Obamacare’s successes create problems for Republicans

The Republican party’s determination to repeal, or at least undermine, the Affordable Care Act (aka Obamacare) by throwing roadblocks in its path was obviously predicated on their fear, not that it would fail, but that it would succeed. They rightly guessed that despite its clunky structure and its pro-health care industry tilt, if it succeeded in providing health care access to large numbers of people at a reasonable cost, then it would become harder to get rid of the program. So it had to be stopped early.
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Legal setback for Obamacare opponents

As was expected, the full panel of judges in the DC District Court of Appeals has decided to re-hear the Halbig v. Burwell case where a panel of three judges voted 2-1 that the tax credits provided by the federal government was not allowed under the Affordable Care Act, saying that the language of the act only allowed exchanges set up the states to do so.
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Two major conflicting rulings on Obamacare

In April, I wrote about a legal challenge to Obamacare in which opponents had argued that the text of the ACA law only allowed state health exchanges to provide subsidies for the health insurance premiums and that the federal government should not have been allowed to provide subsidies through its own exchanges in those states that decided against setting up their own exchanges.
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The Streisand Effect and Obamacare

Despite the debacle of the Obamacare website at its unveiling and the earnest efforts of the Republican party to derail it (anti-Obamacare groups outspent those in favor by a ratio of 15 to 1), the New England Journal of Medicine reports that 20 million people have enrolled in the plan. (The full report can be seen here.) This graphic from the NEJM report shows the different ways that people can sign up.
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Medicaid expansion rejection bites back

The expansion of Medicaid health benefits to people who were too poor to be eligible for the health insurance subsidies was supposed to be an integral part of the Affordable Care Act. But the US Supreme Court ruled that it was an option that states could choose to accept or reject. And of course two-dozen Republican-dominated states chose to reject it even though it seemed like a no-brainer since the federal government would pick up 100% of the costs in the first three years and about 95% after that, because god-forbid that poor people should get health insurance.
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How many will die due to rejecting Medicaid expansion?

We know that some Republican controlled states have refused the Medicaid expansion portion of Affordable Care Act even though the federal government will fully fund it for the first three years and then after that will pay for at least 95% of the cost. By any measure, accepting the expansion should have been a no-brainer for the states and the only reason that it was refused is because those states did not want to do anything that might be construed as supporting Obamacare. As a result, poor people in those states who do not earn enough to qualify for the subsidies in Obamacare are left without any affordable insurance.
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Measuring cost-effectiveness of health care

There is always some rationing involved in providing any service and health care is no exception. In the US, rationing is largely determined by the ability to pay because the limitations are largely set by the for-profit health insurance companies. If you are rich and/or have good employer based health insurance coverage, you get more and better services than if you are poor and do not have an employer who provides it. The Affordable Care Act tried to close that gap by increasing the affordability of health insurance for those with lower incomes.
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People who die due to lack of insurance

charlene dillI have written about the unbelievable cruelty shown by those states that refused to expand Medicaid so that those people who are too poor to be covered by the subsidies offered by the Affordable Care Act could obtain health insurance anyway. As a result, we have the predicable result that some people are now dying because they have no health insurance.

Bill Manes has written an excellent article about such cases, focusing on Charlene Dill, a 32-year old working mother of three small children. In the process, he also describes the complexities of life when one is poor.
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How getting money from the government can be injurious

In order to bring suit against someone in court, the plaintiff has to show that they have ‘standing’, which means that they have suffered a fairly direct injury of some sort that the court can redress. In response to my post on the cases bought against Obamacare because of its use of federal subsidies in the form of tax credits to make health insurance affordable to low income people, reader Mark Dowd posed the good question of how the people who were suing could have standing to do so. How can getting money from the government to purchase health insurance be considered to cause an injury?
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