A measles epidemic is creeping across America, bringing a once-vanquished disease roaring back to life and sickening hundreds of people, mostly children. These serious illnesses, like the outbreak itself, were entirely preventable; the disease has re-emerged because of the anti-vaccine movement, and its victims were largely unvaccinated. You might expect politicians to line up in support of vaccinations. Instead, Gov. Chris Christie and Sen. Rand Paul—both presumptive 2016 Republican presidential candidates—swung in the opposite direction, with Christie calling for parents’ “choice” and Paul advocating for vaccine “freedom.”
Many commentators were puzzled by the politicians’ decisions to pander to the anti-vaccine movement, especially given that turning vaccines into a partisan issue may well cause more people to put their children at risk of preventable illnesses. (There are willfully ignorant liberals who spread lies about vaccines, including one disgrace to his famous name, but no Democratic Party leaders endorse anti-vax conspiracy theories.) But no one should be surprised that Republicans are putting politics ahead of public health. Republicans are currently cheering on an anti-Obamacare lawsuit that could strip millions of health insurance. They’re willing to put Americans at risk of death just to score points against a law they hate.
To see why the GOP’s new legal campaign against Obamacare poses such a serious threat to public health, it helps to understand that it is based on what Slate contributor Eric Segall called “an outright falsehood.” The Affordable Care Act was designed to encourage states to create their own health care exchanges, allowing people to sign up on state-run websites to receive subsidies for health insurance. However, Congress understood that not every state would be eager to partake in the subsidies system. Accordingly, the ACA calls for the federal government to create exchanges in states that refuse to make their own, allowing people in anti-Obamacare states to receive federal subsidies to purchase a health insurance plan.
When the law was passed, everyone—from Scott Walker and Paul Ryan to the arch-conservative Heritage Foundation—understood that its success depended upon these federal exchanges and subsidies. And, indeed, after a bumpy start, healthcare.gov has already registered more than 7.1 million enrollments. Left to function as its drafters intended, the ACA could continue to expand health insurance coverage while permitting states to refuse to set up their own exchanges. But soldiers in the conservative and libertarian war against Obamacare could not bear to let the law unfurl as planned. So two of its fiercest critics penned an astonishingly mendacious plan of attack against the act, one that Republican politicians and activists have now carried to the Supreme Court. It will hear the case, King v. Burwell, in March.
The argument is as straightforward as it is disingenuous. Although the history and text of the law point toward the creation of a federal exchange, Obamacare’s enemies have located a few sentences in the several thousand–page law that describe subsidies available in “an exchange established by the state.” Presenting these sentences in isolation, the act’s adversaries allege that the federal exchanges themselves are illegal, as are the federal subsidies that flow from them, and that only exchanges “established by the state” are valid. Should the Supreme Court accept their dishonest, blatantly political interpretation, according to a study out last month, an estimated 8.2 million Americans will lose their insurance.
Many conservatives are cheerfully unconcerned by this lawsuit’s potentially fatal consequences. In one op-ed titled “End Obamacare, and People Could Die. That’s Okay,” Michael R. Strain of the American Enterprise Institute insisted that the Supreme Court should have no compunction about rendering a decision that will kill Americans. A higher mortality rate, Strain wrote, is “an acceptable price to pay for certain goals,” including “less government coercion and more individual liberty.”
An amicus brief filed by Americans with life-threatening illnesses makes the lawsuit’s threat to human life distressingly clear. The brief explains how a federally run exchange saved the life of people such as David Tedrow, who needed a liver transplant. Tedrow was rejected by every insurer he contacted, and North Carolina, his state of residency, refused to set up its own exchange. Without insurance to cover the cost of a transplant, Tedrow expected to die—but his life was saved when he purchased insurance through a federally run exchange and finally got a transplant. Without the subsidies offered through that exchange, any insurance he managed to purchase would have been wildly expensive, driving him into bankruptcy and financial ruin. But once the federal government set up the exchange and required healthy North Carolinians to purchase insurance, the insurance he obtained had enough healthy customers paying into it to cover the cost of his treatment, and federal subsidies kept his premiums reasonable.
Yet Tedrow also requires chemotherapy to treat the cancer that spread from his old liver while he was waiting for a transplant. The insurance he obtained through the federal exchange covers that treatment. If the Supreme Court obliterates the exchange, myriad healthy individuals are expected to drop their insurance, causing premiums to rise rapidly as insurance companies struggle to gather enough money to cover expensive treatments. As premiums skyrocket, more healthy customers will drop out, creating a so-called death spiral. Tedrow’s insurance could quickly become unaffordable, or it may simply go out of business, leaving him without insurance. And without insurance, Tedrow may well die.
Tedrow is one of six people discussed in the brief who avoided death, sickness, and bankruptcy thanks to a federal exchange. There are thousands more like him. In a recently filed amicus brief, dozens of public health scholars and the American Public Health Association calculated that, if the Supreme Court scraps federal exchanges and subsidies, 9,800 additional Americans will die—each year. These are approximations, but the underlying logic is undeniable. When people get health insurance, they’re more likely to live. When people lose health insurance, they’re more likely to die.
Given these stakes, you might expect politicians to support federal exchanges. But by endorsing the lawsuit, Republicans resumed their role as Obamacare’s assassins. Republican governors have crafted a cruel conundrum, arguing that their states’ citizens shouldn’t be able to purchase insurance from a federal exchange while simultaneously refusing to set up their own state exchanges. A sprawling coalition of Republican attorneys general and legislators has filed amicus briefs encouraging the Supreme Court to invalidate federal exchanges and rip subsidies (and probably health insurance) away from people like David Tedrow—people whose lives may depend on the wobbly vote of a single justice.
If the new case against Obamacare were based on a reasonable reading of the act, Republicans might be able to argue that their opposition to federal exchanges rests in principled respect for statutory fidelity. But their case is so transparently unscrupulous and deceitful that it’s impossible to avoid the conclusion that Republicans oppose the federal exchange for purely political purposes. They don’t despise Obamacare because its benefits aren’t rooted in sound law. They despise Obamacare because doing so gets them votes and campaign cash.
By launching and championing this latest lawsuit, Republicans have already chosen political popularity over life and morality. From its perch beyond the Rubicon, the GOP has every reason to pander to the surprisingly sizable anti-vaccine contingent of its party. When Republican politicians have to decide between standing up for public health and pandering for extra votes, it’s not hard to guess which side they’ll come down on.
