The Affordable Care Act is a big deal, and it does a lot of good for millions of people, but it’s just a start.
Many on the left continue to gripe that President Obama refused to push for a single-payer health plan, such as Medicare For All, which is a popular solution. But they need to recognize that many of those two-thirds of Americans who tell pollsters they would like to see Medicare For All also apparently vote for Republicans.
The limits on health care reform were set when the Senate adopted its rules in January 2009. Those rules kept the filibuster, which allowed 40 determined senators to stop legislation from proceeding — and the Obama administration had every reason to believe that the Senate’s 41 Republicans would block any attempt to pass a single-payer bill. At that time, Democrats had 56 members, plus two independents who caucused with the Dems (Bernie Sanders of Vermont and Joe Lieberman of Connecticut). Republicans were contesting the election of Al Franken in Minnesota and Arlen Specter was still a moderate Republican senator from Pennsylvania.
Republicans have profited from their lies about the Affordable Care Act, starting with the preposterous claim that they were not included in the negotiations, after Senate Finance Chairman Max Baucus (D-Mont.) made a point of including Republicans — and excluding single-payer advocates — from the talks. We now know that Republican leaders agreed on the night of Obama’s inauguration not to cooperate with the new president.
Republicans even taunted Democrats for not passing more of their agenda in the 111th Congress, when they had 60 votes, but Dems only had that working supermajority for about five months — and even then they were forced to rely on senators to rise from their sickbeds to overcome GOP filibusters. Sen. Edward Kennedy (D-Mass.) collapsed at a luncheon after President Obama’s inauguration on Jan. 20, 2009, and he was forced to resume chemotherapy for cancer, coming back to Washington only as necessary. Republicans didn’t cut him any breaks. By the time Specter had switched parties in April and Franken was sworn in on July 7, giving Democrats the long-sought 60th vote, Kennedy was gravely ill; he died Aug. 25, without getting a chance to vote for the health bill his committee had drafted. Kennedy was replaced by interim Sen. Paul Kirk, a former Kennedy aide, on Sept. 24, but as the health of Sen. Robert Byrd (D-W.V.) declined, Republicans saw another opportunity to sideline the legislation. However, Byrd made every crucial vote for the healthcare debate and broke the late night filibuster on Christmas Eve 2009 with the words, “Mr. President, this is for my friend Ted Kennedy! Aye!”
After the Senate passed the bill, the upset election of Sen. Scott Brown (R-Mass.) on Jan. 19, 2010, put an end to the Democratic supermajority. That left the House with a take-it-or-leave it bill from the Senate, with some fixes in the budget reconciliation, which was not subject to filibuster. The House passed the bill March 21, 2010.
Medicare for All is clearly a more efficient way to provide universal health coverage than requiring everybody to be covered by private insurance, but we recognize that the single-payer plan never had a chance in the 111th Congress. The bill has been introduced in every Congress since 2003, but it never made it to the House floor, because leaders are reluctant to expose their caucus members to a vote on a controversial bill that has no chance of passing.
In the Senate, Bernie Sanders tried to pass the Medicare For All bill as a floor amendment to the bill, but he probably counted less than 20 votes for it. If Republicans had not insisted that the 767-page amendment be read out loud while the Senate was in session, while the Senate was trying to finish its business before the Christmas holidays, single-payer advocates would have gotten a Senate record vote. In any event, Joe Lieberman, who had been seeking a way to punish liberals who denied him the Democratic nomination for re-election in 2008, announced that that he would join the Republican filibuster if the bill included a Medicare buy-in.
So the left didn’t get Medicare For All, or even a “public option.” But insurance companies must show that they can provide insurance coverage for all comers and keep costs down. In effect, the insurance industry was put on probation.
Also, the stock market reaction to the court decision was evidence that the ACA was not necessarily a boon for the insurance companies. Insurance stocks fell in the hours after the court ruling was disclosed, reflecting investors’ concerns about the costs of regulations and the limits on corporate profits. However, hospital stocks rose sharply because the new law gives them the prospect of more than 30 million paying customers. Under the current law, about one-fourth of the care provided by hospitals is never paid for. The law is expected to cut that unpaid portion in half.
The Affordable Care Act would still leave 27 million people without health coverage — and millions more if many states take advantage of the Supreme Court rewrite that allows them to reject the expanded Medicaid coverage, under which the federal government offers to cover the working poor, up to 133% of the poverty level ($30,657 for a family of four). Currently, the states set the income levels of the families they cover. Texas, for example, only covers parents of a family of four that make up to $8,277 per year. Full-time minimum-wage workers must rely on charity.
So far, 11 Republican governors have said they will not accept the Medicare expansion, denying coverage to 5.3 million working poor residents, while 18 Republican governors have not decided if they will accept the federal money to cover 3.9 million residents.
Chief Justice John Roberts sided with the liberal wing to uphold the Affordable Care Act, but his decision undermines the use of the commerce clause and “necessary and proper” clause for other federal mandates upon the states. Roberts is no friend of working people or democracy and the court split demonstrates the stakes in the presidential election. There is a good chance that the next president will replace one or more members of the court. Ruth Bader Ginsburg is 79 and has been treated for colon cancer in 1999 and pancreatic cancer in 2009. Antonin Scalia is 76, Anthony Kennedy is 75 and Stephen Breyer is 73. Scalia, Kennedy and Breyer apparently are in good health, but a heart attack could swing the court back to the liberal centrists or it could reinforce the right depending on who makes the nomination.
The right-wing majority June 25 showed that any hopes that it was having second thoughts on Citizens United was wishful thinking on the part of good-government advocates. The court rejected a Montana Supreme Court decision that would allow the state to continue its century-old ban on political spending by corporations.
But the Supreme Court denied the same rights to labor unions, June 21 in another 5-4 decision in Knox v. SEIU. Non-union members can be required to pay their fair share of collective bargaining expenses of labor unions, but employees have had the right to opt out of the union’s political expenses.
In this case, the SEIU issued an “emergency” dues increase to raise funds for fighting anti-worker initiatives on the ballot in California. Seven justices agreed that the union should provide nonmembers to get a refund for political expenses, but the five conservative justices went further and Justice Alito, writing for the majority, said that unions can only assess such an emergency dues increase if employees affirmatively choose to opt-in, departing from the long-standing principle that opting out of paying for political expenses was constitutionally sufficient.
John Nichols noted at TheNation.com that corporations do not have to seek the approval of stockholders in order to direct money into political campaigns. A growing number of union leaders and activists recognize that the campaign finance system being created by Supreme Court radicals is designed to serve multinational corporations, not democracy. The AFL-CIO has edged toward backing a constitutional amendment that overturns Citizens United and restores the principle that corporations do not have the same political rights as human beings. That’s a step in the right direction.
Organize for a constitutional amendment, but a quicker solution might be to re-elect Obama and hope Scalia retires.