Thursday, June 28, 2012

There are no silver linings for the GOP today

What's with this silly new meme that the health care ruling isn't as bad for Republicans as it looks? 

No, wrong. It was a rout. A total defeat. It was a disaster for conservatives, who managed to somehow put their most-hated law in front of a court with 5 very sympathetic conservative justices (including, it seems, the crucial swing vote!) and still come away with essentially nothing at all.

Republicans got two things out of this:

1.  The court accepted Randy Barnett's strange economic activity/inactivity argument, and said economic inactivity falls outside the scope of the commerce clause.  The government, it turns out, cannot  force you to eat your broccoli, and broccoli-haters are safe, at least from criminal sanctions.  But the government has other perfectly allowable means to make you eat your vegetables, such as:
  • Reward you for eating broccoli
  • Tax you for not eating broccoli
In other words, us big-government liberals haven't actually lost any policy tools.  People are acting as if the federal government will be hampered by the inability to unconditionally compel economic participation, but guess what?  Nobody actually wants to do that.  It's not a useful economic tool in just about any circumstance.  What's especially silly is the idea that Roberts somehow accepted the ACA in order to open political space in which he could seriously damage the commerce clause power.  But liberals would happily take that trade, too: universal health care is among the most far-reaching ambitions of the progressive project.  Contra the Tea Party, we don't actually lie awake at night dreaming feverishly of the day when all economic behavior will occur at federal gunpoint.

The Court could have also noted that the commerce clause does not permit the federal government to legislate the weather on Venus, and while you might technically consider that a curtailment, it would have approximately the same effect on progressive policymaking as this ruling does.

2.  The Medicaid extension was limited, and states can now reject the federal money for it, and the coverage expansion requirements that come with it.  

They can, but they won't.  The federal matching funds are extremely heavily weighted in the states' favor, with 90% of the total spending coming from the nation's coffers.  (Initially, that number is actually 100%.)  For comparison, ordinary Medicaid matching funds range from about 65% to 50%--and nobody rejects those

Even if some podunk Republican governor in some podunk red state wants to make a statement by refusing the funds, his resistance can't last for long.  Rejecting the funds will put a serious strain on the state's poor, as they'll still be subject to the mandate (oops, I mean, personal responsibility tax?).  That in turn will open up a huge political opportunity.  State governments love handing out benefits when they can afford it, because it breeds a lot of political goodwill.  I don't care how die-hard an executive is, it's ridiculous to think that ideology could result in a 9:1 federal match being left on the table for more than one term.  Political challengers could truthfully make wild commitments to massively improve access to care (and on the cheap, too!).  Any enterprising executive will quickly realize that they're better off knuckling under, partisan preferences notwithstanding.  D or R, you probably like free money.

If anything, this new twist is lousy for Republicans, because it gives the dumber Republican governors enough string to hang themselves.  Reject the Medicaid expansion, get hammered by a Democratic challenger promising the world.

No, these things aren't silver linings, they're just speedbumps on the way to full implementation of the ACA. Federal provision and regulation of universal health care is proceeding apace, it's as big as ever, and it's here to stay.

But hey, maybe Mitt Romney will save you, Republicans.  

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