Friday, June 12, 2015

Death Spiral


This is the best Conservatives can offer America.

This cast of paranoid clowns, religious pimps, and suicidal fanatics.

I look at the GOP candidates for president I think, seriously? This, this right here, this is the best you can do?

If Jeb Bush was an airplane, it would be like attempting takeoff with one engine on fire.

Bush opens his bid for President this coming Monday with an underfunded campaign in disarray and already in damage control mode to the accompaniment of headlines that keep using the phrase “Failure To Launch.”

Starting out on the defensive? Not really the most auspicious beginning for the scion of a hereditary political dynasty and the guy who was supposed to pull Republican chestnuts out of the fire.

Still, that's better than Mike Huckabee, who apparently doesn't actually know anybody who isn’t under investigation. These two are the GOP's front runners, that’s right, the Stephen Baldwin of the Bush family and a guy who pals around with child molesters. Now, look, I’m not saying the Democratic lineup is all that spectacular either and sure, you could maybe argue Hillary Clinton also hangs out with a certain sexual predator, but at least so far the Democratic candidates aren’t in any danger of screwing up so bad they literally kill off their own party.

And that’s exactly what GOP Chairman Reince Priebus is worried about.

Wednesday on the The Laura Ingraham Show, Priebus showed no confidence whatsoever that any of the unsavory bunch in the current GOP lineup would be able win the White House in 2016. And that loss, he declared, will be the end of Republicans “as a national party.”

Ingraham: On a scale of one to ten, how do-or-die is the 2016 presidential race?”
Priebus: “Ten. Ten. Eleven. Twelve. I mean, we don’t exist as a national party if we don’t win in 2016.  You can’t compete sixteen years out of the White House, it’s just not possible. ”

The end of the GOP as a national party?  Aww, gee, tough break, fellas.

Republicans have nobody, no goddamned body, to blame but themselves.

The thing that worries Reince Priebus the most? It’s not that the best he can offer America is a squalling pack of unlikeable fanatics, candidates so incredibly shitty they actually make conservatives get down on their knees and pray Mitt Romney will stage a coup at the GOP National Convention and run again, it’s that his own party is about to shoot itself in the head and there’s nothing he can do about it.

You see, sometime this month, the Supreme Court of the United States will rule on King vs Burwell.

And it’s possible, even likely, that ruling will be in Republicans’ favor.

And if that happens, if conservatives win and Obama loses, it will essentially destroy the Affordable Healthcare Act – i.e. Obamacare.

That victory, should it happen, will very likely be a pyrrhic one for the GOP – and the last one they ever win.


It’s entirely possible that victory, should it come to pass, will be the place where historians mark the demise of the Grand Old Party.


And that, that right there, is what keeps Reince Priebus awake and sweating in the night. If he wins, he loses.

You see, when the Individual Mandate – the provision of the ACA that requires every American to have healthcare insurance – went into effect in 2014, more than five million Americans signed up for health insurance. Many were overjoyed that they could finally afford healthcare for themselves and their families.

But not everybody was happy about it. 

One of those people was a limo driver from Virginia, a guy named David King. King is sixty-four years old and makes a bit less than $39K per year. Before Obamacare, he didn’t have health insurance.

Now, Virginia, being the birthplace of Thomas Jefferson, liberty, and America Fuck Ya! itself, loudly told Obama to go screw himself and petulantly refused to set up a state healthcare exchange. So, in accordance with the provisions of the ACA, Washington D.C. stepped in and set up a federal exchange.

Under the ACA and against his will, David King purchased a healthcare plan with a monthly premium of $648.

$648. That’s a lot for a guy making less than $40K a year. But see King didn’t have to pay that much because under the ACA he qualified for a federal subsidy which reduced his premium to just $275 per month.  Now, if you’ve ever had to buy your own insurance, you know that $275 for a sixty year old male is a pretty damned good deal indeed. And in fact, given his age it’s likely King wouldn’t be able to qualify for healthcare insurance no matter how much he paid if it wasn’t for Obamacare in the first place.

But, King, he wasn’t happy and he resented anything to do with Obama, healthcare, or federal handouts.

So he and three others sued. 

And conservatives, particularly those in Congress and a number now running for president, cheered them on and offered up outspoken and enthusiastic support, both moral and financial.

Anything to stick it to Obama, right? 

Of course, they have no hope of overturning the law itself, that ship sailed long ago, rather King vs Burwell is attempting to have the federal subsidy itself ruled illegal.

You see, the entire case hinges on four words, a single sentence out of a law that totals more than eleven million, five hundred and eighty-eight thousand words.

King vs Burwell contends that in the portion of the law used to calculate federal subsidies it specifically says a healthcare insurance exchange “established by the State.” The State. Literally. That’s their entire case. Those four word, “established by the state” as in a state not the federal government. Despite the fact that the rest of the law, not to mention two hundred years of legislation, make it abundantly clear that’s not what congress intended. Nevertheless, conservatives insist that’s how the law is written and therefore the subsidies are only legally available to people who are lucky enough to live in the states which chose to set up their own state-run healthcare exchanges and aren’t run by selfish assholes.

Thirty-four states opted not to create their own exchanges, including Virginia.


And if King wins in front of the Supreme court, if the Supreme Court agrees that only those in state run exchanges and not federally run exchanges qualify for the subsidy, more than six million people in thirty-four states will immediately lose their subsidies and will no longer be able to afford healthcare.

King doesn’t care. Fuck ‘em. That’s exactly what he wants.

