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ACA Agonistes
The ACA Debate: Both Moderate and Not

America is cautiously open to the Affordable Care Act, according to a new Bloomberg Politics poll: 51 percent of respondents are willing to give the ACA some more time, replying that the law might need some tweaks but “we should see how it works.” More:

Twelve percent said President Barack Obama’s signature legislative accomplishment should be left alone, 35 percent said it should be repealed, and two percent said they weren’t sure. […]

The number of Americans who want the law erased has remained fairly consistent over the past five years since Obama signed it. In July 2010, 37 percent said the law should be repealed. Two years later, 34 percent favored repealing the law.

Other polls have found that Americans on the whole prefer improving the ACA to full-on repeal-and-replace. That’s a hard sell given the polarized debate over the law, both in DC and in the nation at large. Because while only 35 percent of the country may want repeal, 68 percent of Republicans do, which means that the GOP will be for the time being a party of repeal. With one of the two national parties so strongly committed to repeal, the ACA debate isn’t likely to shift towards a consensus anytime soon.

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  • qet

    Improve, how? “Americans on the whole” refuse to relax their vise-grip on the idea that they CAN have what they want, if only some wonks somewhere make some tweaks here and there. They are confirmed in this fantasy every day by prominent op-ed contributors and other celebrities. Telling Americans on the whole the truth, that the math just doesn’t work, that there simply is not enough money to give Americans on the whole everything they have been assured they are entitled to as “hardworking American families,” means electoral defeat. I mean, rich people, you know. What’s up with that? Lying to Americans on the whole, via the likes of Gruber who not only lied but couldn’t restrain himself from bragging about it, wins elections. Since pretend free medical care feels better to Americans on the whole than real no free medical care, we will continue to receive pretend free medical care, improved by pretend improvements. College faculty and think tanks, Left and Right, will churn out “research,” “studies” and papers by the trainload, all the while allowing Americans on the whole to continue enjoying their pretend free medical care and voting in candidates who vow to pretend improve it.

    • fastrackn1

      “hardworking American families,”


  • FriendlyGoat

    More people would be for “repeal and replace” if there had ever been a COMPLETELY-EXPLAINED “replacement” plan that citizens could ABSOLUTELY see in advance and in DETAIL to be a better deal for all citizens than ACA. No Republican has ever been able to point to such a thing, because such a thing does not exist.

    No, the fast-mumbled phrases about “selling UNSPECIFIED insurance products across state lines” are NOT the level of detail needed for sensible people to get behind and support. Before one buys a car, one likes to know whether it has an engine or whether the front cavity actually contains just a set of tricycle pedals.

    Meanwhile, along comes our dear Supreme Court with King v. Burwell and a big case on same-sex marriage. The court could:

    1) Approve same-sex marriage and approve health care subsidies at

    2) Limit same-sex marriage and approve health care subsidies at

    3) Approve same-sex marriage and destroy health care subsidies at

    4) Limit same-sex marriage and destroy health care subsidies at

    This “bracket” of four outcomes is the one we should have been discussing more than the one for the Final Four.

    Any guesses? Do we get #1 or #2 or #3 or #4 this term?

    • JR

      I think it is important to note that providing subsidies to exchanges run by the State and not the Feds was how the law was written. It was a way to make sure all states set up their own exchange, otherwise they would lose their Medicaid funding. When that was found to be unconstitutional, the whole “we meant the exact opposite of what we wrote into the law” thing came into being.

      • FriendlyGoat

        Perhaps. So, we now have the same five conservative males on SCOTUS who could hang together and ruin some more of ACA, or not. And, they could send same-sex marriage back to states for permanent argument in 50 places for the rest of our lives, or not. I think all liberals and all conservatives should be viewing those cases as a pair and betting on “the bracket” as I described it. What will your fellows do?

        • JR

          My guess is they will OK gay marriage on the Federal level. As for ACA, i think they say law is what the law says and if you want to change it, you, Legislative and Executive Branches of the government, have all the power to do so. Go at it…

          • FriendlyGoat

            You may be guessing correctly #3. But the other three are possible, too.

            Meanwhile, do you suppose any Catholics might wonder what the heck happened if one or more of their particular five guys (Scalia, Roberts, Alito, Thomas and Kennedy) peel off to support same-sex marriage—–BUT—–all hang together to make health insurance less accessible to poor people?

