What America Won Today

Today was a victory. I'll leave it to others to analyze the margins of that victory, parse out what the majority of the Court did and didn't say, and what it means for the progressive movement, the health care reform movement, Democrats, Republicans, the tea party, Mitt Romney, and President Obama. There's a lot that can and will be said about all of the above between now and November. 

But make no mistake about it, the Supreme Court's decision upholding the entirely of the Affordable Care Act is a victory. It's not merely a victory for the president and his party. It is a victory for millions of Americans whose fate rested in the hands of the Court, and who had much to lose if the Court decided differently. 

Most of all, it's a victory for America, and a moment that brings us closer to becoming the kind of country we want to be.

After several tense hours this morning, I breathed a sigh of relief at 10:09 a.m. No thanks to CNN's email alerts. The first one hit my inbox at 10:09 a.m.

The Supreme Court has struck down the individual mandate for health care - the legislation that requires all to have health insurance.

The second followed at 10:18 a.m.

Correction: The Supreme Court backs all parts of President Obama‚s signature health care law, including the individual mandate that requires all to have health insurance.

That cognitive dissonance was reflected on CNN's website.

Fortunately, by that time I'd made it to my computer, and browsed my way to SCOTUSBlog to read this summation: "The bottom line: the entire ACA is upheld."

In fairness to CNN, the Court's decision (which is available online) isn't exactly light reading, nor is it easily digestible by those of us who are less well versed in constitutional legalese. Thankfully, Amy Howe put it in plain English on the SCOTUSBlog liveblog of the ruling. (Howe gave a somewhat more extended reading in a separate blog post.)

In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance.

However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters.

Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn't comply with the new requirements, rather than all of their funding.

What it all means will be hashed out from now to November and beyond. But we know enough about the Affordable Care Act to know it's a victory for millions of Americans.

• It's a victory for 12.5 million to 24 million Americans who who have lost health insurance if the mandate or the entire Affordable Care Act was struck down. 
• It's a victory for 30 million previously uninsured Americans who got health insurance, and would have lost it if the ACA had been repealed
• It's a victory for the 32,000 Americans might have otherwise died because they would have lacked health insurance.
• It's a victory for the the 3.1 million young Americans who gained health coverage, because the ACA enabled them to stay on their families' coverage until age 26.
• It's a victory for 12.8 million Americans who stand to get health insurance rebates.
• It's a victory for families with children who have pre-existing conditions, who cannot be denied coverage and no longer face lifetime caps on coverage.  
• It's a victory for 50,000 Americans with pre-existing conditions, who have gained coverage because the ACA prohibits insurers from discriminating on the basis of pre-existing conditions. And it's a victory for as many as 112 million Americans who have pre-existing conditions (including yours truly) who cannot be denied insurance on that basis, and who had a lot to lose if the Court had ruled differently.
• It's a victory for  54 million Americans who have coverage for preventative care, without a co-pay. 
• It's a victory for 3.6 million seniors who have saved $2.6 billion on their prescription, because the ACA closed the "donut hole."
• It's a victory for Americans who were subject to recissions by insurance companies, because of honest mistakes on health insurance applications, before the ACA did away with that.
• It's a victory for small businesses, that get tax credits to bring down the cost of providing health insurance to workers.

It's a victory for Americans whose lives are the real stories behind those numbers.

It's a victory the millions of Americans who have benefited from health care reform, and for whom Mitt Romney and Republicans in Congress have no solutions or alternatives to offer.

