The Iranian Uranium Enrichment Agreement in a Nutshell

 

By Terry A. AmRhein, Author of Democracy on the Edge

 

The United States and the rest of the world have been given an opportunity to prevent Iran from producing a nuclear weapon.  But there are extreme risks involved in the agreement.  What are these risks?  Should the US take the risk?

            In 2008, intelligence discovered that Iran had built a Uranium enrichment facility.  The US started negotiating with Iran to limit production of enriched uranium¹⁾ but with little progress.  In 2010, when the world became aware that Iran had uranium enrichment facilities, action began to happen.  The five members of the United Nations Security Council, (US, Great Britain, France, China, Russia) plus Germany agreed to impose strong sanctions on Iran and these sanctions held tight.  In addition, the UN imposed sanctions on Iran’s banking and finance system preventing payment for oil revenues from reaching Iranian banks.  By 2013 Iran had significant stock piles of enriched Uranium that could be turned into a bomb with further enrichment.  The sanctions though were having their effect and Iran attitude became more earnest.

            After 20 months of negotiating, the UN Security Council members plus Germany reached an agreement with Iran.  Here’s what the agreement entails:

 

1) Iran will reduce its stockpile of low enriched Uranium to 98% of it present level (i.e to 660 LB or 300 Kilograms), half of what it would take to make a bomb and keep it at this level for 15 years. 

2) For the next 15 years, Iran will keep its number of high speed centrifuges to a low enough number so that it would take one year to enrich enough uranium to produce a bomb.²⁾ 

3) For the next 15 years, Iran must not enrich uranium above 3.67% U235, the concentration required for a commercial nuclear reactor.

4) During this time, Iran will permit detailed inspections of nuclear facilities by the International Atomic Energy Agency (IAEA) and by the international community.  Up to a 24 day prior notice of the inspection is required.

5) Iran will convert its heavy water nuclear reactor³⁾ designed to make plutonium, into a reactor that cannot make plutonium.⁴⁾

           

            Here’s what Iran gets in return:

1) Iran will have a small portion of the international sanction lifted immediately but most of the sanctions will stay in affect until Iran completes implementation of the agreement.  This is scheduled to take about 6 months.

2) Following complete implementation, the sanctions will be lifted.  Iran will then have access to about $100 billion of the oil money that has been held in escrow by international banks.

3) After 5 years, the embargo on Iran’s receiving conventional weapons will be lifted.  After 8 years, the embargo on receiving missile technology will also be lifted.

 

Any breach of the agreement would cause the UN sanctions to “snap back” into place.

 

            The discussion of the agreement has been strenuous and varied.  Some say this could be a remarkably good deal.  Others, particularly Israel’s Prime Minister Benjamin Netanyahu, declare this is a sure way for Iran to get a nuclear weapon.  Senator John McCain said that this will lead to an Iranian “shopping spree” because after 5 years, Iran will have access to $100 billion to buy weapons and after 8 years will access to missile technology.

 

            Some believe that if Iran does break the agreement, the sanctions will not “snap back” into place as the Obama administration claims.  They point out that it took significant effort to establish the sanctions in the first place and the chance of re-establishing them is not likely.   Also the UN Security Council and Germany has already agreed with the deal, somewhat upstaging the US.  If the US now fails to pass the deal, the US will look like the rogue nation. Other point out that Iran will have up to 24 days to “sanitize” any inspection site before any inspection occurs and thus could hide their bomb enrichment process.

 

            During the Republican Presidential Nominee debate on August 6, it was apparent that the Republican candidates for president, are unanimously against Iran Nuclear deal.  Rand Paul expressed the opinion that if the US negotiated from a position of power, we could have gotten a better deal.  (Although he doesn’t explain what a “position of power” is.  Usually in a negotiation, if one party starts out by saying “If you don’t do what I want, I’m going to hit you in the head”, the negotiations don’t get too far.)  On Friday August 10, Senators Chuck Schumer of New York declared that he would not support the nuclear deal.  Chuck Schumer is the likely Senate major leader after Harry Reid leaves next year and represents a symbol for other democrats to likewise vote against the deal.  To scuttle the deal, however, opponents have two high hurdles. They will need 60 votes in the Senate to overcome a filibuster by supporters of the accord. If the opponents get that, the president will veto the resolution. The opponents would then have to get of two-thirds of the lawmakers in both chambers to override the veto.      

