President Barack Obama says Israeli Prime Minister Benjamin Netanyahu didn't offer any "viable alternatives" to the nuclear negotiations with Iran during his speech to Congress. (March 3)The Associated Press
Last week, with little fanfare, newly minted Oregon governor Kate Brown signed a bill that finally killed off one of the biggest bureaucratic boondoggles in the state's recent history. Cover Oregon, the state's once touted healthcare exchange, officially ceased to exist.
Not all that long ago – in late 2013 – Oregon's political leaders hailed Cover Oregon as indicative of a bright new era for the state. The online exchange was the state's own entry point into the Patient Protection and Affordable Care Act, often referred to as Obamacare. In theory, the Cover Oregon web site was supposed to allow residents – including, most importantly, those residents who could not afford or were previously denied coverage – to sign up for a health insurance plan.
There was only one problem: the system didn't work. A cascade of technical glitches hobbled the much-ballyhooed exchange. Months went by without a single person managing to enroll for a plan using the web site. Until governor John Kitzhaber was forced to resign last month amidst myriad conflict of interest allegations and a full-blown federal investigation involving his fiancée, Cover Oregon was the state's highest-profile scandal.
And yet, even as Mr. Kitzhaber's interim successor finally shut the exchange down last week, it disappeared having served what could end up being a hugely significant and totally unforeseen purpose.
Last Wednesday, the U.S. Supreme Court began hearing oral arguments in the case of King v. Burwell. The case is, essentially, a judicial challenge to the Affordable Care Act (a previous Supreme Court challenge failed, and there have been dozens of unsuccessful attempts by Republicans in Washington to repeal the bill through legislative means). The new case is focused on the Act's system of tax credits designed to help individuals who could otherwise not afford insurance plans get coverage. Opponents of the healthcare plan argue that the act states the subsidies – which are a vital component of the act because they allow millions of new people to obtain insurance – can only be applied to plans purchased through healthcare exchanges "established by the state," not a federally run exchange.
That's a significant issue, because in the lead-up to the Act taking effect, most U.S. states opted not to build their own healthcare exchanges. Instead, 34 states cast their lot with the federally run exchange, Healthcare.gov. In effect, if the Supreme Court agrees with the argument that the language of the act prohibits tax credits for all but state-run exchanges, the exchange system may all but collapse across most of the country.
The implications are massive. Part of the reason many insurance companies acquiesced to the ACA's abolition of preexisting conditions as a reason for denying coverage is because that financial hit was offset by the fact that the act would also require millions of people to buy insurance, creating a huge pool of new (and mostly healthy) customers. But if the tax credit system is axed, that pool is put in jeopardy. In all, somewhere between six million and eight million Americans could lose their coverage if the Supreme Court agrees with the plaintiff's reasoning.
It is here where, for totally unforeseen reasons, the multimillion-dollar train wreck that was the Oregon healthcare exchange has proven invaluable to Obamacare proponents. Because the state had its own (albeit dysfunctional) exchange when the ACA kicked in at the start of 2014, it is among the 16 states exempt from the purview of the Supreme Court case.
But it is, in many ways, a temporary reprieve. Like the other 15 unaffected states, Oregon will now wait and see how the Supreme Court rules. Should the court agree with the plaintiffs, the repercussions will almost certainly impact the entire country. For one thing, the ACA is largely dependent on critical mass, and as such is unlikely to function with only 16 participating states.
But there will also likely be a more broad, secondary impact. By siding with the plaintiffs, the Supreme Court will have handed down what will be interpreted by much of the right-wing political class as an important ruling in favour of states' rights – something the will become a central part of the upcoming election cycle, as Republicans head into the 2016 Presidential election focused on the narrative of federal overreach. In one swoop, such a ruling would both hamstring President Barack Obama's signature domestic achievement and energize the right-wing base. For a Republican party coming off a stellar showing in the mid-term elections and looking now to the White House, it's difficult to imagine any greater gift.