Affordable Care Act in Jeopardy

The Supreme Court looks over one aspect of the Affordable Care Act, but make no mistake, this isn’t about constitutional principles. Also, a Christian author takes on Christian sexual ethics.

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Links in this episode:

Kristen Schaal has some advice on women’s issue and name-calling

Supreme Court hearing arguments on Affordable Health Care Act

Maddow on the individual mandate

Fox News pretends the government is gonna make you buy broccoli

Why the broccoli argument is bogus

Limbaugh is intensely stupid

Scott Lively’s ridiculous defense of himself

On this episode of Reality Cast, I’ll be interviewing a Christian author who wrote a book examining the intersection of faith and sexuality. Otherwise, it’s all Affordable Health Care Act. What are the stakes in last week’s Supreme Court arguments? Is the right taking a stand on principle, or is this more partisan posturing?

And because there was an overload of comedy responses to the Sandra Fluke/Rush Limbaugh craziness, I’m just going to play some more from the Daily Show.

  • daily show *

Kristen Schaal could probably eat a bowl of cereal and make me laugh.


With all the furor over contraception mandates in the Affordable Health Care Act, it can be easy to forget that there’s an even larger battle going on when it comes to health care. And that’s over whether or not health care reform will even pass through the Supreme Court unscathed. The Supreme Court began listening to arguments last week about the Affordable Health Care Act, and there is a real concern that the more conservative side of the court is going to use this as an excuse to excise huge portions of the law or even overturn it completely. The first day of arguments was about whether or not the Supreme Court should be listening to the case at all. After that was the real show: a debate over the individual mandate. See, starting in 2014, Americans will be required to buy health insurance or pay a tax fine if they don’t. Opponents of health care reform are claiming this is unconstitutional, and supporters disagree. The court will decide. Conservative justices really attacked the administration’s lawyer.

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It’s distressing, because Justice Kennedy is the swing vote on the court. In recent years, the notion that the Supreme Court is populated by a bunch of patient non-ideologues who are willing to hear an argument out before deciding what to think has been thrown out the window. Now they make their likely vote super-clear by the questions they ask of the attorneys, and they jockey so fast to ask questions that attorneys barely get to make their case anymore. Honestly, it’s getting disgraceful. But it does suggest that Justice Kennedy will, at best, be a tougher nut to crack than many of us had hoped.

One thing that’s interesting is that now that a bunch of conservatives are attacking the individual mandate, liberals are beginning to actually pull their heads out of their butts and actually listen to the administration’s arguments for it. I remember when a lot of liberals were in high Democrats-can-do-nothing-right mode after the public option was regrettably removed from the bill, and they went on the attack against the mandate. Now they’re getting why it’s important.

Rachel Maddow gave some history on the individual mandate as a policy.

  • health care 2 *

To be clear, this individual mandate isn’t based in this “personal responsibility” nonsense. The new law uses employers as the first defense. The individual mandate kicks in for people who don’t have employer coverage or aren’t on government coverage. Many of them, probably most, will be eligible for subsidies to make sure they can afford it.

Why an individual mandate? Well, it’s the quickest way to make sure everyone is in the system, honestly. Since insurance companies can’t refuse to cover you for pre-existing conditions, there’s no penalty for people who aren’t sick to hold off getting insurance until they do get sick. If only sick people are insured, the costs are basically astronomical, and you might as well pay out of pocket. The mandate gets rid of the free rider problem.

That Republicans used to be for it and now are against it demonstrates how empty the arguments against the mandate are. The mandate is just an angle to give the court a shot at overturning health care reform completely, or making it so unworkable Congress has to repeal it. In fact, the people hanging out on the steps of the Supreme Court seem to grasp that there’s no greater principle at stake, just an ideological battle over whether or not we value having a decent health care system or not.