 

            During this process, President Obama and Secretary Kerry have stressed that

1) If the deal is turned down, that Iran will almost certainly continuing enriching Uranium and obtain a bomb within a relative short time.

2) That the inspections will be complete and though and if Iran is enriching beyond 3.67% or the number of centrifuges is exceeded or other terms of the agreement are broken, that sanctions and any other action (e.g. bombing) that is available now, can be implemented at the time the agreement is broken.        

3) That this agreement is only an interim agreement.  That during the next years, US will attempt to negotiate further with Iran to persuade them to give up their desire to make nuclear bombs.  Obama indicates that this represents a opportunity to establish better relationships with Iran. (Remember during the late 1970s, when the Shah of Iran was in power, relationship with Iran was more congenial)

           

So this is the Iranian Uranium Enrichment agreement in a nut shell, hopefully explained simply enough that you don’t have to be a physicist to understand it.  This agreement affects every American.  You should have an opinion about it because it will affect you, your children and your grandchildren.  Then tell your US Senator what you think.

Democracy on the Edge

 

 

Footnotes:

1)  Most of Uranium is 238 containing 92 protons and 147 neutrons in its nucleus.  Uranium 238, called U238, however will not fission and therefore cannot be used as a bomb.  To have a bomb you need U235, 92 protons and only 143 neutrons.  To refine U235 from normal Uranium you must separate the two “isotopes”.  The Uranium containing higher quantities of U235 is called “enriched Uranium”.

2) High speed centrifuges spend extremely fast.  Since the uranium isotopes have different weights, they tend to concentrate is different regions in the centrifuge.  By judiciously gathering the right isotope from the right region you can slowly concentrate the isotope that you want, i.e. you can concentrate the U235.  Uranium must be over 90% U235 to make a bomb.

3) Normal water, H2O, contain two hydrogen atoms.  Each hydrogen atom contains only one proton with an electron circling around it.  But some hydrogen atoms can have one proton and one neutron in its nucleus with an electron circling around.  This hydrogen atom has a special  name called deuterium and since it has two particles in the nucleus, the water it makes is called “heavy water”.

4)  You make plutonium Pu239 from U238 by having the uraniumU238 absorb a neutron and through a nuclear reaction U238 becomes Pu239.

The Supreme Court has another Chance to Destroy Obamacare

How would it affect you?

          The Supreme Court has yet another chance at destroying the Affordable Care Act.  The situation is this.  A large part of Obamacare is to make health care affordable for Americans.  The plan, therefore, subsidizes premiums paid by families for their health insurance.  For example, in 2014 a family of four making $35,775 per year would not pay more than $1430 per year ($119 per month) for a silver plan.  These subsides apply to annual incomes reaching up to about $100,000 a year.  The subsides are paid for by

       -          a much larger pool of participating and mostly healthy individuals

 

      -          more frequent medical checkups to keep people healthier

      -          additional taxes on those making over $200,000 per year and

      -          taxes on medical devices and health care insurance companies, on expensive “Cadillac”health care plans and on tanning salons. 

            The Patient Protection and Affordable Care Act (i.e. Obamacare) was originally written to have each state set up it own health insurance exchange.  Citizens go on-line to health care exchanges and select which plan they want, from the most economical bronze plan to the most expensive platinum plan.  Along the way though, 34 states opted not to set up their own plan, some because setting up the system was too onerous and others because they just opposed Obamacare.  The federal government then established a system where people without state plans could select an insurance plan through the federal government site, www.healthcare.gov. 

            The only problem is the exact wording of the Affordable Care Act.  The Act states that subsidies will be provided to eligible people who purchase insurance through “exchanges established by the states”.  In King v Burwell (Sylvia Burwell, Secretary of the Department of Health and Human Services) King argues that anyone who obtained health insurance through a federal exchange is NOT eligible for subsidies because they’re not “established by the state.”  Even though Obamacare clearly intended that subsidies could be provided through either a state or a federal exchange, the exact wording of the act does NOT say “or the federal government.” 

            All this turmoil and uncertainty results from conservative zealots that loath Obamacare. So if the Supreme Court decides that the federal government cannot provide subsides, here is what could happen.

