Essential Politics: An end to the Obamacare wars? After Supreme Court ruling, GOP leaders wave a white flag

WASHINGTON —  This is the June 18, 2021, edition of the Essential Politics newsletter. Like what you’re reading? Sign up to get it in your inbox three times a week.

The most telling response to the Supreme Court’s 7-2 decision upholding the Affordable Care Act came Thursday from House Republican leader Rep. Kevin McCarthy.

Along with his two top colleagues in the GOP leadership, the Republican from Bakersfield issued a statement that served up standard talking points about the healthcare law’s shortcomings. He also expressed opposition to the efforts by progressive Democrats to create a single-payer healthcare system.

What he notably did not do is repeat the once-standard Republican promise to “repeal and replace” Obamacare.

“Congress must work together to improve American health care,” the statement said. “House Republicans are committed to actually lowering health care costs, protecting those with preexisting conditions, and providing Americans more health care options that best fit their personal health needs.”

With that, 11 years after President Obama signed his signature legislative accomplishment into law, and hours after the Supreme Court for the third time upheld that law against constitutional challenge, GOP leaders quietly waved a white flag on their long and unsuccessful effort to erase it from the books.

A more popular law

In 2010, shortly after the healthcare law passed, opposition to it propelled Republicans to a major victory, giving them control of the House. But over time, as more Americans benefited and as Republicans under President Trump tried to repeal it, the Affordable Care Act gained in popularity. GOP opposition to it has by now become a potent election argument for Democrats.

At its low point, shortly after the bungled launch of its online insurance marketplace in the fall of 2013, only about one-third of Americans approved of the Affordable Care Act, according to polling by the Kaiser Family Foundation. But by the time Trump took office, that had begun to change. Public support for the law hit 50% shortly after the GOP-controlled House voted for repeal in the spring of 2017. As support has stabilized, opposition has dropped and now stands at 35% in Kaiser’s polling.

The Republican retreat from their all-out effort to kill the law recognizes that reality.

The shift doesn’t mean no more controversy, of course. Some conservative Republicans may continue to try to repeal the healthcare law even if the party as a whole has backed away from that fight.

And in the 12 states — mostly in the South — that have not used their authority under the law to expand Medicaid, battles over that issue will continue.

When Congress wrote the law, it envisioned all states expanding Medicaid coverage for people with low incomes — up to about $18,000 a year for single people. Those earning more would be eligible for subsidies to allow them to buy insurance on the Obamacare marketplaces. But then, in 2012, the Supreme Court ruled that Congress couldn’t require states to expand Medicaid. When some conservative states declined to do so, even though the federal government picks up almost all the cost, they created a coverage gap.

Currently, some 2 million low-income Americans fall into that gap — too poor to be eligible for subsidized coverage on the Obamacare insurance marketplaces, but not poor enough to qualify for Medicaid in their home states.

About one-third of those people live in Texas, which sets a very low income limit for Medicaid. Another 19% live in Florida. Congress this year passed new incentives to encourage the remaining states to expand Medicaid; so far, there have been no takers.

Beyond that battle, Democrats in Congress are grappling with how far up the income ladder to offer insurance subsidies, which make premiums more affordable.

As part of President Biden‘s COVID-19 relief plan, Congress expanded eligibility for the subsidies for this year, an expensive move that lawmakers now have to decide whether to continue.

They’re also hoping to take several steps on healthcare as part of a massive budget bill later this year. House Speaker Nancy Pelosi on Thursday reiterated her support for restraining high prescription drug prices, which Congress has repeatedly promised, but failed, to take on. Sen. Bernie Sanders (I-Vt.), who chairs the Senate Budget Committee, wants to enhance Medicare, lowering the age of eligibility to 60 and adding dental, hearing and vision benefits.

The healthcare law also did not tackle the growing problem of high deductibles and co-payments that make employer-provided insurance inadequate for millions.

All those debates will take place in the context of a healthcare system in which the Affordable Care Act is now deeply embedded.

The arc of the ACA resembles that of Medicare and Medicaid, which went from bitterly controversial to widely accepted over a period of years. Arizona, the last state to adopt a Medicaid program, didn’t do so until 1982 — 17 years after Congress passed the law.

That shifting tide can be seen at the high court as well. Thursday’s ruling marked the third time the justices rejected Republican-backed challenges to the healthcare law, each time by an expanding margin.

In the 2012 case, Chief Justice John G. Roberts Jr. wrote for a 5-4 majority in which he joined what were then the court’s four liberals. His decision upheld most of the law, with the major exception of the requirement for states to expand Medicaid.

In 2015, the court upheld the law a second time, with then-Justice Anthony M. Kennedy joining a 6-3 majority.

By the time this latest challenge, from Texas and 17 other Republican-majority states, reached the justices, the high court’s makeup had become more conservative, with Kennedy and the late Justice Ruth Bader Ginsburg replaced by Justices Brett M. Kavanaugh and Amy Coney Barrett. When Republicans pushed Barrett’s nomination through the Senate just before the 2020 election, many Democrats predicted she would vote to strike down the law.

