The last remaining legal hurdle for the Affordable Care Act, the King v. Burwell case, isn’t as complicated as it may seem. The entire controversy boils down to this: was the Affordable Care Act designed specifically to subsidize insurance for consumers nationwide, or only consumers who enroll through state exchanges?
Absolutely everyone involved in the process knows the truth: of course the system was designed to help all American consumers, including those who bought insurance through healthcare.gov. The alternative is a little insane – the architects of the law wouldn’t have any reason to undermine the efficacy of their own system.
But the King v. Burwell lawsuit, which Republicans pretend to believe, is predicated on a genuinely ridiculous assumption: Democrats, on purpose, designed “Obamacare” in such a way as to deny help to every consumer who relied on healthcare.gov. They did this deliberately, the argument goes, in order to entice states to create their own exchange marketplaces.
It’s painfully obvious that this is absurd and that the lawsuit is a joke, and very recently, evidence has emerged that even Republicans who claim to support the case, in reality, don’t genuinely believe their own side’s argument. Consider this latest catch from Ian Millhiser:
The Affordable Care Act gives states a choice. They can either set up their own health exchanges where individuals may buy subsidized health plans, or they can elect to have the federal government set up such an exchange for them. Individuals who purchase insurance on an exchange may receive tax credits to help them pay for that insurance if they qualify on the basis of income.In his brief, which was filed in a lawsuit called King v. Burwell, [Republican Utah Sen. Orrin Hatch] claims that the law “provides that premium subsidies are available only through an exchange established by a State” – i.e. not in an exchange that is operated by the federal government.
But five years ago, before Hatch knew the King v. Burwell case was coming, he accidentally told the truth: he wrote in an op-ed that said state exchanges “are not a condition” for subsidies. The Republican senator understood reality in 2010, but is pretending to support a contradictory reality now in the hopes of tearing down the system.
It’s not just Hatch’s accidental candor. Brian Beutler today continued to expose the stupidity of the entire litigation: It’s a little tricky, but Brian shines a light on the Republicans’ 2011 effort to change the ACA’s “1099” requirement.
What we have in the form of this bill is clear evidence that everyone who voted for it (including every single Republican, save the two GOP congressmen and one GOP senator who weren’t present) understood the Affordable Care Act to provide subsidies everywhere.
Indeed, let’s keep going with this. Here’s still more evidence from last week that the entire case is an elaborate scam.
The Congressional Budget Office wrote 68 reports about the Affordable Care Act during the session that Congress debated the law. Not one of them, a new analysis from Harvard University’s Theda Skocpol, ever explored the possibility of limiting insurance subsidies to the state marketplaces after the law’s full implementation.
The same day, we learned that in 2010, Rep. Paul Ryan (R-Wis.) – Paul Ryan! – also argued that all consumers nationwide, whether they enrolled through a state or federal exchange, were eligible for subsidies.
Look, it we’re being completely honest, no one can actually take the King v. Burwell case seriously on the merits. No one. The Affordable Care Act’s critics on the right may be conservative, and they may have an irrational hatred for families gaining access to basic medical care, but they’re not complete idiots. Literally everyone – Democrats, Republicans, the White House, governors, the non-partisan Congressional Budget Office, journalists, judges, the Office of Management and Budget, Capitol Hill staffers, everyone – has already acknowledged that the ACA was designed to extend subsidies to all income-eligible consumers, regardless of whether they relied on a state or a federal exchange. The case asks the Supreme Court to believe that Congress intended to deny support to healthcare.gov customers, but that’s simply impossible for anyone who understands English to believe.
What the ACA’s critics are doing, with a wink and a nod, is taking one last shot. Republicans clearly don’t care about what’s true, so much as they care about what might work. If that means contradicting everything they’ve already said, fine. If that means backing a plainly stupid lawsuit, fine. If that means covering their eyes, sticking their fingers in their ears, and pretending reality doesn’t exist, fine.
But let’s at least try to be adults about this. We know this entire legal attack on the system is a sham, and this latest evidence helps prove, definitely, that they know it, too.