1)  Five million people signed up for Obamacare from federal exchanges in 2014.  Of those, 87% or about 4.4 million people, received subsidies.  Without those subsidies, many of the lower income and healthy, generally younger people may opt out¹⁾. The numbers get worse though.  In 2015, the second year of enrollment, the estimated number of Obamacare participates is about 11.4 million and, according to E. J. Dionne of the Washington Post, ²⁾ about 8 million lower income and younger people could opt out and be without health insurance.

 2) Most of those who drop health insurance are from the 34 non-participating states.  These are predominately Republican states.

3) With the younger, relatively healthy people not participating, the majority of the participants would be in poor health and require more medical treatment.  However, without insurance, hospital and doctor payments would drop and medical fees would have to increase in order to compensate.  An economic forecast by the RAND Corporation projects that medical fees would increase by 47%, while enrollment in individual health care insurance market would decline by 70%³⁾.  This too would occur predominately in Red states which did not develop exchanges.

4) People without insurance are reluctant to go to the doctor.  The result is many preventable diseases (e.g. asthma, heart problems, high blood pressure, diabetes, and cancer) will not be detected until late in the disease development when the prognosis is not good and the cost of treatment is higher.  Before Obamacare, the American Journal of Public Health reported that about 44,800 people were dying unnecessary each year due to lack of insurance ⁴⁾.  In addition, lack of pre-natal care results in higher infant mortality rates.  The National Vital Statistics Bureau reports that about 25,000 infant deaths result each year from inadequate prenatal care ⁵⁾.  And again, the increase in death and disease will predominately occur in Republican states.

5) The expanded Medicaid program that provides healthcare for those earning less than 138% of the Federal Poverty Level, (about $33,000 for a family of four in 2014) would continue for those 25 states that opted to participate in the program.  The other 25 states refused to participate in expanded Medicaid, even though the federal government will pay almost all of the costs.  The 25 states not participating in the expanded Medicaid is, you guessed it, mostly Republican states. 

So the end result of a Supreme Court decision to uphold King’s complaint is that part of the nation would be receiving huge Federal subsides for health insurance and the remaining states could receive near nothing.  Secretary Burwell told Congress that the administration knows of no legal action it could take to “undo the massive damage to our health care system that will be caused by an adverse decision.”⁶⁾

In closing this article, I quote Ted Cruz’s statement to the International Union of Firefighter on Tuesday March 10 in Dallas, Texas:

“Five years ago reasonable minds could have differed on whether this was a good idea, but today, seeing millions of American who’ve lost their jobs, who’ve been forced into part time work, who’ve lost their health care, who’ve lost their doctor — it is the essence of reasonableness, it is the essence of pragmatism to acknowledge this thing isn’t working. We need to repeal it and start over.”

I think it is the essence of reasonableness for the states to have joined Obamacare.  Thank goodness Cruz doesn’t work for NASA.

1) Fortune.com, “The Supreme Court’s decision on health care subsidies – what you need to know,” by Laura Lorenzetti, March 3, 2015.

2) The Week, “Obamacare’s looming legal showdown’, March 56, 2015

3) Fortune.com, “The Supreme Court’s decision on health care subsidies –

4) Wilper, Andrew P.; Woolhandler, Steffie; Lasser, Karen E.; McCormick, Danny; Bor, David H.; Himmelstein, David U. (December 2009). "Health insurance and mortality in US adults." American Journal of Public Health 99 (12): 2289–2295. DOI:10.2105/AJPH.2008.157685. PMC 2775760. PMID 19762659.

5) National Vital Statistics Report, Vol. 59, No. 6, June 29, 2011

6) www.csmonitor.com/USA/Justice/2015/0304/supreme-court-could-obamacare-ruling-destroy-health-insurance-for-millions             

The President's Immigration Action

What did Obama’s memorandum on immigration actually do?  The memorandum provided additional resources to help law enforcement stem the flow of illegal crossings into the U. S. and placed more emphasize on finding and deporting criminals.  However the most contentious part of the action is that the president’s plan would

-          offers undocumented immigrants, who are parents of U. S. citizens or permanent residents who have been in the U. S. more that 5 years, the opportunity to remain temporarily within the U. S. without fear of deportation and

-          allows those individuals that were brought to the U. S. illegally as children under the age of 16, to avoid  deportation (which is a continuation of Obama 2012 policy).  

