You know it’s been a big week when the Supreme Court once again upholding Obamacare is only the second biggest story to come out of the court. But I wanted to write about this ruling and what it means.
As you may remember, I exulted in 2012 when the Supreme Court upheld Obamacare the first time, rejecting a claim that the law was unconstitutional. It turns out I spoke too soon, because there was another challenge waiting in the wings: King v. Burwell, a right-wing attack which sought to cripple the law rather than strike it down entirely.
Obamacare, like Romneycare in Massachusetts, is a “three-legged stool“: regulations on insurance companies, so they can’t turn people away or drop them for being sick; an individual mandate requiring everyone to buy insurance; and tax credits to help pay for insurance for people who couldn’t otherwise afford it. Some states have their own exchange websites where people can shop for insurance, but a majority use exchanges set up by the federal government. The King lawsuit focused on an ambiguous and obscure clause which said that the tax credits were available on exchanges “established by the state”, which they used to argue that the credits shouldn’t be available for policies purchased on the federal exchanges (even though the law directs the federal government to set up that exchange in the state’s place if the state declines to).
This was no small matter. Without the credits, Obamacare in these states would have turned into a “death spiral”: poor people drop out, raising the cost of premiums for everyone else, which forces still more people to drop their coverage, which raises premiums still further, and so on. Millions of people would have lost their health insurance. The exchanges could have collapsed entirely. (The hand-picked plaintiff, David King, bragged that he has health insurance through the V.A. and wouldn’t have been affected whatever the outcome.)
With an even minimally rational Congress, a one-line legislative fix could have resolved this. But with a fundamentalist Republican Congress dead-set on destroying Obamacare by any means necessary, there would have been no hope of a fix if the court had ruled badly. Even so, the plaintiffs’ gotcha reading was so absurd and tendentious that few legal scholars took it seriously. But then the Supreme Court agreed to hear the case.
I remember the gut-churning anxiety I felt when I heard that news last year. At the time, it seemed plausible that there were five conservative justices who would seize on any excuse to rule against a Democratic accomplishment. But the ruling, when it came down on Thursday, was an enormous relief: not just a victory, but a solid 6-3 victory. Roberts and Kennedy joined the court’s liberals to draw the commonsensical conclusion that all the parts of the law work together as a unified whole, and Congress clearly didn’t intend to set up an exchange that was intended to fail. As Roberts cleverly pointed out, even the more conservative justices understood this until it became politically convenient for them not to.In retrospect, this wasn’t a surprising outcome. John Roberts upheld Obamacare when he could have killed it the first time; it seemed unlikely that he was going to destroy it on the second go-round. Even so, conservatives were furious, accusing Roberts of betrayal as if he had an obligation to rule the way they wanted. Most hilarious was libertarian wingnut Wayne Root, who speculated that President Obama was blackmailing him.
The cynicism and callousness of the conservatives who backed the King lawsuit is astonishing. Without even a constitutional principle at stake, they were willing to create nationwide chaos and take away millions of people’s access to desperately needed medical care, all out of spiteful desire to destroy President Obama’s greatest accomplishment. But they lost – again – and apart from some residual issues (like the continued tussling over the expansion of Medicaid and the birth control mandate), there’s now a wide-open path for Obamacare to do what it was always designed to do.
Just to be clear, I had no personal stake in either of these rulings. I have health insurance through my day job, and, being straight, I’ve never had to fight for recognition or legitimacy for my marriage. But the lives and happiness of millions of people were hanging on the outcomes of both. Since the good guys won in both cases, I think any person of conscience would feel vicarious joy and relief.
There’s one more point relevant to this blog, which is that both rulings undermine the power of religious fundamentalism. With marriage equality, that’s obvious, as I discussed previously. With health care, the connection is more subtle, but just as real. It’s no coincidence that some of the fiercest opposition to Obamacare has come from the religious right: they want to shred the social safety net, so that people have no option but to turn to churches when they need help. There’s plenty of research to establish that in societies that are prosperous, peaceful and secure, people see less need for religious consolation; and I don’t doubt the religious right knows this as well. Their defeat has weakened their influence and made us a more just and humane society, and that’s very much worth celebrating.