That wasn’t ever likely — the arguments made by Texas Atty. Gen. Ken Paxton and his colleagues in the case were widely viewed as implausible even among many conservative legal experts. Nonetheless, the case posed a real threat to the healthcare law. A conservative district judge in Texas had ruled in the state’s favor, and an appeals court had upheld parts of that ruling, which could have invalidated the entire law.

But when the justices heard arguments in the case last fall, Barrett made clear that she found the challenge questionable. In the end, she, Kavanaugh and Justice Clarence Thomas, as well as Roberts, joined in the 7-2 majority opinion written by Justice Stephen G. Breyer that said, in effect, that the case was so lacking that the district court should have dismissed it at the outset.

Never say never, but with three defeats, it’s hard to see opponents launching another major legal challenge.

After more than a decade of legislative and judicial battling, more than 25 million people are covered under the law, either by buying insurance through the marketplaces or gaining coverage through Medicaid expansion. The number of uninsured Americans dropped sharply after the law passed, and although that figure started to increase again under Trump, it is now going down again, in part because of Biden’s policies.

The road to this point was rocky, but Obama likely had it right in his Twitter response to the high court’s ruling:

“The Affordable Care Act is here to stay,” he said.

A fading recall, a burgeoning budget

A few months ago, amid rising death rates from the pandemic and frustration over his administration’s stumbles, Gov. Gavin Newsom looked seriously vulnerable. Today, as Taryn Luna and Phil Willon reported, his political fortunes are rising as California reopens.

The effort to recall Newsom looks increasingly like a long shot.

“The recall thrived because of the pandemic, and now it’s going to wither because of the pandemic,” said Democratic political consultant Rose Kapolczynski, who was former California Sen. Barbara Boxer’s chief campaign advisor.

In addition to the shift in how voters view Newsom, changes in the state’s politics are also bolstering the governor. As Matt Stiles and Paul Duginski showed in a series of graphics, the state has become much more Democratic than it was in 2003, when voters recalled Gov. Gray Davis and elected Arnold Schwarzenegger.

When the recall will take place remains uncertain. As John Myers reported, local elections officials warn that proposed rules changes could cause extensive vote confusion. They’re urging that the vote not take place before mid-September. Under state law, Lt. Gov. Eleni Kounalakis will choose the date, which could be as early as Aug. 24.

The reopening of the economy post-pandemic will also bring a toughening of rules on unemployment benefits, Patrick McGreevy reported. Starting next month, people will once again have to show that they are actively looking for work to qualify for benefits. The state suspended that rule during the pandemic.

The budget passed this week by the state Legislature isn’t the final word on state spending, but it’s still significant, George Skelton wrote. Among other items, the $264 billion spending plan includes a record $96 billion for K-12 schools and community colleges, expanded healthcare for older immigrants living in the country illegally, a restoration of benefits for the aged, blind and disabled that were cut during the recession of 2008-10, and $8.5 billion to combat homelessness.

And in Huntington Beach, Mark Barabak wrote, the short, odd political career of Tito Ortiz, who styled himself the “Trump of Orange County,” provides a miniature case study in the dysfunction of a “political culture that spurs conflict, rewards intransigence and empowers the loud and adversarial” even as voters say they want elected officials to solve problems.

The Putin summit

Biden declared his summit meeting with Vladimir Putin to be “frank.” Whether it will have an impact on Russian behavior remains to be seen, as Eli Stokols and Tracy Wilkinson wrote.

Harris on voting rights

As voting rights bills fizzle in Congress, Vice President Kamala Harris looks to fire up voters for 2022, Noah Bierman reported. Sen. Joe Manchin (D-W.Va.) this week floated a compromise voting rights proposal that he said he hoped Republicans would support, but Senate Minority Leader Mitch McConnell of Kentucky slammed the door on that effort. Given Senate rules that require 60 votes for passage of most legislation, McConnell’s opposition would probably doom a bill. Many Democrats hope that issue will motivate their supporters in key races in the midterm election.

The latest from Washington

Amid inflation worries, the Federal Reserve is signaling an earlier increase in interest rates than had previously been forecast, Don Lee reported. In March, most Fed officials didn’t think rates would go up until after 2023. Now, significantly more of them see a rate increase coming as early as next year.

The House sent Biden a bill creating Juneteenth as a federal holiday. The Senate had previously approved the measure. The new holiday will take effect right away, Sasha Hupka reported.

The House also voted to repeal the authorization for the use of military force in Iraq that Congress first passed in 2002, Sarah Wire reported. Although the measure passed the House 268 to 161 and has the support of the Biden administration, which says the authorization isn’t needed anymore, its chances in the Senate are unclear. Senate Majority Leader Chuck Schumer of New York supports it and says he will bring it to the floor later this summer, but finding 60 votes could be difficult.

In addition to its ruling on Obamacare, the Supreme Court also ruled that Philadelphia could not ban Catholic Charities from its foster care program over the church’s opposition to adoption by gay couples. The unanimous ruling said that Philadelphia’s policy improperly discriminated against the church-related charity on the basis of religious belief, but it stopped short of the kind of sweeping ruling that conservative religious groups had hoped for, David Savage reported.