Living in a post-Ruth world

The guarantee of equitable health insurance for persons with diseases might have died with Ruth Bader Ginsburg.

Expansion of Medicaid that covered nearly a quarter-million poor Arkansans, fattened the state budget, kept rural hospitals open and held down insurance rates for all the state’s privately insured citizens by buying private health insurance for the poor … that also might have died with her.

Those are the headline items of Obamacare, or the Affordable Care Act, which Republicans seem to despise because … well, just because. They never liked Medicare and Social Security either, but those survived through saner times.

This may be different. Republicans say the Affordable Care Act is horrible in part because no Republican in Congress voted for it. Bipartisanship is needed, don’t you see? Ponder that coming from hyperpartisans.

A few of them could have fixed that by admitting the ACA was an imperfect advancement and maybe seeking some improving amendment here or there and then supporting it.

That’s how Congress might function in a competent and well-intended world. The world we’re in is not that. It is all about pandering only to your political base to resist and exploit the hated other side.

So, Republicans have been steadily suing the law since its enactment, losing the main case at the U.S. Supreme Court because Chief Justice John Roberts, a Republican nominee, joined the four Democratic nominees—Ginsburg among them—in declining to declare the law unconstitutional.

It’s generally believed that Roberts has a sense of history—of the legacy of what will be known as the Roberts Court—and did not wish that legacy to be killing health insurance. That could look bad down the line. On the Republicans’ latest try, now before the Supreme Court on the argument that the whole law is somehow invalid because a couple of lines about mandating coverage with a tax penalty are no longer operative considering that the Republicans in Congress axed that tax, we’d been figuring Roberts would save the law again, 5-4.

Now Ginsburg’s tragic passing would seem to enable a 5-4 vote killing Obamacare even with the chief justice continuing to do the right thing.

The current case is an appeal from a conservative judge in Texas who absurdly declared the entire law— pre-existing condition equity, Medicare expansion—invalid because of that single inoperative provision on the mandate and tax.

The New Orleans circuit court of appeals agreed that the mandate was invalid, but deferred a ruling on the rest of the law and instead sent the case back for the Texas judge to think more on that point.

Democratic state attorneys general, perhaps outsmarting themselves, thought they saw a political advantage during a big election season. They interceded to ask the Supreme Court to take the case straightaway based on the nuttiness of the Texas judge and the silence on that point of the rightwing appellate court.

They thought that would fashion a timely focus on an issue they deemed politically favorable. They could laden the Republicans either with a Supreme Court loss in an election year or a pyrrhic victory that would cause them political harm for causing emotional and physical harm to diseased people losing health insurance.

Democrats probably would have been better off letting the Texas judge reconsider and the appeals court re-reconsider.

The Supreme Court agreed to take the case, but, over Democratic objections, deferred a hearing to the fall term. That lessened the focus on the issue until Ginsburg’s battle for life ended.

Republicans assure us that all will be fine because they have an unspecified plan.

Let’s take Medicaid expansion first. Current federal law makes clear that the program is for health care for poor people and cannot be tinkered with to add unrelated policies or conditions such as a work requirement or a work-seeking requirement.

To keep the program alive in Arkansas, Republican Gov. Asa Hutchinson concocted a silly piece of right-wing red meat in the form of a work-reporting requirement that has been declared obviously illegal under existing federal Medicaid law.

Hutchinson’s response to the court action has been to say that, should the Affordable Care Act get axed by the court, then Congress could easily put the program back but with language specifically permitting his work-requirement program.

And poor people would live happily ever after so long as they found a computer every month and remembered to check the box that they’d been busy looking for a job, maybe bussing tables at a restaurant that was closed on account of the virus.

And if they forgot to click? Well, just don’t get sick, all right?

But let’s say Democrats retain control of the U.S. House of Representatives, as seems highly likely. Even more likely is that Nancy Pelosi’s House never would go along with telling a poor man he couldn’t have Medicaid because he didn’t have a job.

The reason Medicaid was created was to cover the guy because he didn’t. One way to help a man find a man a job is to treat his illness.

We’d have a typical federal stalemate.

Absent the ACA’s Medicaid expansion, a state like Arkansas would be left without all that federal matching money flowing into the state budget. Its private insurance market would lose 200,000 government-subsidized customers. Premiums would go up. Rural hospitals would close. And, incidentally, poor people generally would be less healthy.

That would be a win-win for conservative thought, I guess.

Then there is the even greater outrage. Obamacare provides that persons with pre-existing conditions shall receive federally guaranteed comprehensive private health insurance coverage at the same premium as anyone else, with the coverage never to be jerked or price-gouged between, say, one set of cancer treatments and the next.

The Supreme Court’s axing of the ACA would leave those sick people in cruel uncertainty.

Not to worry, Republicans say. Again, they have some sort of plan.

Most likely, it’s to set up a federal pot of matching money to send to states that will set up their own pre-existing coverage systems as they see fit.

That’s like killing Social Security and telling the states to put something back state-by-state if they feel like it.

Take a look at the Arkansas General Assembly and tell me whether such state latitude provides any comfort to Arkansans with diseases. Take a look post-Asa at a Gov. Sarah or a Gov. Leslie or a Gov. Tim and tell me why a diseased Arkansas resident’s first move if the Supreme Court kills Obamacare shouldn’t be to a nice state.

I’d say the solution is to vote, except that in this case your vote in the presidential race probably won’t matter because Republicans are going to rush through, regardless of your vote, a certain fifth anti-Obamacare vote.

There are many reasons RBG’s passing worsens the world. This one is way up there.