What matters to King is that if he doesn’t get the subsidy then he doesn’t have to buy insurance at all because at his income level, $648 per month would cost him so much he would then qualify for an exemption to the Individual Mandate. He’s actually willing to stick it to six million people just so he doesn’t have buy healthcare.

And it’s worse than that, because without those six million people, the ACA goes into a death spiral.

Of course, if you’re paying attention, you realize that any minute now, David King will be eligible for Medicare.

Also, I may have forgotten to mention, King is a Vietnam Veteran, and he could get free healthcare through the VA and be exempt from having to buy healthcare insurance out of pocket at all. This entire fight is a scam – what? You thought a limo driver could fund a legal fight all the way to the Supreme Court on his own, did you? You’re so darned cute. King is nothing but a conservative stalking horse who wants to screw six million people out of medical coverage while he himself gets taken care of under a federal healthcare program.

That’s the kind of selfish self-centered scumbag Republicans championed.

Just to stick it to Obama.

Only one little problem.

You see, the majority of the states which refused to cooperate with the ACA were, naturally, red states. And the vast majority of the six million who will lose coverage? Lower middle-class white conservatives in Southern states.

According to The new Urban study:

“…the biggest regional loser from the court case would be the South. More than 60 percent of people who would lose their individual health insurance live there. Among different income groups, the largest reductions would come for those earning between 200 and 400 percent of the federal poverty level—or between about $40,000 and $80,000 for a family of three. Forty-seven percent of the people who would lose insurance have full-time jobs, and 34 percent have part-time jobs. Sixty-one percent are white. Forty-seven percent have attended at least some college. Ninety-two percent would probably describe their health as better than fair.”

In other words, the people who will get screwed the most if Republicans win King vs Burwell are … Republicans.

In an election year.

Brilliant. Just … brilliant.

The thing is, the Republican majority Congress could easily fix the situation with a single amendment, a single line of text, but hardline conservatives won’t let them do it.  They’d rather 6.4 million people lose healthcare at the end of this month, most of them conservatives in the battleground states of Illinois, North Carolina, Ohio, and Wisconsin, right before the primary debates begin.

And now you know why Reince Priebus is popping anti-depressants like Tic Tacs.

John Boehner and Mitch McConnell will be thoroughly screwed if they win King vs Burwell, they’ll go down with the party boat. They’re damned if they do and damned if they don’t and they’ve got nobody to blame but themselves. If subsidies are thrown out by the court, they will either have to craft a fix to Obamacare, something that is absolutely anathema to majority of hardline conservatives, or they will have to take responsibility for millions of their most devout constituents losing healthcare coverage.

Darrell West, director of governance studies at the Brookings Institute says,

“It does create a political problem for the GOP because there could be millions of people who got health insurance as a result of ObamaCare who lose it. There’s a chance Republicans will get more of the blame because they’re in control of the House and Senate. Unless they can produce legislation, the blame will rest in their corner.”

And don’t think these disingenuous hypocritical sons of bitches don’t know it either.

Wisconsin Senator Ron Johnson who is facing a tough reelection in the swing state of Wisconsin wants to extend subsidies until August 2017. Thirty-one Republican senators have co-sponsored the measure, including Mitch McConnell.

Johnson says,

“My bill is a transition piece of legislation that will allow the American people a voice in what our health care system will look like beyond the 2016 election. It acknowledges political realities by preventing turmoil and disruptions should the Supreme Court rule subsidies cannot be paid through federal exchanges.”


Transition piece of legislation.


Remember how they called Obama’s “If you like your health care plan, you'll be able to keep your health care plan” the lie of the year? Well that fib has nothing on Ron Johnson. Because while Obama believed what he was saying, Johnson is lying directly to your face and he knows it. What Johnson isn’t telling you is that his bill has some very dire consequences. It’s nothing but a bribe, a payoff, to republican voters.

Johnson’s bill is not designed to let you keep your healthcare, it’s designed to let you keep your healthcare just long enough to get Johnson and his cronies reelected. 

Once he’s safely returned to office, the bill phases out federal subsidies and replaces them with … nothing. Fuck you.

If Johnson’s bill passes, more than six million people will lose their healthcare as soon as the election is over.

But it’s worse than that.

Johnson’s bill would not only get rid of federal tax credits in states with federally run exchanges, it would also eliminate them in states that set up their own exchanges, drastically increasing the number of Americans without healthcare insurance.  More, Johnson’s bill would eventually eliminate the Individual Mandate, removing the ACA’s foundation, drastically driving up costs and decreasing accessibility for those who still have healthcare.

The number of people in the United States without healthcare is currently at historic lows, but if those who couldn’t afford insurance without the subsidies go back to being uninsured the number of people without coverage would almost immediately increase to record highs.

Meanwhile, Nebraska Senator Ben Sasse proposed his own similar idea, legislation that would restructure subsidies … and then gradually eliminate them over the next year and a half.

That’s right, do the math on both of these proposals and you see exactly what republicans are up to: They intend to bribe conservative voters long enough to win reelection and then screw those very same people once they are safely back in office.

Johnson, Sasse, Republicans are not even keeping it a secret, they have just exactly that much contempt for their own dimwitted fanatical base.

That said, it’s unlikely Boehner or McConnell will allow either bill to reach a vote – their hardline masters won’t allow anything that gives even the vaguest appearance of refunding Obamacare, election or no election. They’d rather lose the White House and Congress than allow that.