      • Ken Kelly

        You summarized the Petitioners’ position in your first sentence and half, but that the last sentence and half misdescribe the legal situation. In NBIF, the Court ruled that it was unconstitutional for the Feds to force the states to choose between expanding Medicaid, or losing all of their current Medicaid funding. That case has no direct connection with King v Burwell, which would have proceeded even if the NBIF ruling had gone the other way. The central claim in King is that states that did not set up their own Exchanges would lose access to the premium tax credits and cost-sharing subsidies. Petioners are not claiming that they should lose their Medicaid funding too.

        • JR

          Not a lawyer, so I freely submit to your interpretation. The larger question however remains the same. Is the law something that was debated and passed, however shadily. Or is it something that can loosely be interpreted as “whatever’s convenient for Barack Obama at the time”. There are consequences to both interpretations.

          • Ken Kelly

            On that larger question, as a general principle, you and I are in agreement. Where we disagree is on how to properly read the ACA. To put that question into perspective it helps to look at that the opinions of the nine judges who have ruled on the matter so far. They fall into four groups:

            A) Three judges believe that the ACA unambiguously restricts subsidies to State-run Exchanges, and that the IRS reading is impermissible.
            B) Two judges believe that the ACA is ambiguous, but that the IRS reading is better than challengers’s, albeit not by much.
            C) One judge appears to believe that challengers’ reading is plausible, but that the IRS reading is “obviously” better.
            D) Three judges believe that the ACA unambiguously authorizes subsidies through all Exchanges, and that the challengers’ reading is impermissible.

            I agree with the judges in group D.

          • JR

            I think larger questions is the more important one. “Option B” society is a low institutional trust society, and those have been shown to underperform high institutional trust societies by a very wide margin.

    • Frank Natoli
      • FriendlyGoat

        Thanks for link. Did you notice that the second bullet point in the description of this bill is to allow the purchase of health insurance across state lines? That’s always the “centerpiece” of these plans, but WHAT IT MEANS is never explained.

        It means that all federal policy standards are to be repealed, first of all. It then means that citizens of 49 states are to lose control of what they deem “acceptable” policy standards for what is to be sold in their states. It means some 50th red state with the least possible regulation of insurance becomes the home of insurance companies which seek to sell very poor insurance nationally and low-ball everyone else.

        People are being baited to believe that there are insurers waiting in the wings a couple of states away to sell something both good and cheap, if only government would get out of the way. This, of course, is not true BECAUSE any insurer wanting to sell something good and cheap could long ago have become licensed in any state to do so. The “across state lines” thing is a 50-state race to the bottom on consumer protection in insurance policies and people need to KNOW that before anything gets enacted. Republicans won’t tell them, you know.

        • Frank Natoli

          Exactly what “across state lines” in the context of the Flores bill means, I’m not sure. Insurers based in State X are already selling policies in State Y. The key point, at present, is that to sell in State Y, you have to strictly adhere to State Y’s insurance regulations. And to sell in State Z, you have to strictly adhere to State Z’s insurance regulations. As a result, in states like my home state of New Jersey, where the most minimum policy has to cover EVERYTHING, the minimum premiums are astronomical. What I would like “across state lines” to mean is that there will be a federal pre-emption of state insurance regulations, so companies can compete by offering policies that subscribers want, not what insurance regulators and bureaucrats decide is best for all of us.

          During Bush 43, when Republicans controlled both houses of Congress, they attempted to do exactly what I describe above, but Senate Democrats filibustered the attempt. Filibustered. You know, the centuries old Senate rule that Harry Reid and Senate Democrats found could be changed by a simple majority. Why did Senate Democrats filibuster a simple bill to allow interstate competition? To allow insurers to write policies as the market demanded? Just my opinion, but I think Senate Democrats were intent on destroying private insurance and private health care and would allow nothing that could possibly prevent that from happening. Knowing what side of the street you walk, I’m sure you’ll have a benevolent explanation.

          There is exactly one thing that provides best product at lowest price and that’s competition. Period. Government regulation, some of which is necessary, most of which in insurance regulation, particularly ACA, is extremely damaging to product and price. Allow the market to function competitively. Let doctors and hospitals compete with each other. You don’t like it? Fine. Take yourself to a city hospital where the red tape runs around every doctor, every nurse, every janitor. But let the rest of us have a chance.

          • Ken Kelly

            I would love to see national pre-emption of state insurance standards, as you describe, but I must admit that I don’t remember the bill proposing such during the Bush administration. Do you remember the bill’s name or sponsor? Or perhaps just the year?

          • Frank Natoli

            See the section “How the Bush Plan Would Improve Health Insurance Markets”.
            See multiple “Congress failed to enact” which is often a euphemism for “Senate Democrats filibustered”.