• What do conservatives have in mind for Janine Urbaniac and her family? Her 14-year-old son has brain cancer, and she says that without the Affordable Care Act, her family might have been dropped by their insurance company. Within three weeks of being hospitalized, her son's medical bills topped $1.1 million. The family worried about hitting their insurer's $5 million lifetime limit, and probably would have if the ACA hadn't eliminated such caps when it was enacted last year. (Note: Ubrbaniac writes that her son is back in school, walking, talking, and working out at the gym.)
• What do conservatives have in mind for Lianne Valenti? Valenti lost her job last July, and her health insurance along with it. She could have continued her former employers policy, but couldn't afford the $600 monthly premium and figured she wouldn't fare much better in the individual market. In October, Valenti began having chest pains. By January they landed her in the emergency room, where she was was told she'd suffered a heart attack, underwent an angioplasty and had stents inserted to keep her arteries open. She now has a bill for $79,000 in medical costs. If the Affordable Care Act stands, in 2014 it will make it far easier for unemployed people like Valenti to find affordable coverage.
• What do conservatives have in mind for Susan Hannon? When her husband turned 65 and was eligible for Medicare, Hannon lost her health insurance. Last year, she was rejected for insurance due to high cholesterol — one of the many pre-existing conditions private health insurers use as reason to deny coverage. Thanks to the Affordable Care Act, Hannon was able to enroll in Maryland's Pre-Existing Condition Insurance Plan (PCIP), which has been providing affordable coverage to people with pre-existing conditions, who are shut out of the private insurance market, for now. Beginning in 2014, the ACA will prohibit insurers from denying coverage or charging more for coverage to people with pre-existing conditions.
• What do conservatives have in mind for Brad Gates? Diagnosed with scoliosis as a child, Gates faced a lifetime of corrective surgeries. In 1994, he went on disability and leave his job at an engineering firm. He's signed on to his wife's employer-provided insurance policy, and is eligible for Medicare due to his disability. Yet, Gates' pre-existing condition has meant fighting with insurance companies over expenses, as bills piled up because expenses went uncovered and procedures were dropped as "too expensive." Gates said his insurer made clear efforts to "get me off their policy."
• What do conservatives have in mind for Caroline Richmond? In November, nine-year-old Richmond collapsed on her way to school, and was rushed to the emergency room. Doctors determined she'd had a stroke, and needed surgery right away. It got worse. Doctors determined the stroke was caused by leukemia. Richmond underwent chemotherapy, and at one point became so ill that she had to be put on a ventilator. Richmond is uninsured, as her self-employed father has been unable to find insurance. Worried that medical bills might be forced in to bankruptcy and lose their home due to medical bills, friends of the Richmond family have turned to fundraisers — placing "Cups for Caroline" in all the homerooms at Caroline's school, and holding bake sales, fish fries and car washes to raise money for Caroline's medical bills.
• What do conservatives have to offer Nathan and his son Thomas? In 2009, Thomas was born with hemophilia — one of the most expensive medical condition one can have. In fact, Thomas hit his lifetime limits with two health insurance companies before he was seven years old. Thanks to the Affordable Care Act Thomas and about 105 million Americans no longer have lifetime limits on their health coverage.
• What do conservatives have in mind for Joseph La Mountain? Joseph comes from family with a long history of alcoholism. In 2008, he decided he wanted to stop drinking. When it proved harder than he thought. LaMountain visited his doctor, who prescribed an anti-depressant medication that took away his craving for alcohol. He took it for thirty days, and then stopped. LaMountain found out that wasn't the end of the story when, years later, he was an insurance company declined to cover him, due to a history of "substance abuse and anxiety." The company later offered him coverage — a policy with a $1,500 monthly premium, and a $10,000 out-of-pocket deductible.
• What do conservatives have in mind for Josh R.? Josh, thanks to the Affordable Care Act, was able to get a physical for first time in years. The physical revealed that Josh had severe anemia. As a result, he says he's much healthier than he was before he had the physical. Josh says he wouldn't have been able to afford the physical if he was not on his father's insurance, making him one of 2.5 million young adults who have access to coverage they wouldn't have without and didn't have before the ACA.

Even before the Supreme Court announced its ruling, House Speaker John Boehner vowed to repeal what was left of health care reform. After the ruling, Boeher doubled down on repeal, and House Majority Leader Eric Cantor tweeted that the House would vote on repeal right after the 4th of July Holiday.

In a sense, its appropriate that the Court has upheld health care reform as the 4th of July approaches, and that Republicans will once again vote to repeal health care reform with the sound of holiday fireworks still ringing in their ears.