In order to qualify for this temporary stay from deportation, the applicant must register, pass a criminal background check and pay their back taxes.  Also the memorandum does not grant citizenship or permanent status but they can seek citizenship through other procedures. This action will permit approximately 4 to 5 million (no one knows for sure) illegal immigrants to remain in the U. S.  

Now there is something we can do about “Citizens United”

           

The Supreme Court’s decision on “Citizens United” gave corporations and unions the right to spend unlimited amounts of money on political commercials and advertisements.  The court’s reasoning was that political commercials are a form of free speech and free speech is protected by the constitution.  But the constitution is referring to “free speech” for citizens.  Corporations and unions are not citizens.  They are quite different from citizens.  Corporation’s main goal is to make profit and union’s goal is to increase the pay and benefits for their members.  They are not subject to the same moral characteristics as people.  Furthermore, corporations and unions are not subject to the same laws as people.  Corporations are immune from judicial prosecution, there has never been a corporation thrown in jail!  So if corporations and unions are not subject to the same laws as people, why should they have the same rights?

            Every American citizen, regardless of political affiliation, race, gender or age should be appalled by this situation.  It reduces the authority the voters have to determine who their state and federal representatives will be and increases the control that businesses and unions have in making that decision.

            Now there is something you can do!  Ben Cohen, of Ben and Jerry’s Ice Cream in Vermont, has started a grass-roots campaign to put the election power back in the hands of the American people and to repeal the “Citizen United” decision.  This idea is GREAT!  Buy a rubber stamp and stamp every piece of paper currency with a slogan urging congress to repeal Citizens United.  Slogans like, “STAMP MONEY OUT OF POLITICS”, “NOT TO BE USED FOR BRIBING POLITICIANS” and other great stamps are available.  This is entirely legal.  Join the thousands of people who have already joined the “Stamp Stampede”.  Go to www.stampstampede.org to get your stamp.  Just imagine what members of congress would think if every piece of currency were stamped.  Get your power back.  You decide who is going to represent you.

 

www.stampstampede.org

 

 

 

 

 

 

A Brief Trip to China

 

 

Shanghai

What is China really like?  I just returned from an 8 day trip to China.  In a trip sponsored by the Vermont Council on World Affairs, we visited  Beijing, Suzhoe (pronounced su joe), Shanghai and Hangzhou (hang joe).  While an eight day trip makes me just a tiny bit more knowledgeable than most Americans, it does provide at least a first impression of the country. 

            China by any analysis is a booming, growing country.  In the big cities along the east coast where we visited, construction projects are everywhere.  In fact, some people claim that the new national bird of China is the “boom crane”.  It is not unusual to see four, five, six cranes busily working on many construction sites in these growing cities and Shanghai must be considered one of the most modern cities in the world. 



Construction, the Chinese "national
bird", the boom crane

            It’s also easy to see that the people in China are prospering. The citizens in the cities are dressing in nice business attire and are usually on the go.  People in the parks and gardens are dressed in clean, casual attire and are strolling more casually but still appear to be on a mission.  I saw only a few who were obviously poor.  A few disabled sitting on the side walks begging for money; but able-bodied pan-handlers begging for money, I saw none of these.  There are, however, the ubiquitous street vendors, who we impolitely called “mosquitoes” because they bug you whenever you get on or off the tour bus. These persistent sales people will offer you the opportunity to buy a “genuine” Rolex watch for five US dollars or other street trinkets that you just can’t live without and they don’t go away with a simple “no thank you”.  Also I saw many people sweeping the streets with brooms.  In fact, I didn’t see street litter anywhere in China, not even in Beijing or Shanghai that are homes for millions of people. The government employs thousands of people as municipal workers to keep the streets clean and that seems to work. 

                      

Keeping the city clean

          It’s also obvious that the Chinese people are fond of Americans and Europeans (I don’t think they can tell us apart).  If you ask a Chinese person on the street to take their picture, he/she could not be more willing.  Ask a Chinese woman to take a picture with her adorable baby and she’s eager to do it.  Ask them to take your picture and they gladly do it.  In fact, they want to be in the picture too! 

           Another curious phenomenon is that the US dollar is accepted for currency everywhere, not British pound or German deutsche mark that I could see, but US dollar, yes!  Six yuan per dollar is accepted everywhere.  I soon became proficient at dividing the price in yuan by six.         



