers set up a Vaccine Prioritization Dashboard to track how
states were handling disability eligibility for vaccines and help
disabled people navigate incredibly confusing guidance. The disabled
researchers drew upon their own experiences and fears in developing an
accessible, clear product to help the community, filling a gap in the
public-health outreach system.
We should not just cheer
these examples as cases where some often overlooked people happened to
offer something useful during a disaster; we should see them as a road
map for the future. As we move forward, we should use the knowledge and
skills of nurses, disabled people, health care coordinators and myriad
others to build the health care system we deserve. Those people need to
be represented in the rooms where policy is developed, including among
legislatures, advocacy groups and other entities that push policy
priorities. People interested in health care reform should actively seek
out these voices: to learn more about how to advocate for what people
actually need, and to figure out what questions to ask those in power.
When people raise issues that make advocates uncomfortable, it’s
necessary to lean into that discomfort and use it as an opportunity to
do better.
People with extensive experience in the health care
landscape have critiques that may improve proposals to fix it. Consider
the notion of a government-funded single-payer health care system. Many
Americans, as much as 36% based on a 2020 Pew survey, say they support
such a program, but the public conversation on this topic does not
clearly define what such a plan would look like, and it’s been muddled
by conflicting proposals. Although people without experience in the
health care space may think it’s as simple as needing care and getting
it paid for by the government, disabled people want answers to questions
that, to others, might seem in the weeds but are actually critical to
everyone, such as how prescription benefits would be covered, or what
happens when a costly test or procedure is recommended but a patient
doesn’t meet strict criteria. We are emerging from a hard-fought war
against an invisible enemy and we know the current system is broken, but
if we leave out the voices of people in the know when we fix it,
whatever we develop may not be an improvement, but rather, the same
problems in a new package.
As post–World War II
Japan slowly began its economic recovery and manufacturing began to
bloom, Toyota introduced the Andon cord: a literal cord that anyone on
the production line could pull to pause production to address a safety
or quality issue. The prospect of allowing anyone to bring a
multimillion-dollar process to a halt may sound wild, but it turned out
to be highly effective, making everyone into an experienced stakeholder,
no matter the nature of the task they were performing. The Andon played
a role in the culture turnaround of the NUMMI auto-manufacturing plant
in Fremont, Calif., which had a toxic and unproductive work environment
until the mid-1980s, when Toyota and GM began jointly operating it using
Toyota’s manufacturing processes. Empowering workers with the Andon
proved successful in improving morale and increasing buy-in.
The
U.S. health care system as a whole needs a metaphorical Andon cord.
It’s something we know works in health care settings, as some facilities
use similar safety checks to protect patients and providers—one
of which is “Stop the Line,” which can be called by anyone to stop and
address a safety concern or other issue such as the wrong medication or
improper use of equipment. The point is, the real expert is not always
the foreman or the team lead, the prestigious surgeon or the person with
the broad, big-picture view. Sometimes it’s someone on the assembly
line, or it’s the hospital orderly who cleans rooms between patients. A
physical plant worker can have a sharp idea for more safely sealing
doors. An intern reading about right-to-repair laws can fight to get
sidelined ventilators up and running.
We may not know when the next pandemic will strike,
but we do know that everyone needs health care, and the system needs to
be much more robust the next time a new virus or mass-casualty event
happens. Repairing America’s health care system requires the humility to
recognize expertise no matter where it comes from, and the ability to
integrate stakeholders into the process as early as possible. If we
truly want everyone in the U.S. to have access to high-quality, safe,
equitable, compassionate health care, we must stop to value everyone
who’s embedded in the system.
smith is a National Magazine Award–winning essayist and journalist
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