  • health care 3 *

Worth noting is that Republican candidates all promise to overturn the law in its entirety. Not  just the individual mandate, but other parts, such as requiring preventive care to be offered without a co-pay and requiring insurers to cover an employee’s children until age 26. This isn’t about the individual mandate, and because it’s not, I do worry that the court is going to consider overturning the entire bill altogether. After the interview, some evidence from right wing media that this is about the bill in total, and not just the individual mandate.


insert interview


The full-blown hysteria over health care reform in right wing media betrays the claim that this is just about some newly hatched concern about the individual mandate, which as Rachel Maddow explained in a clip in the last segment, was a Republican idea to begin with. First of all, there were illegitimate slippery slope arguments being offered, comparing the individual mandate with frankly ridiculous laws that don’t and won’t exist in the future.

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Let’s be clear: What liberals actually wanted was to handle health care like we do public education, Social Security, or like England handles it. We wanted a single payer system, where it comes out of a tax levied on all people, and everyone can access health care for free. That would have neatly elided conservative claims that they’re worried about the government making you buy a so-called consumer item. But because conservatives threw an absolute fit and wouldn’t have it, Democrats created a compromise between liberal and conservative positions. Now right wing media is painting this compromise as some unholy attack on liberty. But it’s only there because they would not accept a single payer system.

Interestingly, the former solicitor general under Reagan shot down the broccoli argument on Fox News.

  • right wing 2 *

The notion that you can opt out of the health care market is a joke. If you think that you can, go try to have a heart attack on a street corner or get hit by a car, and see how swiftly you get shoved into an ambulance and therefore into the health care market. This law is simply preventing you from calling up an insurance company from the ambulance and getting coverage now that you need it. You have to have the insurance before. It’s important to note that while this was a Republican idea in the U.S., this kind of law is common in many countries that provide universal health care with the assistance of private insurance companies.

Some conservatives didn’t even bother with building up straw versions of the mandate, but instead made bold attacks on health care reform for addressing women’s health care alongside men’s.

  • right wing 3 *

Rush Limbaugh is intensely stupid. That’s what I’ve decided. This claim makes no sense, in two ways. First of all, the official complaint from conservatives is an objection to the individual mandate. They don’t want to PAY for insurance by law. Which means that they know that people who BUY health insurance are PAYING for it. Which means these aren’t “free” birth control pills, but like all other medications on your insurance, are covered. The question at hand this time isn’t Title X or Medicaid, which are untouched in the conservative arguments in this case. The second reason Limbaugh is clearly stupid is that his arguments hinge on the assumption that until health care reform, birth control wasn’t a mainstream part of health care coverage, but was instead treated like movie magazines and beer, entertainment items you buy with cash. In reality, most insurance companies already cover contraception, This law just tells them what percentage they must cover by law, and that’s it. This isn’t the seismic shift in understanding of contraception care that Limbaugh pretends it is. 


And now for the Wisdom of Wingnuts, Uganda edition. American fundie Scott Lively is being sued in U.S. court by gay rights groups in Uganda for breaking international law by inciting persecution of gays and lesbians. He went on the American Family Association’s radio show to defend himself. Quoted at length, because this is a very important story.

  • scott lively *

This is all hogwash, of course, but more critically, it’s right wing projection. There is substantial evidence that the real “infiltrator” is Scott Lively, who spent years in Uganda, claiming that homosexuality is the cause of fascism, that it’s a choice and not an orientation, and other hateful lies that have led to the repeated attempts to pass a law that has the death penalty attached for homosexuality.

Follow Amanda Marcotte on twitter: @amandamarcotte

  • johann7

    I did avoid the ‘health care market’ for a number of years (before being coerced back into it by my mother), and I was hit by a car and refused to go to the hospital (before being coerced into it by my father). It’s possible to avoid health care (well, hospital and clinic care for which insurance matters) entirely or refuse treatment (if one is worried about being unconscious, get a medic alert bracelet informing readers that if one receives medical treatment and survives, one will sue), though you might be right that few people actually will do so (especially female people, as many of them use hormonal contraceptives and/or contraceptives involving a surgical procedure, though, as I was not having potentially-procreative sex with female persons at this point, I was also not secondarily benefiting from their health care).