As another celebration of America's birth approaches, these events offer a wonderful opportunity to reflect on our past and chart a course for our future. Americans have consistently supported health care reform, and overwhelmingly oppose repeal. Among those who are ambivalent about the law itself there is strong support its provisions. Even Republicans who want to repeal health care reform like most of what it does. 

However Americans feel about the health care law as a whole, a majority like what it does. And what it does it take America in a very different direction than John Boeher, Eric Cantor, Mitch McConnell, Mitt Romney and the Republican want to take us. What it offers us is a very different vision of American, than the one envisioned by conservatives. That vision was recently summed up by conservative economist Tyler Cohen, in terms of health care policy.

Breathe deeply and try to summon your inner peace before reading this description, from economist Tyler Cowen, of what conservatives and libertarians should put in health care policy. You're going to need every drop of calm and sanity you can muster.

2. A rejection of health care egalitarianism, namely a recognition that the wealthy will purchase more and better health care than the poor. Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence. We need to accept the principle that sometimes poor people will die just because they are poor. Some of you don’t like the sound of that, but we already let the wealthy enjoy all sorts of other goods — most importantly status — which lengthen their lives and which the poor enjoy to a much lesser degree. We shouldn’t screw up our health care institutions by being determined to fight inegalitarian principles for one very select set of factors which determine health care outcomes.

I'm going to repeat that: "We need to accept the principle that sometimes poor people will die just because they are poor." 

I think President Obama offered the best rebuttal in his remarks on the Court's decision.

Well, it should be pretty clear by now that I didn’t do this because it was good politics. I did it because I believed it was good for the country. I did it because I believed it was good for the American people.

There’s a framed letter that hangs in my office right now. It was sent to me during the health care debate by a woman named Natoma Canfield. For years and years, Natoma did everything right. She bought health insurance. She paid her premiums on time. But 18 years ago, Natoma was diagnosed with cancer. And even though she’d been cancer-free for more than a decade, her insurance company kept jacking up her rates, year after year. And despite her desire to keep her coverage -- despite her fears that she would get sick again -- she had to surrender her health insurance, and was forced to hang her fortunes on chance.

I carried Natoma’s story with me every day of the fight to pass this law. It reminded me of all the Americans, all across the country, who have had to worry not only about getting sick, but about the cost of getting well.

Natoma is well today. And because of this law, there are other Americans -- other sons and daughters, brothers and sisters, fathers and mothers -- who will not have to hang their fortunes on chance. These are the Americans for whom we passed this law.

The fight over health care reform is far from over. It's an important fight, and we experienced a victory in that fight for Americans like Natoma, who "will not have to hang their fortunes on chance."

As Vice President Biden told the National Association of Black Journalists recently, this year's election is really "About who the hell we are." I've said it before and I'll say it again. On election night, in November of 2008, Americans were not just choosing a president, but choosing the kind of country we want to be.

Four years later, that journey continues — sometimes in fits and starts, and sometimes in great strides. Today American took another great stride.

We took one more step away from becoming the kind of country where we "accept the principle that sometimes poor people will die just because they are poor." We took one more step away from becoming the kind of country that "accepts the principle" that sometimes poor people should die just because they are poor. 

We took one more being the kind of country where accepting that "principle" is not in our character.

On issues like these, Ted Kennedy’s passion was born not of some rigid ideology, but of his own experience. It was the experience of having two children stricken with cancer. He never forgot the sheer terror and helplessness that any parent feels when a child is badly sick. And he was able to imagine what it must be like for those without insurance, what it would be like to have to say to a wife or a child or an aging parent, there is something that could make you better, but I just can’t afford it.

That large-heartedness—that concern and regard for the plight of others—is not a partisan feeling. It’s not a Republican or a Democratic feeling. It, too, is part of the American character—our ability to stand in other people’s shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand; a belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgment that sometimes government has to step in to help deliver on that promise.

We took one more step towards becoming a country where people don't have to "hang their fortunes on chance," because we understand "all the ways our hopes and dreams are bound together."