Republicans in fact have five plans, none of which are anywhere near ready for prime time and neither John Boehner nor Mitch McConnell have made any effort to rally their respective houses behind any one plan – with less than two weeks remaining before the hammer falls. McConnell claims to have something up in his sleeve, but he’s provided no details and there’s been no discussion or debate in the Senate.

The simple truth of the matter is that Republicans have managed to hoist themselves on their own petard. 

They somehow managed to put themselves in a position where they are mortally terrified of winning in front of the supreme court.

Ironic, isn’t it?

Predictably, the only thing Republicans can agree on in the face of this looming GOP disaster is that it’s somehow all Obama’s fault.

Don Stewart, Mitch McConnell’s spokesman, attacked Obama for having no contingency plan in case the court rules for King,

“Unlike the Obama administration, which has no plan, Republicans are working to protect families from the consequences of ObamaCare.”


Protect families by leaving them uninsured and uncovered. Brilliant. Just … brilliant.

You know, America for better or for worse is country of the people, by the people and for the people. And if millions of the most hardcore conservatives lose access to medical care because the intractable sons of bitches they themselves elected to run this country would rather screw us all instead of doing their jobs, well, you know there’s a certain degree of poetic justice there. 

And if those same hardcore conservatives have to get screwed, have to go sick, have to watch their kids go without access to medical care, in order to finally wake up to the damage their selfish shitty ideology has done to this country, to the world, well, there’s a certain poetic justice in that too.

And if, like Reince Priebus fears, this really is the end of the once great party of Lincoln, I will shed not one goddamned tear.

Good bye and good riddance.


  1. The Republicans are doing it to themselves (snicker, snicker)!

    Dayumn, Jim, you've said it again!

    Pat in Canada

  2. What would be truly delicious irony is a republican implosion over the demise of the ACA resulting in it coming back as what it should have been in the first place.
    Single payer.

    1. IF that might happen, it would be worth it. But they've been attempting to dismantle Medicare and Social Security as well, so I doubt they'd allow single payer to come into being.

      Hubby said, back during Obama's first election cycle, that as president, he should simply use an executive order to eliminate the age restriction on Medicare, and tell congress it was up to them to fund it. Yes, they would cry, but their constituents who were newly able to access healthcare would rebel against them taking it away again.

      We both may realize it's not that simple, but maybe it SHOULD be.

      Gretchen in KS (who generally votes D in a red state, and just today got to watch my state elected leadership raise my taxes. (Only on the little people--it's on things like food, ya know.) Oddly enough, I don't make enough to get the subsidies, and my state didn't expand Medicaid, so King vs. Burwell won't have an immediate effect on me, either way. Of course, the long-term effects will surely be felt, even though I voted, but not for the ones who hold power right now.)

    2. Dear Gretchen in KS:

      From your mouth to The Powers' ears.

  3. What?. . . I can't even. . .What is WRONG with these people?

    That Other Jean

  4. Darn, I have things to do before I have places to go, yet, here I am, reading yet another good essay from Jim Wright. Thanks.

  5. Time and time again, the republicans have proven themselves quite adept at running for office (and getting elected). And time and time again, they have proven themselves unable and incapable of governing.
    The lock-step, get-in-line party mentality has served them well, again.

  6. I almost choked on my coffee yesterday when I read a complaint about the Obama Administration having no contingency plan if the King v Burwell lawsuit succeeds. Nice to try to place the blame on the President when the GOP doesn't have and never has had any kind of plan to help people have affordable healthcare insurance and health care security. When is the last time in 2014 or 2015 that we have read about people going bankrupt or losing their homes or being driven into poverty because of a big medical bill if they opted for Obamacare? Just that quickly, the ACA changed life for the better for all of us in the US.

  7. I totally agree with every thing in this post except one small detail. You spelled the name of the RNC chairman wrong, it should be Rancid Prepuce.

    1. I also think of John Fugelsang's "rewriting", which is merely to remove the vowels from Reince Prebus' name, which ends up being "RNC PR BS".

    2. C: that's *brilliant* disemvowelling!


    3. Isn't it though, glinda? :)

      He started saying that during the Republican National Convention in 2012 and I've picked it up and continued to say it and crediting him every time I do :)

    4. Maybe he will vowel out of politics - ya think?

  8. But the thing is, Democrats must use this singular moment and seize the day. Time for Medicare for all as the alternative.

    1. Ugh, I hate this solution! Medicare doesn't pay JACK SHIT. Unless they're willing to restructure Medicare and how it pays out, you may as well just keep it the system as is. Medicaid pays better than Medicare. I know this because my parents, in their 80's, are up to their eyeballs in medical debt.

    2. Have you seen what an Exchange plan pays? Even a good one?

    3. I keep forgetting that the reason my Medicare pays so well is because my Medicare supplement picks up so much of the bill.

  9. Amen! Good bye & good riddance- if we are lucky. Unfortunately, I don't know if Americans are smart enough to connect the dots. I could see them blaming Democrats instead. Thanks for the brilliant essay.
    Barbara Schneider

    1. Too right! Somehow it will all be Obama's fault. If the Dems don't get out in front of this with a really strong pushback to counter all the inevitable Repub lies, by election day 2016 a fair percentage of low information voters will have been convinced that Obama/Reid/Pelosi took away their healthcare.

  10. If the Supremes throw out subsidies for a majority of states, they will be doing it on the flimsiest of reasons. Scalia, for one, would have to perform a one-eighty from some of his other opinions where he was focused on "the intent" of the law.

