Fix It

No rust on this one

When one of my old trucks start to fail, I always have to decide, is it worth fixing? Sometimes it is; sometimes it just ought to be junked. I tend to be a fixer, but I have junked one. The rust won. It was the right thing to do.

We are about there with the ACA. President-elect Biden campaigned on fixing it, not buying a brand-new model (Medicare for all). Trump campaigned on everybody having the kind of insurance and treatment he got for his Covid infection. Oops, he never said that. Actually, there has been little proposed on health care from the National Republican Party, except: “Repeal Obamacare!”

Tuesday, November 10th, the Supreme Court will hear arguments about junking the ACA. Some states and the Federal Government want it declared unconstitutional. Some states are defending it.

The arguments are long and complicated, and the path to this situation has been tortuous. The ACA passed congress without a single Republican vote. It was upheld by SCOTUS as constitutional (5-4) at the first lawsuit in 2012. The individual mandate was called a “tax”, thus within congresses power to levy. Then, after Trump got elected and the Republicans had control of the Senate and the House they tried to pass a replacement, but couldn’t. Instead they zeroed out the individual mandate “tax”. This gave room for states to sue that the law was now unconstitutional. Since the Trump administration supports the repeal it couldn’t get done in congress, they have joined the states in the lawsuit. The Federal Government is asking the court to repeal a law it couldn’t do through legislation. Isn’t this the kind of thing “originalists” don’t want from court decisions?

I’m on the fence with this one. It’s like both the transmission and engine are bad, but I can’t afford a brand new one.

The ACA tried to work within our current health care insurance model. It tried to make companies offer comparable plans, establish a floor for minimum coverage, not exclude people for preexisting conditions, get young people enrolled on their parents plans and a thousand other things. But each of these market manipulations required attention. If the individual marketplaces (exchanges) weren’t working right, they needed tweaking. If the costs of policies rose to be unaffordable, the supports to the insurance providers needed to increase. And for over ten years now there has been no attention to maintenance. No point putting in a new engine if you don’t plan to change the oil.

All these complicated rules, and more: the plan as originally passed was supposed to be cost neutral. But since it’s passage, most of the tax increases (medical device, Cadillac plans) that helped pay for the savings have been repealed.

If we had a functioning congress, one where both parties accepted that this is a problem to solve, not use for political gain, there might be hope. I thought when Romney got the Republican nomination he would change the conversation, since the model for the ACA is based on the program he got passed in Massachusetts when he was governor. But no, he couldn’t talk about healthcare either. Have we poisoned this issue?

So now we will have a Supreme Court with three justices nominated by this administration deciding whether to keep the engine, replace the transmission, or in fact tow it to the junkyard. Heck, they could just wash and wax and call it good. Who knows? It’s just amazing to me, that as an engaged electorate, we have let this happen.

Most who look at this pending case agree that if the whole law is found unconstitutional, the effect will be very broad and profound. The health insurance market will be scrambling, people will lose health insurance, and the disruption will be explosive. Maybe then we will be able to talk about a solution. But we need to fix it or junk it.

About ddxdx

A Family physician, former county coroner and former Idaho State Senator
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