65,840 reasons to be bitter this week (at least)

I voted 2014

And was clearly in the minority.

I knew the 2014 midterms were going to be bad for Democrats but, damn, that was pretty awful.

However this was more than just election seesawing, the expense of maintaining power, and class voting behavior (though obviously there’s that, too). This was a particularly bad election for millions of low-income uninsured Americans:

Already, nine Republican governors have expanded their Medicaid programs, including a few who easily won re-election last night. And Medicaid expansion has support from hospitals, which hold considerable political clout and have a lot to lose without the infusion of federal funds from the expansion.

But any Republican governors who might consider the expansion next year could face a considerable obstacle: their own state legislatures. Last night’s Republican wave also hit state legislatures, which became even more Republican, and the past two years of Obamacare politics show they’re not afraid to battle Republican governors on this major piece of Obamacare.

“The people who elected them will be more conservative than the governor, and they will feel that the people who voted for them don’t want to see any steps moving the ACA or the Medicaid expansion forward,” said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. The GOP state legislators, he said, will likely push governors to wait and see what changes to the law Congress will try to make now that Republicans control both chambers.

Right. It isn’t just about the top tickets in each state, but that red states have become more red (even if their constituents benefited most from health care reform) and further emboldened to defy Republican governors who might have also gotten squishy ideas about expanding medical coverage to their low-income residents.

While certainly not the only place for this to be true, there is no other state larger in my mind for this reality than the state of Florida. Republican Governor Rick Scott, who has been silent about pushing the Republican-controlled state legislature to produce some type of Medicaid expansion bill, won reelection against former Governor Charlie Crist, who advocated expansionwith slightly more than 48 percent of votes cast.

It is difficult to suss out counter-factuals in this way, but it’s easy to imagine there would have been far better odds of some type of expansion under Crist — whatever else you may have thought about him. But, man, 65,839. That’s the number of votes separating the two. That’s the number that will keep an estimated 1,043,000 Floridians in the Medicaid coverage gap — with too much income to qualify for Florida’s absurdly low eligibility levels and too little income to receive subsidies on the federal marketplace. Including myself.

Yet because this is apparently the opportune time to entertain and expect the awful for the least among us, let’s add one more to that number and end the week with the news that Supreme Court of the United States is tackling Obamacare again by taking up King v Burwell:

The high court agreed Friday to hear a challenge to Obamacare’s subsidies, SCOTUSBlog reported. The case, King v. Burwell, contests the financial help available to some enrollees on the federal insurance exchanges in 36 states. It makes a similar argument as a better-known case, Halbig v. Burwell. Without subsidies, health reform starts to fall apart.

Earlier this summer, the US Court of Appeals for the Fourth Circuit ruled for the government in King, asserting that subsidies are legal on all exchanges. The plaintiffs appealed the decision to the Supreme Court in August. The Court granted that petition on Monday morning, which required votes from four or more justices.

“What’s troubling is that four justices apparently think — or at least are inclined to think — that King was wrongly decided,” writes Nicholas Bagley, a law professor at the University of Michigan. “As I’ve said before, there’s no other reason to take King.”

That’s from Adrianna McIntyre’s explainer piece for King. You should also read the rest of Nicholas Bagley’s thoughts to truly grok how terrible this could be for the law and, you know, not-rich human beings who’ve finally had a chance to gain insurance under health care reform.

There’s no way around me viewing this all as especially depressing (rare bright spots not-withstanding). I’m better off than a lot of far less-fortunate folks that lost on Tuesday, but we’re all a part of a larger story that doesn’t have a good ending based on what happened this week. A SCOTUS ruling in King revoking health insurance subsidies for ~4.7 million Americans based on the most laughable of legal arguments would be a #headdesk moment for the ages. The median estimated income for those that will now continue to fall into the Medicaid gap here in Florida is $9,000 a year. If I’m bitter about all of this, well, I’m not particularly sorry. They deserve better. We deserve better. And at least for the foreseeable future we’re not going to get it — and maybe a whole lot worse.


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