    But not this time, I guess.

    Yet I'm an optimist. I don't think Roberts will screw up his "legacy" by letting the ACA go down. He would look like a horse's backside, after voting for the constitutionality of the law a couple of years ago. I guess we'll see, won't we?

  11. It begs the question, if the GOP meets its fitting end, what parties will vie to fill the void?

    1. I've been predicting the formation of a new party for years now. I suspect it will emerge from the coalition of moderate leftists and Tea Partiers that just stopped fast track. Going to be a bloody weird thing, but then, aren't they all?

    2. My intuition is that we are going to see a states rights decision from the Court. Possibly states will be allowed to stay on the exchanges, but they will have to vote for it.

      BTW, I don't see that the exit of the red states from the Exchanges will cause failure of the ACA in the states that have established exchanges. How do you figure?

    3. The ACA remains affordable only so long as enough people are signed up that insurance companies can keep rates "low." It works on the premise that a large number of people will sign up for health insurance that never previously had it. The volume of customers is what will help keep costs down.

  12. Dayeinu (because I don't know the future tense)

    Not so anonymous, Dale Kelley

  13. I guess my husband and I would be considered "collateral damage" – Democrats from Ohio who would also lose their coverage. So I don't have the wherewithal to indulge in schadenfreude right now, if the Republicans have their way, now or later. I'll vote my beliefs when that chance comes around, but in the meantime, and if the Democrats lose, I'll be paying $800 for ONE of my prescriptions.

    1. Sitting here in The UK on the edge of Europe, I dread to think how much my meds would cost if they weren't free.

    2. Janet, if that sadly comes to pass, please research your prescriptions on goodrx.com. It saved my family's pocketbook for almost a year while we were in 'transition' without the pharmacy copay.

  14. Unfortunately, the Republican party has been declared dead before, and manages to pull itself back out of the grave. It is busily gerrymandering every state while it owns most of them to make sure they never do run out of power. I think they will convince their supporters that Obama somehow took their health insurance away, and won't suffer any backlash.

  15. I will argue that for better or worse, this country needs two viable political parties. If one party collapses (which I would doubt even in this scenario - the GOP is too heavily ensconced in state legislatures to collapse), that leaves one party unchecked. I think the only reason the Democrats show any competence at all is that the Republicans forced it from them. I'm not going in the direction that "both parties do it", which I hear from time to time. What I want is for everybody to...

    ...join the GOP. No, seriously. The Republican Party needs us. They don't know it, and they darn sure don't want us, but they need normal people to drown out the wingnuts. It doesn't mean you vote for any of the Klown Kar Kids, because you can vote anyway you want in November. However, the Republicans need normal people to run for office in the primaries, and unless normal people flock to the GOP, the wingnuts will continue to win the primaries and hold the spots in the platform committees and stuff like that. It's time for normal people to flood the GOP and send the Dixiecrats back where they came from: the Democratic Party!

    1. Wouldn't it be better to form a new party?

    2. I've seriously thought about joining the GOP - in order to hasten our march into a new dark ages, which seems imminent. My hope is that we will emerge into a new Golden Age once the darkness passes. Let's accelerate the process. Vote GOP!

      But certainly not because they need us. We damn well don't need them.

    3. Lee, I've been registered GOP for years now. There are no sane ones to vote for in the primary. So I usually vote for the craziest, wingnuttiest one of the bunch.

      I've written in Sarah Palin a couple of times. lol

  16. Sadly you are giving the average Republican voter way to much intelligence. I have a family member who received notice that this might happen to them and who do you think they blamed. Anything negative that happens to health insurance at all will forever be linked to Obama in the minds of their voters.

  17. Here in San Diego, a young man died the other day trying to take some stupid video stunt with a freight train and I have sympathy for his family but have real trouble working up any kind of sympathy for an adult that is stupid enough to play on the train tracks.

    I have the same feelings about this. I feel sorry for all those that will be caught in this mess as collateral damage but I can't work up to any sympathy for the Republican party. I was a member of that party for over 30 years and finally gave up when it was obvious that they weren't just crazy, they were openly contemptuous of our nation -- both the common people and every government institution. At this point, I hope they do implode because maybe something will takes its place that is responsible and actually cares about the US.

    Anne, San Diego

  18. I know -- I tend to dream about the GOP SOBs in Congress having their health care yanked out from under them too. "You, a 72-year-old guy with LOTS of pre-existing conditions, have to buy an individual plan on the open market! Bwa ha! How do you like THEM apples, bucko?"

    I also admit to a certain amount of bitter amusement at the thought of the GOP working very hard to remove access to health care from their own constituents. But I then stop. These are real people we're talking about.

    Okay, they're not real bright; yes, they're being led into disaster by people who do not care whether they suffer or not; no, this is not good. Sick babies, guys with hernias, women who find lumps in their breasts, guys with heart conditions, kids with whooping cough and diphtheria, women whose knees are torn up from years of waiting tables -- people, okay? Just people. Who finally got health insurance, briefly, and are about to get it yanked away.

    Big tear-jerker, yeah? Not as tear-jerky as the fact that pulling the subsidies and wrecking the ACA is also likely to cause massive damage to the health insurance business and the American health care delivery system -- the hospitals and clinics and doctors' offices and whatnot.