          • Ken Kelly

            Thanks for the link. Using it as a starting point, I searched the Heritage site for information on bills that promoted interstate sale of health insurance. I found only one that managed to get out of committee – The Health Care Choice Act of 2005. The House bill – HR 2355 – died in the House without getting a vote. The Senate version (S.1015) died in committee.

            It’s worth noting that this bill enacts something much closer to the “race to the bottom” described by FriendlyGoat than to a single, national, federally-regulated market. The only Federal requirement in the bill imposed minimum solvency requirements on all insurers, regardless of state laws. No other state regulations were pre-empted, as far as I can see. In fact, it seems that Heritage is flatly opposed to the model you describe.


          • Frank Natoli

            In response to your original question, I spent a half hour searching and the only reference to failed health care initiatives that I could find was the Heritage articles. I have a personal recollection, however, of the Republican attempts at the time, along with Republican attempts to open ANWR, all of which died courtesy of Democrat filibuster. If my recollection is inadequate for you, I am sorry.

          • Ken Kelly

            The ANWR filibuster was in Dec 2005, so you must be thinking of the Health Care Choice Act which died in Feb 2006, though, as I pointed out, not by filibuster.


          • FriendlyGoat

            In good faith—–really—-I am doing my best to explain what I believe “across state lines” means in the context of the Flores bill. I do understand why people want to believe that more competition is “better”—–like getting to vote with your feet to choose the best $1.00 sandwich off the dollar menu between McDonald’s, Wendy’s or Burger King.

            But in bigger matters we now have corporations putting the PEOPLE of states into competitions for benefit of the corporations—-instead of the other way around like people naturally assume. Two major examples of this are the push for right-to-work laws from state to state and the ever-present “economic development incentives” war to see which states can give away the most to various businesses.
            The flip of who is obligated to serve whom then changes from,
            “If you don’t like us, we’ll give you a better burger”—–to—–“If you don’t give us what we want, we’ll leave your state”.

            When the insurers are able to lobby the citizen legislatures to reduce health insurance standards in order to “compete” with policies suddenly offered on the lower standards of some other state, citizens are then in great peril in terms of ever again being able to buy quality insurance.

            The GOP plan is a sham, period. You and I may be actually debating these details, but MOST people are expected by the GOP to just buy the burger analogy, shut up and not cause trouble. This is why we need lots and lots of Dems to at least raise the questions. Your side isn’t doing it at all.

          • Frank Natoli

            An individual company is no better than government in being arbitrary and capricious, purely in the interest of company.

            There is only one government, so there is no need for the adjective “individual”. Government is far worse than one company, because government has physically coercive powers that companies do not.

            Multiple companies, unless restricted by government, are fundamentally competitive and deliver the best product at the least cost, not by purely altruistic notions but by competitive excellence.

            I’ll take the multiple company scenario. I understand you prefer the [one and only, physically coercive] government. Unfortunately, your preference gives all the rest of us zero choice.

          • FriendlyGoat

            You might want to consider that government, operating the ACA subsdies, does not necessarily need to make money off of policyholders and in most cases won’t.

            The multiple insurers, however, absolutely do need to make money off of you. They not only have no other intention, they will not be seen as solvent and remain eligible to write coverage unless they absolutely charge you more than your coverage actually costs and consistently.

            After buying personal coverage (from a company based in another state, by the way, licensed then in my state) for self-employment in years before Obamacare, I have NO ILLUSIONS about how expensive it is/was/will be and NO ILLUSIONS about what a pain in the butt they could be for a claim. I really don’t know why you insist on having those illusions.

            You might get some Alabama-standards insurance offered to you in New Jersey, but if you do, it will be rated on the prices of medical care in New Jersey, not Alabama. There is no way in thunder you’re going to be offered a bargain from “across state lines”.
            It cannot happen and it will not happen.

  • Frank Natoli

    Only 35% want repeal? Ergo 65% think it’s peachy keen? Wouldst the author be so kind as to enquire whether the 65% had their medical policies that were in force for years cancelled? That saw their premiums skyrocket, networks shrink to almost walking distance, single men required to pay for maternity and pediatric coverage? What’s that? No, they haven’t? Well then they don’t really have the faintest idea what they’re talking about, do they?

    • Ken Kelly

      For what it’s worth, only 12% could be said to think the ACA is peachy keen as is. 51% chose “It may need small modifications, but we should see how it works.” What people generally think a “small modification” might be is anybody’s guess.

  • NicholasBourbaki

    More than 35% of americans believe all kind of nonsense. The 35% in this case are republicans who also believe that Obama was born in Kenya, that he is a socialist, that is more dangerous to America than Al Qaeda.

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