The Day After the Day

I'm thoroughly exhausted.  There was the anticipation, the fear that we would lose it all.  The elation at winning.  The concern about giving states like Mississippi, Florida, Texas the right to opt out of the Medicaid expansion.  The need to explain, over and over again, that the mandate does not require people to buy insurance they can't afford; it means to make people who can afford insurance pay their own way if they choose not to do so, so we the taxpayers will not have to foot the bill if they land in the hospital due to illness or injury, as we do now.  I want you all to feel as elated as I do that those of us with pre-existing conditions -- meaning everyone with a chronic illness -- are one giant step closer to having equal access to health insurance.

Of course, there's a ton of commentary and I can't possibly cover it all.  I posted Atul Gawande's New Yorker piece in a separate post below -- it's the best piece I've read about health reform and what it means to people like me and you.  But here's a smattering of what others are saying.  

The GOP predictably is using this as a rallying cry -- they promise to repeal the law if Governor Romney is president and they hold the House and take the Senate.  That's fair -- had we lost, they'd have used it to argue that President Obama made a huge mistake, and President Obama would have used it as a rallying cry, too -- vote for me so I can salvage something of health reform.  Sarah Palin heralding the Supreme Court decision because it will fire up conservatives is predictable -- as if conservatives weren't already fired up?  The fact is that the closer we get to implementation, the harder it will be to turn back.  Under any circumstance, health care was going to be part of the November elections.  Still, there is no question that this was a victory for President Obama.  More importantly, though, it was a victory for us.  I have to wonder, though -- how will Governor Romney shake off the fact that he signed Massachusetts' reform law, paving the way for the federal law?  The first repeal vote is scheduled for July 11.  It won't go anywhere in the Senate, and if it did, President Obama would veto it, but it should remind us of the need for continued vigilance. 

We have to be vigilant about the lies, too.  Senator Marco Rubio warned yesterday that the IRS is giong to be coming after people who don't buy insurance.  This is utterly ridiculous.  If you don't buy insurance, you're going to have to make a payment to the IRS with your annual tax return.  There is no criminal penalty whatsoever.  No jail.  No prosecutions.  Just collection of a tax.  And only for those who could afford insurance and choose not to buy it. 

Who'd have thought Chief Justice Roberts would be the hero of it all?  Pundits are saying it's in line with his view of the importance of judicial restraint when assessing an Act of Congress.  Still, it was brave, knowing full well that he would suffer the wrath of many GOP Senators who voted to confirm him. His vote in this case surely will be a huge part of his legacy. 

The ruling on the Medicaid expansion is going to be tough to swallow in states that provide few benefits to their poor residents.  Basically, the Court said that Congress cannot threaten to take away a state's Medicaid funding if it doesn't comply with the Medicaid expansion that would cover adults up to 133 percent of federal poverty level.  That means that states like Mississippi, Florida, Texas may opt out of the expansion, leaving millions of the most vulnerable without coverage.  Because Congress anticipated the Medicaid expansion, subsidies were designed to be available only to people at 100% of federal poverty level and up, leaving people under 100% of federal poverty level with no coverage.  The current Congress surely isn't going to fix this, so we will have to work hard in the states to mobilize people to tell their elected officials that this matters to them. 

I have to say that I was really moved when i read that Nancy Pelosi's first phone call was to Vicki Kennedy, the late Senator Ted Kennedy's widow.  Now Teddy can rest, she said.  This was the cause of his lifetime, and it remains largely intact.  His legacy lives on. 

And now I'm gonna rest, too.  Jennifer