Tienanman Square and Entrance
to the Forbidden City

            Of course, China is thought of as a communist country and most of us were brought up to believe that communism is bad, removing all liberty from the people, and ruling the people with a heavy handed dictatorial power.  Well if the Chinese people are unhappy they certainly don’t show it.  In fact, China is not strictly communist.  There are millions of small businesses owned and operated by private people. China is a giant at making small businesses thrive.  In fact, I asked the tour guide, “In China, who owns the electric company?”  “The government” he replied.  Then I ask him, “Who owns the office buildings that are being constructed?”  “Well the development company owns that, and the construction company builds it for the development company.”  That sounds capitalistic to me.  But many of the big businesses are controlled by the government, all the provincial government employees work for the government, all the electronic, telecommunications and power companies are government controlled and some of the manufacturing and industrial companies are owned and operated by the government   However, some foreign manufacturing companies are owned by the foreign company.  For example car parts made for Ford and General Motors are owned by Ford and General Motors and employee’s paychecks probably have Ford and GM at the top.   These businesses operate in China according to Chinese regulations and must pay the Chinese government for the opportunity to have factories in China.  The point being, China in not a strictly communist country where all the means of production are owned by the government (or in communist lingo, all the means of production are owned by the “people”).  China is a blend, a mish mash, of government operations and private operations.



High speed rail

            There’s no doubt though that China is a centrally controlled country, how else could birth rates be controlled to only one child per family.  I think that this is a more important fact then it’s supposedly communist form of government.  China deals with issues, whether political, economic, social, international, by centralized government control.  Yes, China is a single party system. All members of the government are communists, but it is the central control that’s the crucial factor, not that it is nominally communist.  It may be that a central authority works well in a country like China where people are more society oriented.  Perhaps it is centuries of people living in close proximity that allows them to work more closely as a society, as a community.  Or perhaps it is the approximately 40 centuries of being ruled by an emperor who was the ultimate authority.  China was ruled by an emperor from 2000 years before Christ until 1912, when the emperor was overturned and a more democrat government called the Republic of China was established by Chiang Kai-Shek.    Chiang lasted until 1949 when Mao Zedong forced Chiang into Formosa (present day Taiwan) who formed the Republic of China (ROC) and Mao formed the People’s Republic of China (PRC) over the rest of China.

431 Km/h or 270 mph on the High
Speed Rail line

            The centralized government has several distinguishing features.  It allows the government to direct policy swiftly and efficiently.  This has resulted in phenomenal economic growth in China.  Over the last 30 years, China has experienced a GDP growth rate hovering around 10% per year.  China’s GDP, after adjusted for inflation and cost of living differences, is approaching that of the US’s ($16.7 trillion in 2013) if it hasn’t already passed it.  So China will become the largest economy in the world.  But really, so what?  China has 1.35 billion people, the US has 325 million (.325 billion).  So China has over four times as many people as we have.  You wouldn’t expect a small country like Switzerland to out produce a big country like the United States.  Likewise you wouldn’t expect the US to out produce China.  Also remember that China after World War II was a third world country.  After the war, China reformed itself and has been catching up with other countries ever since.  Starting from a lower level of productivity it’s easier to have high rates of growth.  As time passes, however, growth becomes more difficult, the low hanging fruit of progress has already been picked. China’s rate of growth will slow as the economy catches up.  

Typical housing complex

          Furthermore, even if China’s economy is bigger that ours, Chinese citizens are not better off.  Using the GDP per person as an estimator for the citizen’s wealth, China’s GDP per person is about $12,000 per year in 2013 after inflation adjustments while the US has about $53,000.  So the US population, in general, enjoys a higher standard of living.  While we were in China, we were graciously allowed to have lunch in what I believe to be a typical Chinese apartment.  The food was good and plentiful.  The apartment consisted to three rooms, each about 12 to 15 feet wide and 12 to 15 feet long, aligned in a row.  The first room was the dinning room, the second the bedroom and the back room was the kitchen.  The bathroom was provided for by a public bath down the block.  In spite of the fact that the hostess was very hospitable and kind, the dwelling was modest by any description.    