    "The potential impact of a Supreme Court decision gutting Obamacare subsidies in three dozen states is often discussed in terms of the millions who could lose health coverage, potentially destabilizing insurance markets across the country. But it turns out that the impact could be considerably more dramatic than that, radiating out to produce untold economic damage, too."
    I'll just leave the link -- the reporter explains it much more clearly than I could.

    1. That line of argument is from a conservative who wants to do think like privatize Medicare and turn Medicaid into a block-grant program which the states can raid for money. I have some doubts about his credibility.

      A narrower, but probably more accurate assessment, comes from Richard Mayhew at Balloon Juice.

    2. If you had read that brief article, you wouldn't make uninformed remarks about "conservative" or "privatize" or "block-grant programs."

      The point of the article is that wrecking the ACA, which would cause chaos in the health insurance and do massive damage to the healthcare industry, would ALSO - surprise, surprise! -- have a serious economic effect as well. And that's just what we need: A big negative shock to our economy.

      And the effect won't be a short one. I worked in the health insurance industry for some years, in underwriting. Those fools in the GOP have no idea that they're trying to hit a bottle of liquid nitroglycerine with a brick, mainly because they don't care. Their overriding ambition is to wreck the ACA, and they do * not * care * what else goes down. Like, say, the health insurance industry. You're familiar with the term "death spiral," I take it. . .

      God have mercy but it's gonna get ugly.

    3. I not only read the article, I clicked through to the longer article uses as a source. That article cites Dr. Stuart Butler of the Brookings Institute, a sometime Heritage Foundation "scholar." Take a look at the guy's list of publications. Go on, look. The link I gave is to his Heritage page, they're all there.

      I believe Dr. Butler is talking up the potential problems of a decision in favor of King so that he can discredit the ACA, I think he ignores the reality that, percentage-wise, not that many people are getting the ACA subsidies. Losing them would hurt the beneficiaries, yes. Likely some would will die. However, I don't think the financial losses are big enough to affect the health care system as a whole. It's just more scare talk, like we've been hearing from ACA opponents, including Dr. Butler, all along.

      I stand by my earlier remarks.

    4. To which I will add that I don't see the employer insurance market or hospitals as shutting down. But the collapse of the Exchanges in the red states will hurt the insurance industry in those states, and, should the subsides be restored, raise prices or even make the system by making offering Exchange plans a riskier investment—who knows if the Court or Congress will trash the market again?

    5. And this Kaiser link from 2014 gives some actual numbers. I spot-checked Alaska, Alabama, California, Florida, Wyoming. The numbers of people getting Exchange tax credits as of that study are single-digit percentages of those state populations. I don't see how the withdrawal of those relatively small numbers of people can crash the whole system. Hurt, sure. But, am I missing something?

  19. "Don Stewart, Mitch McConnell’s spokesman, attacked Obama for having no contingency plan in case the court rules for King,

    “Unlike the Obama administration, which has no plan, Republicans are working to protect families from the consequences of ObamaCare.” "

    (side note: I don't know how to properly quote something in the comments, so I'm doing it this way. Apologies to Mr. Wright if it's not the right way to do this.)

    *sigh* it is statements like the above quote that make me want to go bang some Republican and Tea Party heads together. The claim that President Obama "has no plan" is such bull-crap that I can barely contain my anger.

    President Obama has a plan. It is the same plan the GOP/TP want to destroy merely to spite Mr. Obama. But that is not what the FoxNews cloned media will say.


  20. Just a quibble: Brookings is generally considered centrist or liberalish rather than conservative. https://en.wikipedia.org/wiki/Brookings_Institution

  21. I was cheering as I read each paragraph, Jim! I am sharing on my Flakebook page in the hope that it will be passed around so that more people understand exactly what is on the line in this decision, this election, and this country. The contempt shown by the Gassy Old Penisheads for their constituents and the nation as a whole is so openly displayed these days that I cannot fathom ANYONE believing these politicians have their best interests at heart. I guess I can't underestimate how the power of the brainwashing doled out by the Republicans/Tea Partiers and Fox has influenced the knuckle draggers, the "patriots", and the just plain stupid people in sealing their own demise. I only hope Reince Priebus and his country-club-silver-spoon-ridiculous moniker is the first one to hit the water when the ship goes down.

    Pam in PA

    P.S. To Rick Belongs-In-A-Sanitarium-What if you threw a campaign event and nobody came? Hahahahaha!!!! Asshat.

  22. It is, I think, worth pointing out that there is no conservative alternative to the ACA because the ACA is the conservative alternative. If the ACA goes down, it is probably good politics to remind conservatives that this is what you asked for, this is what you wanted, and to keep doing it until it sinks in.

  23. Not to change the subject, but personally I do have a bone to pick regarding how the ACA was implemented. And I believe it needs to be amended. I do believe many people were helped by the passing of the ACA, but I also feel it is incredibly unfair to have made the purchase of insurance mandatory. In my case, I make a reasonable amount (50k), but I also have some exceptional expenses (student loans, custody payments, living in an area without enough affordable housing – expensive rent, etc.) which make getting by every month a bit of a challenge. And as much as I make, given these expenses are not counted against my income, I don’t receive any expense reduction for health insurance.

    Last year when I was unemployed for a couple months through no fault of my own, I didn't pay for health insurance as I couldn’t afford it without ending up homeless. Thankfully I was able to waive the penalty by claiming insurance plans in my area were too expensive on my taxes. Now my new employer pays my insurance, which is great, and possibly wouldn’t happen without the ACA. However, my insurance has so far been worthless, as it doesn’t pay for any services from Planned Parenthood which has pretty much been my only medical expense so far – to update my birth control prescription, go figure.

