Personally, I am delighted that Chief Justice Roberts voted to uphold the Affordable Care Act. But, I am troubled that the fate of U.S. healthcare turned on one man’s opinion. This is not how things are supposed to work in a democracy.
Healthcare represents 16 percent of our economy. It touches all of our lives. If we don’t like the laws our elected representatives pass, we can vote them out of office. The Supreme Court, on the other hand, doesn’t have to worry whether its decisions reflect the will of the people. The Justices are appointed for life. This is why they are not charged with setting public policy.
How then, did the Court wind up with the power to affirm or overturn the ACA?
The media shapes our expectations
As I suggested when oral arguments began back in March, a “media narrative” drove the case to the Court – a fiction that caught on, in the press, on television, and in the blogosphere, where it began to take on a reality of its own. A handful of “state attorneys general and governors” saw “a political opportunity” and floated the idea that the law might be unconstitutional. The media picked up the story, repeated the heated rhetoric, and “fanned the flames … Before long, what constitutional experts thought was a non-story became a Supreme Court case.”
These media narratives are based on what “that those in power and in the media have concluded is likely to happen,” observes Lyle Denniston, known by some as the Dean of Supreme Court reporters.
Writing on Scotusblog.com, he observes: “One ‘narrative’ about the health care law began building up in Washington, and perhaps beyond, right after the Supreme Court held its hearings in late March. The mandate, it was said, was going to be struck down, the government’s lawyer had blown it, and the President was going to be deeply wounded politically over the loss of his treasured domestic initiative.” Some media outlets were so persuaded by their own myth-making that initially, they reported that the Court had ruled against reform!
Denniston explains that once the story goes viral, the conventional wisdom is then repeated, over and over, until “often, it seems, such ‘narratives’ become self-fulfilling.”
He then points a “currently prevailing ‘narrative’ that most of the country is stubbornly committed to the Tea Party’s wish to limit the power of the federal government.” The facts contradict the fiction: Tea Party Candidates have been “losing steam” in recent elections.
In April, a WashingtonPost/ABC poll revealed that support for the Tea Party among young adults had plunged to 31 percent – down from 52 percent in the fall 2011. Half of those polled said that the more they heard about the Tea Party, the less they liked it.
Tea Partiers claims that the Court’s decision invigorated its base, but offer little evidence. As I reported on HealthBeat last week, polling suggested that the ruling lifted support for reform among Independents, while having little effect on Republicans.
Media props up Governors’ threat to thwart ACA
Nevertheless, belief in the Tea Party’ grip on the country is now leading many to suggest that because far- right conservatives “hate the poor,” some states will turn down federal funding to expand Medicaid.
I doubt it. The money is too good. The Federal government would cover the entire cost for the first three years, 90 percent thereafter. Over eight years (2014-22) the Center on Budget Policy and Priorities calculates that state spending on Medicaid spending would increase by only 2.8 percent.
Moreover, as former CBO director Peter Orzag pointed out yesterday on Bloomberg, Medicaid expansion will reduce others state costs: “As the number of uninsured decreases, so does the cost of uncompensated care. In 2008, state and local governments paid roughly 20 percent of the hospital costs for uninsured people, according to an Urban Institute Study.”
Tea Party Governors may threaten to opt out, but The Incidental Economist’s Aaron Carroll observes they will “face enormous pressure from doctors, hospitals, pharma, etc.” who now provide billions of dollars worth of uncompensated care. “They have pretty good lobbying groups,” he adds.
And Medicaid dollars would translate into new jobs for hospital and lab workers – something state legislators cannot ignore.
But “that won’t stop the media from breathlessly covering the [governors’] threats as reality” Carroll notes. “The ‘battle’ will likely sell a lot of advertising.” There, he puts his finger on why even moderate to liberal publications repeat the conservatives’ fictions: the image of a governor shaking his fist at Washington sells newspapers.
Keep in mind these governors are not all-powerful. State legislatures will have a say. And, while the Tea Party Tide swept many candidates into office in 2010, some will be swept out in coming elections.
Commenting on upcoming gubernatorial races, healthcare economist Len Nichols recently told Kaiser Health News “Medicaid will be an issue anywhere Democrats have a chance to win,” He named West Virginia, North Carolina, Washington state and possibly Missouri.”
The Supreme Court’s decision buys time
Now, the power to make a decision about health reform is back where it should be – in the hands of the American people. In November, they will vote.
Ironically, the Supreme Court challenge may have put them in a better position to vote in their own self interest. When the case went to the Court, a dreary policy debate turned into a contest that piqued our interest. Americans like spectator sports: Who will win? Who will lose?
Thanks to the publicity, some learned that the Affordable Care Act’s mandate will apply only to Americans who don’t have employer-based insurance, Medicaid or Medicare. And while that relatively small group will be subject to a penalty if they don’t buy insurance, they also will be eligible for a subsidy if they do.
Last week, the Christian Science Monitor offered a quick lesson in How the Supreme Court Ruling Affects Families. Consider a “family of four, headed by a 45-year-old, with an income of $60,000″ purchasing their own insurance. In 2014, they “would reap a tax subsidy of $9,308.”
If they didn’t buy insurance, in 2014 they would pay a penalty of $285. In the first year of reform, the penalty for a family that chooses not to purchase insurance will be $285, or 1 percent of their income, whichever is greater. In 2016, the penalty for a family peaks at $2,085, or 2½ percent of their income, whichever is greater. Alternatively, CSM’s family of four could purchase a policy and receive a subsidy of more than $9,000.
Suddenly health reform doesn’t sound so scary. To find out how large a tax credit you would be likely to receive if your employer doesn’t offer health benefits and you find yourself shopping for your own insurance, check out the Kaiser Family Foundation’s subsidy calculator.
Subsidies vary according to your age, your income, the size of your family and whether the cost of health care in your region is higher than average, average, or below average.
The Supreme Court has ruled that the ACA is legal. I hope that in the months ahead, as we approach the November election, more and more journalists and bloggers will follow CSM’s example, and focus on the concrete details of the ACA.
Too often the media broadcasts Tea Party fantasies that turn out to be false. Now, voters want to know the truth: “What would the ACA mean for me?”
Maggie Mahar is an author and financial journalist who has written extensively about the American health care system. Her book, Money-Driven Medicine: The Real Reason Health Care Costs So Much, was the inspiration for the documentary, Money Driven Medicine. She is a prolific blogger, writing most recently for TIME’s Moneyland. Previously she wrote and edited the Health Beat blog for the progressive think tank, The Century Foundation. Previous work for the Health Insurance Resource Center includesWill the Supreme Court strike down health reform? She also recently provided background on Congressional health care legislation for HealthReformVotes.org, a special project of the Health Insurance Resource Center. This post first appeared at healthinsurance.org