Seems like just about every elected official and candidate in Arizona went into rhetorical hyper drive last week when the U.S. Supreme Court upheld the politically pivotal Affordable Healthcare Act, with one major reservation that may cast a long political shadow in Arizona.
Chief Justice Roberts surprised many of the pundits when he upheld the linchpin requirement that everyone must buy health insurance or face fines. Many legal experts predicted the decision would turn on whether Congress had stretched the Constitution’s commerce clause shapeless with the insurance mandate. But Roberts neatly sidestepped the issue by concluding that Congress couldn’t impose the mandate under the commerce clause — but could invoke its taxing power.
The only bone tossed to opponents by the court’s majority opinion lay in the rejection of the act’s threat to withhold all Medicaid funds for any states that balked at the reform’s major expansion of Medicaid — which in Arizona goes by the name AHCCCS. The expansion of Medicaid played a key role in the reform’s promised expansion of coverage to an estimated 34 million Americans.
The court majority ruled that taking away all the money from states that balked at the expansion amounted to blackmail. That may allow some states to reject the expansion, although the federal government will foot 90 percent of the cost. Please note: Arizona has already cut hundreds of thousands of people — mostly children — from AHCCCS to save the state match.
Hardly anyone on either side of the aisle so much as took a breath before hailing the Supreme Court’s decision as either the salvation of the middle class or a slide into socialist tyranny.
Most Rim Country Republican candidates doubled down on the party line, insisting that only the election of a Republican president, House and Senate could now save the economy by repealing “ObamaCare.”
Most of their Democratic opponents insisted the focus should now shift to implementing the law, especially in Arizona with about 20 percent of the population uninsured.
Gov. Jan Brewer made an overtly political appeal, saying, “If nothing else, today’s decision officially sets the stakes for the November election. It is now up to the American people to save our country from the fiscal and regulatory nightmare known as ObamaCare.”
Rep. Paul Gosar, who represents Rim Country and is duking it out in a scorched earth primary with State House Rep. Ron Gould, said “Americans stand resolved this legislation will spell the ruin of health care in this country by driving up taxes, increasing health care costs as well as weakening the physician patient relationship with bureaucratic interference.”
Rep. Jeff Flake, in a tight contest for the Republican nomination to replace outgoing Sen. Jon Kyl, vowed to work to strip away funding to prevent the Obama administration from implementing the act. “Our health care system is badly in need of reform, but ObamaCare is not the answer. We need to replace it with effective, market-based health care reforms that increase competition, lower costs and raise the level of care for everyone.”
His Republican primary opponent, Wil Cardon, agreed, “Constitutional or not, ObamaCare is dead wrong and absolutely must be repealed. Wil Cardon won’t stop fighting until ObamaCare is repealed.”
The Democratic Senate candidate took the most thoughtful and nuanced approach, perhaps because he’s an emergency room trauma surgeon and former Surgeon General of the United States. Dr. Richard Carmona said “both Democrats and Republicans got it wrong. The fact is, we don’t have a health care system, we have a sick care system. More than 75 percent of the $2.8 trillion we now spend on health care costs annually goes towards treating chronic diseases, much of which are preventable. The health and fiscal security of our nation is on the line, but neither side is willing to shed special interest politics to fix it.”
That makes Carmona one of the few people on either side to mention the elephant in the room — the lack of any real provisions in the Affordable Care Act to control the ruinous rise in health care costs, which routinely rise at twice the rate of inflation overall.
In fact, the Goldwater Institute has vowed to file a new lawsuit seeking to overturn one of the few cost-control elements in the bundle of reforms, the establishment of a panel of experts set up to make recommendations on what must be covered, based on the latest studies on which treatments actually work.
Ironically, the idea of a health care mandate to retain the current, insurance-based system came first from Republicans, when they were fighting President Bill Clinton’s plan. Now, most Republicans quickly shifted from decrying the reforms as an unconstitutional power grab to labeling it as a huge, new tax.
Democrats — who shied away from a “Medicare for all” approach in hopes of enlisting Republican support — mostly clung to the hope that voters will get to like the health care reforms as they actually come into play.
The federal department of health and human services last week noted that the health care reforms have already triggered payments of $28 million to 414,000 Arizona residents by health plans that have violated the new 20 percent limit on administrative overhead.
Moreover, people on Medicare in Arizona have so far saved $66 million on prescription drug costs, as a result of the reform act’s elimination of the so-called “donut hole” in their existing coverage.
Groups like the Children’s Action Alliance hailed the Supreme Court’s decision with the observation that so far the reforms provided 60,000 young Arizonans with health care by letting them stay on their parent’s policies.
The Alliance expressed concern that the Arizona Legislature will opt out of the proposed expansion of AHCCCS, which would increase the size of the program by about a third.
Some 600,000 Arizona children already get coverage through AHCCCS, with about 250,000 on waiting lists as a result of last year’s cutbacks.
House Speaker Andy Tobin sounded ready to do just that, pointing out that the opt-out escape hatch in the Supreme Court ruling could save the state $850 million if exercised. He didn’t note that the state would lose nine times that amount if it rejected the federal funds.
Tobin didn’t mince words, and quoted former Chief Justice John Marshall who said: “The power to tax involves the power to destroy.” Tobin added, “if that is the case, President Obama will go down as having led the most economically destructive administration in American history.”
Lost in the furor are the estimated 50,000 deaths annually caused by a lack of health insurance — and the crushing cost of our insurance-based approach.
For instance, the U.S. spends twice as much per person for medical care as Canada, but has a higher infant death rate, lower life expectancy and higher death rates from a host of diseases. The U.S. spends about 16 percent of its GNP on health care compared to about 10 percent in Canada.
But then, you can trust most politicians not to let inconvenient facts get in the way of simplistic sound bites.