    My point is that making healthcare a mandatory expense hasn’t been helpful at least in my experience, especially if the insurance offered doesn’t cover common expenses. Hopefully this occurrence causes an amendment in favor of the poor and middle class instead of just hurting them – but that’s probably too much to ask for.

    1. "as it doesn’t pay for any services from Planned Parenthood", courtesy of The GOP, as I recall. God forbid that someone would get care from The Planned Parenthood Abortionists.

    2. I believe you are thinking like the guy that didn't want to buy health insurance because he was against it, and he always pays things by himself without government help. Now, he has diabetes and is going blind and doesn't have money to pay the surgery.My point? You never know when you REALLY need to have health insurance. Being young doesn't mean that suddenly you don't get sick, very sick.

    3. Unfortunately, if you have an insurance based system, the only way it works is to require everyone to have insurance. Bowing down to the gods of the (non-existent) free market and protecting the health insurance industry is why the Heritage Foundation, in 1989, proposed what later became "RomneyCare" in Mass and the ACA....The ACA began as a Republican plan, curtesy of Heritage, and it remains so. And, I am on medicare, so I don't know personally, but all ACA plans were supposed to cover things like annual checkups and birth control for free...and it should not matter if you obtain those types of services from Planned Parenthood....good luck!

    4. Jim sir, I object to your permitting Long Ben Avery to insult the previous Ms. Anonymous on your forum. Thank you for your attention to this.

    5. Anonymous @12:07 I think you missed the sarcasm. Ben wasn't insulting the commenter, he was agreeing

    6. Vicki, What has happened is PP is not an accepted provider under your policy. The good news is your annual well woman exam, where you would get your BC prescription, is 100% covered so long as you go to a doctor that is accepted under your plan. If you find a Family Doc or Internist you like they can also perform your annual physical, also 100% covered. And a piece of advice: Don't discuss any type if 'illness' at either one of those preventive appointments or they will bill you for the doc visit. Stupid, I know, but true.

    7. It would be much more fair to fund health care through the graduated income tax, but then who would support the poor, poor—well, very rich, actually—health insurance companies?

      Still, this is the system we for the moment have, so here's a few thoughts on dealing with it:

      1. Are you claiming the student loan interest tax adjustment? If you need to go back on ACA coverage, claiming that adjustment raises your tax credit.

      2. Most employers are now required to make contraception available through their health insurance plans, but some are not, some will but don't yet, etc. etc. It's complicated. You may have some choices you are not aware of. A summary is available from The National Women's Law Center.

      3. The ACA requires preventative care, including women’s preventive health care services, to be covered.

      4. Insurance plans get you price breaks on doctor visits and pharmaceuticals, even if they provide no other payments.

      So, no, it ain't great, it ain't even good, but it is an improvement.

    8. Anonymous at 1:41, thanks for the hint about the doctor accepted by my plan. I will have to check that out. I've been risking not having birth control because I really couldn't afford to pay for renewing my prescription out of pocket (stupid I know) so if it is covered that's a lifesaver. Regardless, I don't understand why my plan wouldn't cover Planned Parenthood as their services are provided at a far cheaper cost and for a much broader geographic range than the average OB-GYN. I have to assume someone set it up that way intending to reduce support toward PP. It makes me think I need to work with my employer to get a more acceptable plan. - original Anon

    9. "I don't understand why my plan wouldn't cover Planned Parenthood as their services are provided at a far cheaper cost and for a much broader geographic range than the average OB-GYN."

      The price you see from PP isn't necessarily the one an insurance company negotiates, so they might be getting a better deal from other providers. Especially at the low end of rates, insurance companies are penny-pinchers—your ability to access care is not in the calculation. On the other hand, you could be right, and this could be bigotry at work. Insurance company management is nasty. These are the same firms that, pre-ACA, routinely looked for excuses to cancel the insurance of very sick people. They haven't magically turned into good corporate citizens just because they're under modest regulation.

      (If anyone is wondering, yes, this is part of why I say the ACA "isn't even good.")

  24. the republican 'dimwitted, fanatical' base always votes against it's own self interest. I don't see them stopping doing that just because they lose their health insurance. they will do what they always do when their lives become harder due to republican policies...they will blame the black guy and continue to vote republican.

  25. The insurance companies will decide this case. For or against, whatever maximizes profits the most will be the ruling. I'm sure the insurance industry has an army of lobbyists working to get the outcome they want.

    Without the subsidies many folks will drop coverage and that will force rates to go up for those that don't receive subsidies. This could set up a chain reaction of price increases for individual and company plans so big business is looking at this case with great interest also.

  26. Rather unsurprisingly, Reince Priebus is also displaying a notable ignorance of this country's political history if he's worried about not being able to "compete" "sixteen years out" (2020 one supposes). In fact, with the singular exception of the Roosevelt-Truman years (20) in power - which was significantly influenced by that little incident known as the Second World War - the typical rule has been that just twelve consecutive years of holding the Presidency is usually enough to tire the public on whichever party holds it. However, Priebus does have a point that the GOP is going to have to - eventually - offer the national voting public something more than the the current menu of rehashed resentment politics and hollow warmongering, in order to stay relevant on the national level. The worst part, though, is that the Republican deathgrip on Congress, and State legislatures throughout the country is unlikely to be much affected - unless by some miraculous Democratic landslide in 2020 which will allow them to undo the worst of the GOP gerrymandering from 2010. Good luck.