China per capita GDP compared
with other countries, World Bank Dec 2014

          Another feature of a central government, as you may guess, the powerful will do everything they can to stay in power and to empower and enrich themselves through graft, criminality and nepotism.  The people are, of course, aware of these actions and, according to Tiger Head Snakes Tails by Jonathan Fenby, previous editor of South China Morning Post, there are about 180,000 protests a year on such matters.  Occasionally public officials are arrested and jailed by the government.  But I believe most of these criminal actions go unpunished.  Relatives of Xi Jinping, the new Chinese leader, has assets of $376 million while outgoing Premier, Wen Jiabao, has asset of $2.7 billion.  Forty per cent of the private wealth in China is held by 1 per cent of the population.¹⁾  Unfortunately, and surprisingly, in the United States in 2010, wealth was also distributed almost as un-equally, 1% of the population own 35.4% of the wealth.²⁾ Distribution of wealth is important because it portrays how the common citizen partakes in the economic success of a nation and how widely the wealth is spread throughout the country.  For right now, the US is the leader of the financial and democratic world, but based on distribution of wealth statistic, this may not always be the case.   

 

1) “Tiger Head Snake Tails, China Today, How it got There and Where it is Heading, ”, by Jonathan Fenby, The Overlook Press, Copyright, 2012

 

2) “Who Rules America? Wealth, Income and Power,” G. William Dornhoff, Socialogy Dept, University of California, Santa Cruz

The Cost of Obamacare is Costing Less than Expected

 

The Congressional Budget Office indicates that the health insurance costs under the Affordable Care Act are less than they were previously estimated. 

            The Congressional Budget Office, CBO, is a non-partisan government organization that provides estimates for congressional use and consideration.  At the inception of the Affordable Care Act in March 2010, the CBO estimated that insurance related costs from 2015 to 2019 (i.e. the last 5 years of the 10 years estimating period) would amount to $710 billion.  This March, the CBO revised that estimate to $506 billion, a 29% reduction.  Most of this reduction comes from insurance subsidies provided by the federal government.  In 2010, the CBO estimated that by year 2015, insurance subsidies would average $5200 per person.  The CBO’s new estimate is $3960 per person in 2015.  The CBO now estimates that the total insurance subsidies over the next decade will be $849 billion.  This is $209 billion less (20% less) that the CBO’s previous 10 year estimate made in January 2015.     

            In addition, the CBO estimates that the 10 year costs of the “Expanded Medicaid” program for the poor is $847 billion, down from $920 billion of the previous estimate, an 8% decline.     

            This is good news for all of us.  What all these statistics mean is that health care insurance costs are being reduced by the Affordable Care Act.  The costs are lower because the insurance premiums are lower.  This means that individuals and businesses pay less for health care insurance than they did before.  As the White House press secretary, Josh Earnest, said “the Affordable Care Act is contributing in a very positive way to holding down the growth of health care costs.”  It also means that since the subsidies are less, the government has to spend less money to support the Affordable Care Act.  This means that the Affordable Care Act is really helping to roll back the deficit.  In fact the CBO estimates that the deficit over the next 10 years will decline from an estimate of $7.6 trillion to $7.2 trillion, a $400 billion decline.

 

         Agree with it or not, the Affordable Care Act is working.

 

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The Supreme Court has another Chance to Destroy Obamacare, How would it affect you?

          The Supreme Court has yet another chance at destroying the Affordable Care Act.  The situation is this.  A large part of Obamacare is to make health care affordable for Americans.  The plan, therefore, subsidizes premiums paid by families for their health insurance.  For example, in 2014 a family of four making $35,775 per year would not pay more than $1430 per year ($119 per month) for a silver plan.  These subsides apply to annual incomes reaching up to about $100,000 a year.  The subsides are paid for by
-          a much larger pool of participating and mostly healthy individuals
-          more frequent medical checkups to keep people healthier
-          additional taxes on those making over $200,000 per year and
-          taxes on medical devices and health care insurance companies, on expensive "Cadillac" health  care plans and on tanning salons. 

            The Patient Protection and Affordable Care Act (i.e. Obamacare) was originally written to have each state set up it own health insurance exchange.  Citizens go on-line to health care exchanges and select which plan they want, from the most economical bronze plan to the most expensive platinum plan.  Along the way though, 34 states opted not to set up their own plan, some because setting up the system was too onerous and others because they just opposed Obamacare.  The federal government then established a system where people without state plans could select an insurance plan through the federal government site, www.healthcare.gov. 