    I disagree with the individual mandate – in fact, I don’t think health insurance should exist at all. Instead, I think we need public hospitals: no concerns about what’s covered by insurance and what’s not, no concerns about care day/dollar/procedure-per-year limits; just walk in, get treated, walk out. I still think the individual mandate is an actively bad thing, because I strenuously dislike public/private partnerships and other neo-Liberal economic strategies that use public monies to fund private-sector, for-profit enterprises (NOT because I dislike ‘forcing’ people to buy something that they may never use – that’s what taxes and the public sector are – though I have to say, I think I’d come out ahead if I could opt out of funding our military or ‘national security’ enterprises). Then again, I don’t think health care per se is a human right, I think equal access to health care is (or is a matter of equal treatment under the law, which is a human right; said equal access could be anywhere from zero to any and all technological interventions on the body, across the board), so I don’t exactly agree that expanding health insurance coverage (and by extension access to health care for people who were previously unable to access it) is a good enough reason to justify the massively problematic individual mandate. I’m very interested in the outcome here – striking ONLY the individual mandate could cripple or even kill the insurance industry, and that would be very, very good (in order to meet its obligations under the rest of the ACA, the federal government might be forced to expand Medicare eligibility to everyone, under the pricing and coverage terms specified in the ACA – single payer by default; once single payer is in place, the question becomes why we’re spending so much public money on for-profit hospitals, motivating, hopefully, the creation of an actual public health infrastructure).

    Also, once again, the Affordable Care Act doesn’t change health CARE at all, it changes how health INSURANCE operates.

  • leftcoaster

    Where have the so-called compassionate progressives gone?

    This piece dumbs down the issue so ridiculously I can’t see straight. Anyone who actually believes that in an economy where people are losing their homes and cars and cannot keep their bills paid, tens of millions will be able to cough up hundreds per month to buy a health insurance plan that will still cost hundreds or thousands to access (copays and deductibles? check – still there) needs a lobotomy.

    This childish notion that insurance companies will now accept all-comers, exclude no pre-existing conditions, pay every claim, cancel no one for excessive costs and still meet their profit thresholds is humiliating. That the president of the United States believes it’s true shows he is either stupid or out of touch, or just wanted any damn bill passed.

    And he got one. But do the math, because Congress didn’t. This is a hideous piece of legislation that is only a prototype – unless you have the answers I’m looking for, such as how subsidies will be paid (in cash to me? To my insurer? Or in tax credits 12 months after I’ve forked out $800 a month in premiums, which ain’t gonna happen anyway)?

    Do you have these answers? What about those who can’t afford their premiums for 2-3 months in a row because of emergencies or (ironically) a short-term illness? Will insurance companies be bound by law to keep their coverage intact even though they aren’t collecting premiums?

    I’m embarrassed for anyone who bought into this nonsense and I’m disgusted with my progressive friends who are now taking swipes at people like me who are self-employed and living on a variable income, and know for certain I will NOT be able to pay even $200 a month towards an insurance policy (and believe me on this: Mine would be at least double, even after subsidies).

    The attitude that “everyone should be able to afford this” is no different from the rightwingnut parallel universe in which welfare recipients are actually lazy bums who don’t want to work.

    What’s really infuriating is that Obama blew his chance at truly meaningful reform. Landmark legislation passes every 20 years or so, and if the healthcare crisis were as bad as they said it was (which it is), there is zero excuse for not offering AT LEAST a public option as a safety net for those who literally cannot come up with the money to buy insurance. Because buying insurance is not the same as paying for healthcare, and the fact that Obama took the most toxic element of our broken system — the private, for-profit third-party payer – and put it on steroids is enough to make me know for sure he will never have my vote. Show me a Green Party candidate. The Easter Bunny. ANYONE who isn’t brazen or unintelligent enough to understand how real Americans live.