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God, I haven’t done one of these posts in a while.
I really don’t want to do one of these posts. After the exhausing spectacle of 2016 when Republicans, having just seized control of the House of Representatives, the Senate, and the Presidency, tried again and again to make good on their promise to repeal and replace Obamacare, only to be thwarted by the slimmest of margins. Despite having a majority in the Senate, 3 Republicans, Lisa Murkowski, Susan Collins, and John McCain, surprised everyone by breaking party ranks to vote against the repeal measure.
And in 2018 when the Democrats successfully retook the House, we all thought the fight to kill Obamacare was over.
Well, turns out, it isn’t.
Ah, 2020. If a year could have a slogan, I’d give it “Oh, great. What’s gone wrong NOW?” As if this year hadn’t thrown us enough curve balls already, the recent death of Supreme Court Justice Ruth Bader Ginsburg has given Republicans a last-minute chance to screw with everyone’s health care right before the election.
If you aren’t caught up in the news, Ruth Bader Ginsburg was a liberal icon, and the de-facto head of the liberal wing of the US Supreme Court. Her death opens up a seat, a seat that Republicans are eager to fill. The reason why they’re so excited is that prior to her death, the Supreme Court had a 5-4 split in conservative’s favour. By filling the seat with a socially conservative nominee, the Supreme Court will tilt heavily conservative by a margin of 6-3.
Why this is important for health care is that Republicans currently have a lawsuit sitting on the Supreme Court’s docket related to Obamacare. While I won’t get into the legal nitty-gritties of the suit, basically Republicans, after proving unable to abolish Obamacare legislatively, used a rider on an unrelated tax bill to effectively eliminate the individual mandate that would have charged people a penalty if they didn’t sign up for health care. Now, Republicans are arguing that Obamacare compelling people to buy insurance without the individual mandate penalty (which, again, they were responsible for eliminating) is unconstitutional, and therefore the entire law should be struck down.
The judicial nominee has, in the past, made her stance on being against Obamacare known, so if she’s successfully confirmed before the election, Obamacare is toast.
What’s The Worst That Could Happen?
I’ve written about this in the past, specifically with regards to this issue’s impact on the FIRE community, and through it all my personal stance on Obamacare is that it’s overall good for the FIRE communtity because it gives people who retire early the ability to get (relatively) affordable health care coverage without being tied to their jobs. And back in 2016, while the Republican effort to repeal and replace Obamacare was infuriating to watch, the fact they were replacing it with something gave me hope that even if they were successful, at least some of the most popular provisions of the Affordable Care Act like coverage for pre-existing conditions and income-based government subsidies would survive.
This, however, is the worst possible outcome when it comes to overturning Obamacare.
If the Supreme Court sides with the Republicans and strikes the law down, nothing will be there to replace it. The Republicans have no plan ready to go, and even if they did they don’t have enough time (or the votes in the House) to pass it before the election.
So if Obamacare gets struck down, this will not only hurt the people who were relying on its system of subsidies and grants to afford health care coverage, it will hurt literally everyone in the US because it will eliminate protection for people with pre-existing conditions.
Remember, before Obamacare it was relatively common for health insurance companies to take your money, wait until you were sick with something really serious, then deny you coverage for some pre-existing condition in your past like a yeast infection or being overweight. Even if that pre-existing condition was completely unrelated to your current condition, the bet was that by denying you coverage, you would die from lack of treatment before you could take them to court to force them to pay.
A health care system that doesn’t take care of you if you get seriously ill is not a functional health care system. That was what America had before Obamacare, and that’s what would come back.
And oh yeah, exposure to COVID would almost definitely count as a pre-existing condition, so anyone who’s taken a COVID test could have the results be used against them in the future to deny them coverage.
That doesn’t just hurt the FIRE community, that hurts everyone.
Can Democrats Block The Nominaton?
On the surface, it looks like no, they can’t. Republicans currently have a 53-47 majority in the Senate, so you’d figure that they’d just be able to rubber stamp this thing through in 10 minutes, right?
