Special Briefing
IN ASSOCIATION WITH THE PRESIDENTIAL DAILY BRIEF

To Your Health

The Obamacare Dossier

This is an OZY Special Briefing, an extension of the Presidential Daily Brief. The Special Briefing tells you what you need to know about an important issue, individual or story that is making news. Each one serves up an interesting selection of facts, opinions, images and videos in order to catch you up and vault you ahead.

WHAT TO KNOW

What happened? Federal Judge Reed O’Connor of Texas made headlines Friday when he struck down the Affordable Care Act (ACA), aka Obamacare. He deemed that mandating the purchase of health insurance was unconstitutional — and thus that the whole law should be tossed out. O’Connor’s ruling is at odds with a 2012 Supreme Court ruling the mandate constitutional. The reasoning? That it’s within Congress’ purview to impose tax penalties. But the group of Republican governors and state officials who brought the current lawsuit argue that since the penalty for not buying coverage has been reduced to zero, the mandate is no longer a tax and thus is now not allowed under U.S. law.

Why does it matter? If O’Connor’s decision is upheld — Obamacare’s protections will stay in place while an anticipated appeal is pending — about 17 million Americans could lose their insurance. An appeal would first have to make its way through the 5th Circuit Court, and from there to the Supreme Court. But the timing of the controversial ruling, which came one day before the end of the main open-enrollment period on Dec. 15, may have confused people and could lower sign-up numbers even for those with extensions. Enrollment is already down 11 percent, likely the result of changes to the attendant tax penalties and a slashed publicity budget that hurt advertising efforts.

HOW TO THINK ABOUT IT

The clincher. Chief Justice John Roberts’ ruling in favor of the ACA six years ago surprised observers, not least conservatives who were expecting him to strike it down. He sided again with Obamacare in a 2015 ruling, albeit with a less significant split on the bench. Some observers have theorized Roberts (pictured right) was playing a political long game by appearing nonpolitical; others say he’s keen to separate himself from partisan political wrangling. Either way, his judgment is unlikely to change for any future ruling if, as is expected, the case makes it all the way back to the Supreme Court.

Political play. As many as 34 Republican lawmakers who voted to repeal Obamacare in 2017 saw their seats go to Democrats in the midterms. Though not all lost their elections — some retired — it’s still a powerful message that the ACA may be a winning issue for Democrats, and this ruling keeps it squarely in the spotlight. Meanwhile, Republicans who campaigned on promises to protect coverage for those with pre-existing conditions, which 90 percent of Americans say they support, may now find themselves having to defend a ruling that eliminates those protections.

Mercury rising. That political reckoning is likely to hit soon. House Democrats are expected to introduce a resolution defending the law immediately after the 116th Congress is sworn in on Jan. 3. But this won’t be a straightforward win for anybody: Democrats and Republicans are divided within their own parties over the best way forward, be that single-payer health care, Obamacare, a repeal or something else. Meanwhile, America’s health care industry has expressed trepidation about what’s likely to be a very uncertain road ahead.

Another threat. Shortly before the Texas ruling, news broke of leaked emails from the Trump administration that discussed how cutting 90 percent of the advertising budget for HealthCare.gov would likely cause sign-ups to plummet. While the administration had claimed it had no reason to think the cuts were related to dropping enrollment numbers, these emails paint a different picture. Still, officials refute claims that their actions amounted to sabotage.

WHAT TO READ

Texas Obamacare Blunder in The Wall Street Journal
“President Trump hailed the ruling in a tweet, but he has never understood the Affordable Care Act. His administration has done good work revising regulations to reduce health-care costs and increase access, but the risk is that the lawsuit will cause Republicans in Congress to panic politically and strike a deal with Democrats that reinforces Obamacare.”

Are Republicans Crazy Enough to Kill Obamacare Like This? by Michael Tomasky in The Daily Beast
“They have no plan for insuring the uninsured. They don’t want to insure the uninsured. Oh, maybe, if you’re basically healthy and reasonably well-off (which makes you statistically more likely to be white, which is just a coincidence, honestly!). But if people are sick and poor, forget it.”

WHAT TO WATCH

What’s Next for Patients Covered Under the Affordable Care Act?

“Anybody that has a pre-existing condition, anybody that was relying on Medicare or Medicaid, or anybody that enrolled … that law that they were relying on was just declared unconstitutional.”

Trump Aide Stephen Miller on the Affordable Care Act

“We’ve increased choice, we’ve increased competition, and for the first time in a long time, premiums on the exchanges are going down.”

WHAT TO SAY AT THE WATERCOOLER

What do the people think? Obamacare has broad public support — its popularity has risen from 34 percent in 2014, when it went into effect, to an all-time high of 53 percent now. And those approval ratings made their highest jump in 2017 when the law was under existential threat, which means it could see a similar bump now. But if it’s struck down, there’s also a formerly fringe “Medicare-for-all” single-payer plan that’s gaining ground, with 59 percent of Americans favoring it overall and 75 percent saying they like it as long as other options remain available.

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