Obamacare and State’s Rights
It is 8pm on a Saturday night and the last thing I want to be doing is writing yet another piece about a manufactured crisis arising from Republican attempts to undermine the Affordable Care Act. I HATE writing these pieces and I HATE these peckerwoods who have spent the past 8 years proving that they like insurance companies better than they like people who buy insurance. I especially hate the Texas judge who dropped a ruling last night saying that absent the individual mandate – which was nullified by a provision of the tax reform bill last year – nothing in the ACA should remain. Hate. Hate, hate, hate.
I bet the only person who hates this more that me is Chief Justice John Roberts, who has done pretty much everything in his power to avoid dealing with the questions of severability in the Affordable Care Act. The guy had to work really hard to find a legal justification for upholding the individual mandate in 2012. He didn’t want to answer the question of how much of the rest of the law should survive if the mandate was struck down so he redefined the mandate as a tax and said it was as constitutional as apple pie and slavery before the 13th Amendment was ratified.
At least that’s how I read it. I’m not a legal scholar. So I will leave the subject of severability rulings to people who are (and believe me, they are alllllll weighing in on the likely next rulings as this case makes its way to appeal).
What I will do is reassure everyone that not changes will take effect at this time. Your insurance election for 2019 will be compliant with the ACA. So don’t stress about that part.
However, it is clear that the GOP does not want to leave even a shred of Obama’s signature bill standing. They are picking at it piece by piece and before long, we will find ourselves looking at one of two outcomes. Either we will have a full scale return to the kind of private insurance market we had prior to 2010, where employers and insurers decided who got to have health insurance. Or we will see some sort of public option made available to people below Medicare age.
I would actually place my bets on the second thing happening because consumers really like being able to buy insurance and they don’t want to go back to a market where insurers are allowed to say “Oh, you had wonky mole once and now you want a health insurance policy? LOL, nope.”
But until we reach the breaking point that ushers in a new insurance world order, we have to proactively protect ourselves from the predatory practices of the insurance industry. Since we can’t lobby the courts to rule the way we want, we have to turn our attentions to state legislatures.
Yep. That’s right. I, Rebekah Kuschmider, a known proponent of a strong federal government, am telling you to abandon Congress and head to your state capitol instead.
The key insurance industry reforms of the Affordable Care Act, specifically must-issue rules for insurers, combined with abolishing annual and lifetime coverage caps, are extremely popular (one poll shows that 81% of people think it should be illegal to deny coverage based on health history). It would not be a heavy advocacy lift to ask state lawmakers to pass such rules in individual states. Building out those regulations without also tying them to reforms that directly address consumer behavior the way the individual mandate did could make them nearly unassailable in the courts. States certainly have the right to protect consumers from abusive or discriminatory industry practices.
But, like with everything else in advocacy, your elected officials don’t know you want this unless you tell them. This is the time to tell them.
State legislative sessions will begin in the first months of 2019. Get online now and find the contact information for your state lawmakers. Drop them a line saying you want to be protected by ACA-like regulations on the health insurance industry and ask them to add that to the agenda for the new year. Then keep emailing and calling until they listen.
As Margaret Mead said, “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” It’s time to be a part of one of those thoughtful, committed groups again. You know how to do it. Let’s get it done.