The disastrous ACA ruling

The disastrous ACA ruling

By now you probably know that an activist, right-wing federal judge in Texas ruled in favor of Louisiana Attorney Jeff Landry and more than a dozen of his colleagues late Friday by striking down the Affordable Care Act. You may also know that the ruling, if upheld, would jeopardize the health coverage of 23 million Americans, including nearly 600,000 Louisianans who are covered either through Medicaid expansion or the health insurance marketplace. It also could have disastrous consequences for 849,000 Louisianans with pre-existing conditions, whose coverage could now become unaffordable. So what’s next? The Washington Post’s Amy Goldstein has a good explainer on the ruling itself and what it means:

The opinion, if upheld on appeal, would upend the health insurance industry, the way doctors and hospitals function, and the ability of millions of Americans to access treatments they need to combat serious diseases. Parts of the law that would need to be unwound include no-charge preventive services for older Americans on Medicare, allowing parents to keep children on their plans through age 26, a variety of efforts to rein in prescription drug costs and even requirements that some restaurants post calorie counts. “It affects almost everyone in America,” said Tim Jost, a specialist in health law and a professor emeritus at Washington and Lee University.

But Jan Hoffman, Robert Pear and Adam Liptak of The New York Times spoke to legal scholars who think the judge’s opinion is far too broad and likely to be struck down on appeal.

Lawyers on both sides of previous A.C.A. battles said the reasoning behind this one was badly flawed, notably in its insistence that the entire 2010 law must fall because one of its provisions may have been rendered invalid by the 2017 tax overhaul legislation. Had Congress meant to take such radical action, they said, it would have said so at the time. Legal experts also noted that the Supreme Court, where most people believe the case is headed, historically has been reluctant to strike down federal laws, particularly those that have become ingrained in the lives of millions of citizens.

Vox’s Ezra Klein notes that the ruling is likely to increase support among progressives for some version of Medicare-for-all.

If Hillary Clinton had won in 2016 and Democrats had filled Antonin Scalia’s seat, Obamacare would be safe, and it’s likely the party would’ve largely moved on from health care to focus on paid maternity leave, universal pre-K, or some other priority. But with Obamacare under constant threat, Republicans have refocused Democrats on building what they failed to build in 2010: a universal health care system simple enough and popular enough that it is safe from constant political and legal assault. And that means some version of Medicare-for-all.

For more on the Texas vs. United States case, and its implications for Louisiana, read this post by former LBP Policy Director Jeanie Donovan.


Making sense of the REC kerfuffle
Gov. John Bel Edwards’ push for an across-the-board pay raise for Louisiana teachers and school support workers will almost certainly not be derailed because of the ongoing stalemate over revenue forecasting. But the inclusion of the raise in next year’s budget could be delayed by the antics of House Speaker Taylor Barras, who has decided to substitute his own judgment for that of two non-partisan state economists in rejecting an update to the revenue forecast. The AP’s Melinda Deslatte digs in:

The proposal Edwards outlined involves a $1,000 pay raise for teachers and a $500 increase for support staff such as teacher aides and cafeteria workers. He said he’ll have a three-year plan to raise salaries to the Southern average, along with block grant increases to school districts. The price tag for the first year, Edwards said, is about $135 million. Edwards expected improved tax collection projections to help cover that cost in his budget proposal due to lawmakers in February. … (Rep. Cameron) Henry said if the governor wants a pay raise in his budget proposal, he needs to prioritize available dollars. Louisiana is projected to have $162 million more in general state tax income next budget year than this year, under existing projections. (Commissioner of Administration Jay) Dardenne said without additional revenue, financing a teacher pay hike in next year’s budget would require cuts elsewhere, digging into dollars planned for another agency. He called it “creating an unnecessary political firestorm.”

Louisiana Association of Educators President Deborah Meaux, writing in The Advocate, bemoans the politics surrounding the long-overdue pay raise.

For more than a decade now, the proper and adequate state funding needed for education has been ignored, and school employees across the state are becoming increasingly unsettled. For far too long, their work has been undervalued, and their status as professionals has been overlooked. We cannot ask these dedicated public servants to continue to absorb the impacts of depleted school funding. State legislators must prioritize their focus to ensure Louisiana attracts (and retains) talented teachers and support professionals — our students deserve the best and brightest working in their schools.


“Saving” the rural economy
Much has been written about the growing divide between the richest Americans and everyone else. Less energy has been focused on the emerging split between fast-growing urban areas and rural towns and small cities that are increasingly being left behind. The New York Times’ Eduardo Porter examines the way this chasm has widened since 2000 – and the scattershot attempts to fix the problem.

Even after a robust eight-year growth spell, there are fewer than 13 million workers in manufacturing across the entire economy. Robots and workers in China put together most of the manufactured goods that Americans buy, and the high-tech industries powering the economy today don’t have much need for the cheap labor that rural communities contributed to America’s industrial past. They mostly need highly educated workers. They find those most easily in big cities, not in small towns. … In a report published in November, Mark Muro, William Galston and Clara Hendrickson of the Brookings Institution laid out a portfolio of ideas to rescue the substantial swath of the country that they identify as “left behind.” They identify critical shortages bedeviling declining communities: workers with digital skills, broadband connections, capital. And they have plans to address them: I.T. training and education initiatives, regulatory changes to boost lending to small businesses, incentives to invest in broadband.


Modernizing Medicaid
The conservative critics of Louisiana’s Medicaid program have devoted a lot of time and energy to the idea that the health insurance program for low-income citizens and people with disabilities is riddled with fraud and waste. It’s true that the program is not perfect. But it’s also true that part of the reason for that is years of foot-dragging by the Legislature in updating the computer systems at the Louisiana Department of Health. But as The Advocate notes in an editorial, a long-awaited IT upgrade is finally complete.

At a cost of $71 million, not small change, the Louisiana Department of Health has installed an overhaul of the ancient — in computer terms — enrollment system for the giant Medicaid program. … We think that was a good move. Louisiana’s population includes many people dependent on low-paying and often sporadic jobs. Health insurance coverage is vital to not only the finances of those families but the ability of people to work in the first place. But with new and old enrollments, an early 1990s computer system was simply inadequate to police the rules for Medicaid. As with many Medicaid administrative costs, the expense of the new computers is partly financed by the state but is mostly paid for with federal funds. But it is the state government that is responsible for spending Medicaid money, although private insurers have been contractors for service delivery since the administration of former Gov. Bobby Jindal.


Number of the Day
$135 million – Estimated annual cost of providing a $1,000 pay raise for Louisiana public school teachers, and a $500 raise for school support workers. (Source: The Associated Press).