  27. I'm glad the Democratic members of the Democratic party stuck it to Our President and his crappy "trade" bill.

    Still being pushed by Obama and most of the GOP.

  28. Checking "You are my God" is a bit much for one such as I who believes that he is also God. Were it not for that, I would. I will say that do I listen to what you say. It will get interesting if you are right about this. Luckily, I was born with parents who placed us in farm country in the state of New York. There are worse places even considering the weather. Be well, sir.

  29. From "Scott F"

    Jim, great writing, as usual. Thank you.

    Based on the title or the article, I was a bit disappointed that you didn't expand on what the "death spiral" actually is.

    If people at the bottom of the income ladder can't afford the insurance without the subsidies, then they will not buy the insurance, regardless of the penalties. (The penalties are pretty trivial, compared to the full fare of the insurance.)

    However, if the pool of people paying insurance premiums shrinks, then the cost of the insurance premiums for the remaining people are going to go up. When they do, the people on the next rung-up on the income ladder will find that *they* can't pay the premiums either, and they will stop paying into the insurance pool. Insurance premiums will again go up.

    Repeat for each rung of the economic ladder.

    What this means is that payments to *hospitals* will start to dry up. All these newly uninsured people will continue to go the hospital… the hospital *emergency room*, which is the most expensive kind of medical care. While the payments from the ACA (or Medicare or Medicaid for that matter) to hospitals aren't great, they are better than zero, which is what the uninsured will be (not) paying.

    Remember, hospitals are not allowed, by law, to turn people away.

    So, either hospitals will close, or they will start raising their rates for those people who *can* pay. This will even effect people with existing insurance plans, which will then have to raise their rates. Which will force more people out of the insurance market, continuing the "death spiral" of the health care industry.

    Hospitals in Red States are already closing, because those Red States refused the Medicaid expansion. People in those Red States are paying *twice* for their medical care. First, they are having to pay out-of-pocket because they aren't covered by the expanded Medicaid. Second, the people in the state are still paying the higher taxes and fees to the Federal government that were intended to pay for the ACA. So, the Red States are paying the ACA taxes to the Federal government, but not getting the ACA benefits from the Federal government.

    Just one more way the Red States are screwing themselves.

    Finally, (though I know it was covered earlier) to question of why there needs to be a mandate at all. The mandate is required for two reasons. First (as mentioned) the whole idea of insurance is to spread the cost of paying for health care. If everyone pays a little, then those that actually need it can afford to receive it.

    Second, and just as important, is that the ACA requires that insurance companies cover a certain minimum number of things. One of those things is that the insurance company cannot refuse to insure someone if they have a "pre-existing condition". If you don't know what that means, look it up.

    Imagine, if you will, if auto insurance worked that way. Let's say, you didn't have to buy auto insurance, but the insurance company was required to pay your expenses, even if you had an accident. So what do you, as a rational-self-interested person do? You refuse to buy insurance. Then, *after* you have an accident you run out, buy the insurance, and then insist that the insurance company pay your bills that haven't come do yet.

    How long do you think the auto insurance market would last if it had to work under those rules.

    1. That death spiral was exactly where we were before the ACA was passed. But Republicans can't remember that period of recent time.. Nobody then was wearing tricorner hats or carrying muskets much I guess.

    2. Well, yes and no. It's similar, but not exactly the same.

      Actually, the "death spiral" would be worse now than before the ACA was passed. All that King would do would be to invalidate the subsidies. The rest of the ACA would remain in tact: the taxes and fees to pay for the whole thing, the individual mandate to have medical coverage, and the regulations on the insurance companies.

      Prior to the ACA, insurance companies didn't have to cover pre-existing conditions, and a bunch of other things. If you didn't have insurance and got diabetes, too bad. No insurance company would touch you. Now, under the ACA, insurance companies are required to insure you.

      So, as a rational-self-interested person, you would refuse to buy insurance. Then, you get diabetes. Then you go buy the insurance, and you cannot be refused.

      In this kind of market, under the ACA, the insurance companies cannot control their income and expenses. Insurance prices would rise dramatically faster than before the ACA was passed, because the ACA has changed the insurance market place.

      (The guy in the news recently who refused to buy insurance and is now desperate to get medical care is an anomaly, or at least not the norm. His problem is that his condition is acute, needs immediate attention, and he is outside the open-enrollment period. If his problem was more chronic, he could just wait 9 months and buy new insurance to cover his expenses.)

      Scott F

    3. I take your point Scott, but it's not really so very different. Yes people can't be turned away now, but before, when they were turned away, they generally ended up in the emergency room and had to be treated (at the expense to a very large extent of those who still had insurance). Of course their outcomes wouldn't be very good but the expense of those poor outcomes would probably be even higher than if they had treatment when they should have done. Step back a bit and under either system the main point is that the entire population remains in the system, one way or another, but fewer and fewer people would be paying for insurance. Under the pre-ACA death spiral premiums for those who could still get insurance were going to rise and rise (driving more people out, and thus making premiums for the remaining subscribers go up and up even faster).
      So yes, it's a spiral with a (slightly) different shape to it, but it's still a spiral. Only way out is to have everyone in the pool, and it's still cheaper to subsidize the members of the pool who can't pay for themselves, because treating illness in good time is almost invariably categorically cheaper than waiting until illness progresses until it puts a person into an emergency room situation. BB (same anon as above)

  30. Members of my family and I were discussing the idiotic statement by Sen John Thune where he blamed Obama for not recognizing how bad Obamacare would be once the subsidies were eliminated, cheered on by the GOP at large (I know, I know...hard to argue with that logic.....I mean really, really hard to argue with stupid.) I commented that the GOP politicians probably weren't that stupid and that one could argue they are playing to their base. I just wonder if the base is that stupid or are they offended by their politicians who think they are. Some of them are surely stupid and will blame Obama for everything but where do the other non-idiots go? I wouldn't be surprised if republican turnout this cycle is less than in years past. Wouldn't be surprised if some actually vote for Clinton, either.