But dig a little deeper and we realize there’s some wiggle room.
Two Republican senators, Lisa Murkowski and Susan Collins, have already signalled that they wouldn’t vote for a Supreme Court nominee so close to the election. These are also the same two senators that, along with John McCain, torpedoed Trump’s earlier efforts to kill Obamacare. So the Republican’s effective majority is 51-49.
But so what, you might think. A majority’s a majority. Well, yes and no. Because of Senate rules, the Senate can’t do anything unless they have what’s called a quorum, which means at least 50 senators are physically in the chamber. So that means if just two Republican senators can’t go to the Senate because, say, they’ve tested positive for COVID and are forced to quarantine, then the Democrats can simply boycott the Senate chambers and block the nomination that way.
As of the time of this writing, three Republican Senators have tested positive for COVID.
Things are changing day by day, of course, but all I can say is if a global pandemic somehow ends up saving Obamacare, I’m going to need to lie down from my head spinning.
You can’t make this shit up! If I were a writer on West Wing and I proposed that as a storyline, Aaron Sorkin would shoot it down for being too unbelievable.
What If Biden Wins in November?
But lets say that COVID doesn’t end up saving the day (yeesh, there’s a phrase I never thought I’d have to write). That makes the upcoming election hugely consequential, especially for health care.
Joe Biden was one of the chief architects of Obamacare, and has pledged to not only defend it but expand it as well, adding back the state-run public option that didn’t make it in the first go around. So if he gets elected as president, Democrats would be able to dust off the old Obamacare bill, make a few tweaks to fix whatever the Supreme Court finds unconstitutional, and re-pass it as, I guess, Bidencare. Or Joecare? Nah, Bidencare sounds better.
Anyway, polls are placing Joe Biden as favoured to win in November, and now that Trump’s hospitalized with COVID and unable to campaign, momentum will favour Democrats, but remember, polls also heavily predicted Hillary Clinton’s win back in 2016, so who the Hell knows what’s going to happen in a month? Remember the slogan of 2020: “Oh Great. What’s gone wrong NOW?”
What If Trump Wins in November?
While a come-from-behind Trump win sounds like it would be terrible for health care, there would still be room for some optimism here. Don’t get me wrong, it’s still definitely negative, but at the very least this would give Republicans the opportunity to fulfill the “replace” part of their “repeal and replace” slogan.
Republicans did have some replacement bills back in 2016, and they did retain some of the more popular provisions of Obamacare like protection for people with pre-existing conditions. So if Republicans win, health care would likely be rolled back, but not all the way to the pre-ACA system.
Or Trump could just spend his entire second term trying to repeal term limits and having himself installed as President for life. Who knows.
What If the election produces a Split Government?
But as bad as a second Trump term might sound, this secenario is actually more likely and much more harmful. If Joe Biden wins the presidency, he would definitely take the House of Representatives since every seat is up for grabs. But because not every Senate seat will be voted on in November, it’s possible that Democrats get the presidency and House, but Republicans maintain a majority in the Senate by the tips of their fingers.
This would be the worst case scenario for health care. Because without the Senate and zero appetite for bipartisanship in America, Joe Biden would be a lame duck as soon as he enters office. Obamacare would get struck down in the Supreme Court, but Republicans would be able to block Democrats from passing a replacement. Both sides would then spend the next two to four years finger pointing and blaming each other while millions will lose their health care coverage. The pandemic would then spin even more out of control, since people will avoid getting tested out of fear of getting a pre-existing condition, making the spread even worse since health officials won’t know where the outbreaks are.
So this is by far the least appealing outcome of the election in November. In order to have a functional health care system, not only does one side need to win, they need to win resoundingly enough to seize control of both chambers of Congress.
Which will it be? I honestly don’t know. But we’ll found out in…*checks calendar*…29 days.
Yikes. Buckle up, people. 2020’s not done with us just yet.
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