So it’s a Hate Jon Gruber party. The “architect” of Obamacare, as they’re calling him on the right, was just discovered to have said on a panel a year ago that voters are “stupid” and that “lack of transparency” was basically necessary to passing the law. Naturally, in these perfervid analyses, Gruber = All of Liberalism and All Liberals, so the video “proves” that all of us from Barack Obama on down think the people are stupid and the ACA was a huge con.
On Actually Existing Earth, Jon Gruber = Jon Gruber. Yes, he was “an” architect—not “the” architect—of the law. But he doesn’t speak for the administration or for me. And even if he did, what exactly would that prove? I’ll happily go toe to toe with any conservative and argue the point that even if liberals think voters are stupid, the fact remains that the political party with which liberals broadly identify passed a law to help them get health care, while the party with which conservatives identify, no matter how much it purports to value the people’s homespun wisdom, would appear to prefer that many of them just die.
So let’s move past Gruber (hoping that he now understands he’s on video everywhere he goes). He is a convenient smokescreen. The real health care controversy in this country this week remains that the Supreme Court granted certiorari to this preposterous legal challenge, which should not have a leg to stand on.
If you’ve been reading about this you are broadly familiar with the debate on my side of the fence. Monday, I took the dour view that the Supreme Court is very likely to support this nonsense challenge, and the law could unravel, and the GOP will box Obama in politically.
My column was about the Court and Congress. But others have focused on what might happen in the states after such a ruling. And several who’ve written about that, like Michael Cohen in the Boston Globe, retort that if the Court rules as we fear, the political pressure will be on Republican governors and state legislators. Because then the Court’s conservative majority, and GOP pols who resist a legislative fix, will be actively ripping existing health insurance out of the hands of tens or even hundreds of thousands of their constituents, and for all the spitting hatred of Obamacare out there, there’s simply no way they’ll do that.
Tuesday in The New Republic, Jonathan Cohn had a great rundown of exactly how many people we’re talking about. If the Court holds that people who bought their coverage through the federal marketplace rather than a state exchange no longer qualify for subsidies, wrote Cohn, then:
More than 800,000 Floridians would see their monthly insurance premiums rise, from an average of around $70 to an average of around $350, or roughly a factor of five. More than 600,000 people in Texas, about 325,000 in North Carolina, and another 275,000 in Georgia would see insurance premiums soar by similar amounts.
As Cohn notes, more than 4 million people in 37 states would find themselves in similar situations, and surely the overwhelmingly majority will just drop their coverage—unless their state governments rush in to set up state-run exchanges.
Theda Skocpol, the esteemed Harvard social scientist, agrees with Cohen that they will set up the exchanges. She notes that before the Court might rule, the Department of Health and Human Services will surely issue new regulations making it much easier for states to set them up. But mainly, she argues, governors simply won’t de-insure people currently getting subsidies, about half of whom, according to one analysis, are Republicans. And she hastens to point out that it isn’t just people who’ll stand to lose—after all, those people are buying their insurance from somebody, right?
“Even more to the point, the insurance marketplaces are channeling profits to private insurance companies that are powerful players in mostly GOP politics,” Skocpol says. “Such a Court decision would put a noose around GOP governors’ necks, because each governor of a GOP state who refused next summer to execute a simple fix to keep subsidies and profits flowing on his/her state insurance market would be hurting his/her own constituents — by taking away benefits/profits they already enjoy, the worst kind of political provocation.”
All this is true. And yet…
Let’s look at the states that did not set up their own exchanges and that might be compelled to spring into such action. Here’s a map for you. Click on it, gaze over it, and think about which of those states in the two shades of light blue might rush to buy into Obamacare. Let’s start our list with the largest states that Obama won that did not set up state exchanges:
• Pennsylvania. Just changed to a Democratic governor. About 250,000 people are getting subsidized through Obamacare. But the Republicans control both houses of the legislature and just expanded their majorities.
• Virginia. Democratic governor, 177,000 who’ve received subsidized insurance…but an extremely conservative, and extremely resistant, state legislature.
• Florida. Nearly 900,000 with subsidized insurance, but a GOP governor and very GOP legislature. Governor Rick Scott has made some “soft on Obamacare”-type noises, but it seemed like that was just to blunt Charlie Crist’s attacks.
• Ohio. A Republican governor, Kasich, but remember he did take the Medicaid money (but did not set up a state exchange; they’re two different things). About 155,000 people signed up for plans under Obamacare, as near as I can tell about two-thirds of them subsidized. But Kasich has presidential aspirations, does he not? He’s going to facilitate an Obamacare expansion under those circumstances?
• New Jersey. One would think an obvious candidate, but again, if Chris Christie is seeking the GOP nomination for president, not a chance.
• Wisconsin. Scott Walker. Duh.
That’s six states. The politics look potentially most amenable in Pennsylvania, and even there a GOP legislature has to go along. In the other five—look, I pray Skocpol is right. But the grassroots pressure from the right wing, the howls from Limbaugh and company, the money pouring in from the Kochs, the threats of primaries against the governor or legislator who’d be treacherous enough to come to the aid of Barack Hussein Obama, especially after the Supreme Court had issued a ruling that could potentially put Obamacare in the grave…I don’t know.
Then in the other states, forget it. They’re red. Even in a non-extreme red state like Missouri, well, there’s a Democratic governor, but a GOP legislature that has blocked him time and again from trying to bring Obamacare to the state.
This fight, if it comes to pass—remember, the Court might surprise us—will be the culmination, the main event of the Obama era, our contentious politics distilled to its essence. Will Republicans in these states act on symbolic cultural gesture (oppose Obamacare at all costs) or will a cautious reluctance against actually taking coverage out of the hands of existing humans (to say nothing of taking business away from insurance providers) trump the symbolism? You can make persuasive arguments to me that they’ll be pragmatic. However, the idea that today’s Republican Party wouldn’t yank an existing benefit out of Americans’ hands is definitely not one of them.
