I think in the present moment, the tax would be backbreaking for a lot of people. We’re kind of lucky we don’t have it in the short term - with people in such dire financial straits over the lockdowns. GOP propaganda probably wouldn’t change, but a lot of people who couldn’t give a rats ass about the culture war nonsense are going to notice if a chunk of the stimulus check they just got gets scooped back up by Uncle Sam.
Although in the long term I’m not entirely sure the ACA as presently constructed can last forever with no penalty.
I think for the ACA to truly get us to UHC, we’d need a penalty with real teeth (example: Switzerland). But without a penalty, I see the ACA continuing on like it is, giving millions access to health insurance, but without being able to get everyone in the game. I think there’s a certain % that won’t buy unless they’re made to buy.
I agree, but anything that looks like a penalty and not a “tax” would run afoul of the fifth Roberts vote in the ACA case and make the entire scheme unconstitutional.
My thought on the best way to get universal coverage is to impose a fee on anyone who has not signed up for appropriate coverage, and use that fee to pay for signing them up for either a public option, or at the very least, a certified private insurer on the exchange.
When the likely alternative was public transport that was “whites-only”, yes, I can see it being seen as a progressive decision. In theory, it ensured that Black people could have access to public services.
But that wasn’t the question I asked. Yes, Plessy was a step forward. Brown was a further step forward. Obergefell was a step forward.
What I was asking is if SCOTUS has ever reversed such a decision.
This is similar to Biden’s plan - he essentially had a plan where a loss in coverage would automatically enroll someone in the public option.
Personally I don’t think it’s necessary to risk that something like this would get struck down, and I definitely wouldn’t trust the court post-ACB to narrowly remove the exact thing they construe as mandatory healthcare without neutering the rest of the law in this scenario.
Just having a public option available to everyone would dramatically improve the situation, possibly more than just adding a fee would. Public option + the old fee from the original ACA would likely be better. If we wanted to get to 99+% of people covered we would either have to do some sort of automatic enrollment or we’d have to just go to single-payer. We could potentially just make the fee for not having coverage equal to the cost of the public option. There might be some concern there that people might think they are forced to pay the fee and not get care for some reason.
Obviously truly universal coverage is the ideal, and the most legally airtight way to make that happen is single-payer. If we’re not willing to do that, I’d rather see the safest way to get 95%+ covered that we’re extremely sure wouldn’t get struck down.
The other thing we have going on now is that the American Rescue Plan subsidizes 100% of COBRA. There’s a chance this just becomes the new normal also. I don’t think that would eliminate the need for a public option but it may dramatically reduce the need for a penalty.
There’s been a big change on that front. The Senate Parliamentarian has determined that it is possible to amend resolutions with the reconciliation process. So it is possible for the Democrats to amend the bill they’ve already passed.
Here is Beau of the Fifth Column taking about it, arguing they’ll probably pass about half of Biden’s infrastructure bill that way. That said, this video was nearly 2 weeks ago, and I don’t know what’s gone on since then.
Plessy was indeed a step forward. Separate but equal was positive. Unfortunately, the “equal” was never enforced, certainly not in the context of schools. In fact, there was some debate at the time of Brown whether they should have gone instead for equal.
But to get back to the point raised, I assume the 1960s voting rights act was once upheld in the court and then that decision was reversed in 2013. Sure only one provision of the act was reversed but that was the heart of it.
So, the ACA was not overturned. For the third time, SCOTUS refused to throw it away.
Amazingly, there are about 31 million who have health insurance via the ACA, either from expanded Medicaid or from private policies on the ACA State Exchanges.
This was a huge win. Biden now needs to do the things that will shore this act up and make it more like it was originally envisioned. The law is long overdue for an ACA 2.0 bill to shore it up. Make the recent changes from the Covid relief bill permanent, and plug some of the coverage holes. Also, there are 12 states left that still won’t expand Medicaid. Dems need to come up with something to help the 4 million people who are left out in those 12 states.
He can do things around the edges to help. But congress will need to include an ACA 2.0 as part of a bill to really move the needle. Biden’s admin can do things like more advertising and outreach, paying more for navigators to help people get enrolled, rule against state waivers that try to make medicaid eligibility harder, and approve state waivers that do things like a public option. These help, but aren’t enough by themselves
Legislation will be needed to make the stronger tax credits permanent, and to get rid of things like the “family glitch”.
Thanks for Kenobi for doing the explanation on the family glitch. That’s something that an ACA 2.0 could easily fix. In addition to a basic ACA 2.0, there are other things in the works:
Getting around the 12 medicaid resistant states: There’s the medicaid gap in the 12 states that won’t expand medicaid. This has left millions of people who make too much to get medicaid and too little to qualify for the individual policy tax credits. These are strictly in red-states, where at this point the Republican opposition has been proven to be strictly partisan or ideological - not anything to do with the financial benefits of expanding medicaid to the state. The states that have expanded it have done quite well for their citizens, without bankrupting their state.
Dems are now considering a bill which would actually bypass these 12 states, and go to counties or cities within their states, going local. It would be like a Medicaid expansion at the local level only. An interesting idea:
Public Option: Also, there are 3 states where a public option is now on the table. Washington launched one last year (it needs more work to make it more attractive), and now Colorado and Nevada are getting into the game.
