Affordable Care Act: What's The Real Problem?

Economist Brad DeLong calls attention to a piece by Jim Tankerslee in Ezra Klein's Blog. Tankerslee explains the problems poor workers in Rome, Georgia have with the ACA as "due to a quirk in the law."

DeLong makes it very plain that it is NOT due to the law. It IS due to a decision by Justice Roberts and his cohorts on the US Supreme Court, coupled with efforts by Republican Governors and State Legislators who intentionally sabotaged the law.

Here is how DeLong explains it:

"The phrases "because of a quirk in the health-care law, and the fact that Georgia declined to expand Medicaid coverage for low-income people like him, Rizer can’t qualify for a subsidy to buy coverage" are not adequate. What Tankersley means is:

1. The ACA provides subsidies for people with incomes more than 1/3 above the poverty level to afford insurance via the exchange-marketplace.
2. The ACA provides coverage for people with lower incomes via the expanded Medicaid program.
3. Chief Justice John Roberts and the other four right-wing justices broke this system by giving individual states the option not to accept the federal money to pay for the expansion of Medicaid.
4. This was a lawless and unforeseen action: no precedent for it in previous court decisions and no warrant for it in the constitution.
5. Because it was a lawless and unforeseen action, it had never struck the minds of anybody drafting the ACA that the John Roberts, C.J., and his Four Horsemen of the Constitution-in-Exile would do such a thing.
6. Thus people with incomes less than 1 1/3 times the poverty level are left high and dry: since they are supposed to be covered by expanded Medicaid, there is no language in the ACA allowing them to claim subsidies.
7. If Roberts, C.J., had been a public-spirited an intelligent man, he would have realized that if he was going to rewrite the ACA to break its Medicaid expansion provision, he also needed to rewrite the exchange subsidy provision to provide people with incomes less than 1 1/3 times the poverty level with access to subsidies.
8. Roberts, C.J., did not do this.
9. Perhaps Roberts simply wanted to harm people with incomes lower than 1 1/3 times poverty who lived in states that would pick up the ball not to expand Medicaid he had given them and run with it, on the theory that creating an aggrieved class for whom the ACA is clearly not working would redound to the political benefit of the Republican Party.
10. Perhaps Roberts did not understand what he was doing.
11. In any event, Roberts rewrote the ACA from the bunch--and so left people with incomes like Donald Rizen's in red states with governors and legislatures who fear the Tea Party out in the cold. All of numbers (1) through (11) are inside Tankersley's "quirk in the health-care law". I know that that is what is inside Tankersley's "quirk in the health-care law". But how many of Tankersley's readers will know that?
12. The state of Georgia did, indeed--in spite of the protests of doctors and hospitals that want Medicaid expansion so they don't have to keep playing the shell-game of cost-shifting in order to raise the resources to cover the treatment of the uninsured--did indeed refuse to expand Medicaid.
13. And that is how the Governor Nathan Deal, the legislature of Georgia, John Roberts, C.J., and the Four Horsemen of the Constitution-in-Exile casually #@#&^ed Donald Rizen, a fifty-something with a bad shoulder, and many other Americans as well. All of numbers (1) through (13) are inside Tankersley's "quirk in the health-care law, and the fact that Georgia declined to expand Medicaid". I know that's what those clauses in Tankersley's article are really saying. But how many of Tankersley's readers will know?
14. And then comes the end of Tankersley's article: "When he visited the federal health insurance exchange Web site, he found the cheapest policy available to him cost $200 a month — one quarter of his current salary. 'Obama', he said, 'he thinks that he’s helping things, but he ain’t'. He fished out a bruised green apple and tossed it aside. Only a few boxes were left." Could there be a crueler irony? The original ACA--the one that Pelosi and Reid passed and that Obama signed--provides Donald Rizen with health-insurance coverage (Medicaid, admittedly, but coverage) for free. It is Republicans John Roberts, Nathan Deal, the legislature, and the Four Horsemen who have casually #@#&^ed him. But who does he blame? He blames Barack Obama."

Make no mistake. That is the Republican scheme.