            The only problem is the exact wording of the Affordable Care Act.  The Act states that subsidies will be provided to eligible people who purchase insurance through “exchanges established by the states”.  In King v Burwell (Sylvia Burwell, Secretary of the Department of Health and Human Services) King argues that anyone who obtained health insurance through a federal exchange is NOT eligible for subsidies because they’re not “established by the state.”  Even though Obamacare clearly intended that subsidies could be provided through either a state or a federal exchange, the exact wording of the act does NOT say “or the federal government.” 

            All this turmoil and uncertainty results from conservative zealots that loath Obamacare. So if the Supreme Court decides that the federal government cannot provide subsides, here is what could happen.

1)  Five million people signed up for Obamacare from federal exchanges in 2014.  Of those, 87% or about 4.4 million people, received subsidies.  Without those subsidies, many of the lower income and healthy, generally younger people may opt out¹⁾. The numbers get worse though.  In 2015, the second year of enrollment, the estimated number of Obamacare participates is about 11.4 million and, according to E. J. Dionne of the Washington Post, ²⁾ about 8 million lower income and younger people could opt out and be without health insurance.

 

2) Most of those who drop health insurance are from the 34 non-participating states.  These are predominately Republican states.

3) With the younger, relatively healthy people not participating, the majority of the participants would be in poor health and require more medical treatment.  However, without insurance, hospital and doctor payments would drop and medical fees would have to increase in order to compensate.  An economic forecast by the RAND Corporation projects that medical fees would increase by 47%, while enrollment in individual health care insurance market would decline by 70%³⁾.  This too would occur predominately in Red states which did not develop exchanges.

4) People without insurance are reluctant to go to the doctor.  The result is many preventable diseases (e.g. asthma, heart problems, high blood pressure, diabetes, and cancer) will not be detected until late in the disease development when the prognosis is not good and the cost of treatment is higher.  Before Obamacare, the American Journal of Public Health reported that about 44,800 people were dying unnecessary each year due to lack of insurance ⁴⁾.  In addition, lack of pre-natal care results in higher infant mortality rates.  The National Vital Statistics Bureau reports that about 25,000 infant deaths result each year from inadequate prenatal care ⁵⁾.  And again, the increase in death and disease will predominately occur in Republican states.

5) The expanded Medicaid program that provides healthcare for those earning less than 138% of the Federal Poverty Level, (about $33,000 for a family of four in 2014) would continue for those 25 states that opted to participate in the program.  The other 25 states refused to participate in expanded Medicaid, even though the federal government will pay almost all of the costs.  The 25 states not participating in the expanded Medicaid is, you guessed it, mostly Republican states. 

So the end result of a Supreme Court decision to uphold King’s complaint is that part of the nation would be receiving huge Federal subsides for health insurance and the remaining states could receive near nothing.  Secretary Burwell told Congress that the administration knows of no legal action it could take to “undo the massive damage to our health care system that will be caused by an adverse decision.”⁶⁾

In closing this article, I quote Ted Cruz’s statement to the International Union of Firefighter on Tuesday March 10 in Dallas, Texas:

“Five years ago reasonable minds could have differed on whether this was a good idea, but today, seeing millions of American who’ve lost their jobs, who’ve been forced into part time work, who’ve lost their health care, who’ve lost their doctor — it is the essence of reasonableness, it is the essence of pragmatism to acknowledge this thing isn’t working. We need to repeal it and start over.”

I think it is the essence of reasonableness for the states to have joined Obamacare.  Thank goodness Cruz doesn’t work for NASA.

 

1) Fortune.com, “The Supreme Court’s decision on health care subsidies – what you need to know,” by Laura Lorenzetti, March 3, 2015.

2) The Week, “Obamacare’s looming legal showdown’, March 56, 2015
3) Fortune.com, “The Supreme Court’s decision on health care subsidies –
4) Wilper, Andrew P.; Woolhandler, Steffie; Lasser, Karen E.; McCormick, Danny; Bor, David H.; Himmelstein, David U. (December 2009). "Health insurance and mortality in US adults." American Journal of Public Health 99 (12): 2289–2295. DOI:10.2105/AJPH.2008.157685. PMC 2775760. PMID 19762659.
5) National Vital Statistics Report, Vol. 59, No. 6, June 29, 2011
6) www.csmonitor.com/USA/Justice/2015/0304/supreme-court-could-obamacare-ruling-destroy-health-insurance-for-millions