    1. I live in SD - Thune's state and no I have never voted for the man. South Dakota is a staunchly red state and gotten worse in the 23 or so years that I've lived here. My in-laws say that the average SD GOP voter would vote for a dead horse with GOP next to the name on the ballot before they would vote for a Dem. From what I've seen and heard, I'd have to agree. But, the GOP is fracturing to some degree in this state too. There are party factions and they are nearly as militant against each other as they are against the Dems. I suspect, but can't prove that the factions are mostly grouped by income levels. The higher income levels determining which candidates appear on the ballot. The rank and file voter, on the lower end of the economic ladder, will cast a straight red ballot as a matter of self-importance and is that much 'better' [or maybe just pious enough to vote 'pro-life' no matter what] than those Dems.
      V. Shriver

  31. The good news (for the country) (except it gets these Republican haters off the hook) is that King will not prevail. 5 members of the court may be conservative, but even they could not bear to make the law look like such an ass as that. It won't happen. Mark my word. BB.

    1. “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter. [The disputed] Section 36B can fairly be read consistent with what we see as Congress’s plan, and that is the reading we adopt.”

      All's well that ends well. For the next two years anyway. BB

  32. Not as cynical as you think you are, Jim.

    You think when it goes down, Republican voters will connect the dots. Why? Have they ever done before?

    Consider Senator Thune

    "'Six million people risk losing their health care subsidies, yet @POTUS continues to deny that Obamacare is bad for the American people.'"

    Parse that. In what universe does that make sense?

    Will Republican Voters really blame the GOP? Or will they believe because the socialist-muslim-atheist-[whisper it]-nigger did it badly, it's his fault?

    I did something I don't like doing. Something that make me want to scrub my brain with wire wool. Even though I am British, and 5000 miles away it angers me that this is even a thing.

    I went to Free Republic. More accurately I typed Free Republic Thune into my search bar.

    It's a post by someone critical of Thune. A liberal who can be bothered to type on Freeper.


    Now look at the replies.

    It's Obama's fault for forcing the secretive legislation through, without letting Republicans see it.


    That's right, because the one thing that people really want from their government is 'Devil take the hindmost'.

    Well, as it turns out, some of them do. Because if you are poor then it's your own fault. Those comments say all that has changed is those who buy their own are now forced to buy for those who don't.

    Read those replies. Compare with the facts as know, Well I say facts, because we all know that Liberals control the media and lie about Obamacare constantly.

    Some research was published recently. It turns out that telling humans facts tends to reinforce their own incorrect opinions. Remember - changing your view is flip-flopping; a sign of weakness.


      The most amazing thing is that this is exactly backwards. States without the ACA subsidies are at a competitive disadvantage, because they (the State in general) are having to pay twice for medical care: once for the ACA and Medicaid taxes and fees, and a second time to actually pay for the medical care of those low income people.

      Even the people in the state of Texas (for example) are starting to notice.

      This isn't lost on the hospitals in those Red States, which are having to start closing their doors because they can't afford to stay open even now. Just wait until the "Death Spiral" starts to kick in. Even if you are lucky enough to have medical insurance, if you don't have a hospital in your neck of the woods, the insurance doesn't do you a bit of good. You're SOL, screwed over by the politicians that you've elected for yourselves.

      Scott F

  33. Down here in ol' red Texas, I'm hearing from a lot of people whose insurance premiums went up a lot. Of course, that may be because their old insurance didn't cover very much. A bigger problem that I hear about is that many providers are not accepting Exchange patients. So all these formerly uninsured folks are paying a premium, even a subsidized one, and can't find a doctor to see them. That's a big problem (and one that Medicare patients have known about for a long time.) I don't see any of that changing as long as malpractice insurance is the physician's biggest expense and as long as the only way to make money for private insurance companies is to deny or minimize care. The single payer countries all have their own problems for sure, but we'll never get there until Congress can stand up to the insurance industry. ACA was the century's biggest giveaway for them with all those mandated customers, and still they complain.

    1. The problem we are having with the NHS in the UK is that it is underfunded compared to Europe - approx 8% of GDP goes on health, in Germany and Europe it is above 10%. But this way the right can say 'Look, it isn't working - lets privatise.' Unfortunately Brits want Scandavian public services with US tax rates.

      Interestingly the Federal (only) US health spend per head is only a little less than the total health spend in the UK (these are back in 2008 - not sure how ACA has affected this), with insurance about the same again. That means for no more than DC was already spending the US could have had a a near NHS, with all that extra money to cover the above and beyonds, or just improve the economy.

  34. "And the vast majority of the six million who will lose coverage? Lower middle-class white conservatives in Southern states."

    The sad thing is that if SCOTUS decides against the ACA, they won't be sticking it to Obama. President Obama has healthcare and so do the Republican politicians who keep voting to repeal the ACA.


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