It was the Supremes all week, exceeding exceedingly low expectations. They struck down most of Arizona’s obnoxious anti-immigrant law on Tuesday, and on the same day found that mandatory life without parole sentences for juveniles are 100% unconstitutional.  Yesterday, a bare majority including extra-conservative Chief Justice John Roberts upheld Obamacare.

Good thing. The Transgender Law Center pointed out that the  Supreme Court’s affirmation of the Affordable Care Act means the provisions protecting transgender people from discrimination based on gender identity remain in place.

As for the rest of the decision, remember that the ACA did not reform health care; it reformed the health care insurance industry. Reforming health care itself would have thrown the insurance companies out altogether, but that was politically impossible, so the ACA started with the assumption that insurance companies would continue to play a central role in the U.S. health care system, and tried to make that industry a little more fair and affordable.

Though I’ve developed a tic in my left eye – not covered – from dealing with health insurance companies, there’s nothing inherently horrible about insurance.  In fact, insurance is built on a profoundly moral notion.  Recognizing that we are all both strong and frail creatures, we draw a circle of care around us, making us when we are strong responsible for us when we are frail. That noble notion gets fucked up when, in a capitalist free market, insurance companies make profit their first priority, and so do everything they can to draw a circle excluding the frail, then try to screw those they do allow inside the circle.

What the ACA did was to try and bring as many people as possible into the circle, using a buffet of mechanisms for doing that: mandating that nearly everyone be insured, expanding Medicaid in the states, forbidding insurance companies from excluding people, etc.  Here’s what the Supremes said about each of the pieces –

1. The individual mandate, which requires nearly everyone to be insured, was given the thumbs up.  Progressives think the individual mandate is a stinker because it’s part of a more fundamental flaw in the law, that rather than mandating everyone to pay in to fund a Canada-style government-sponsored health care system (which we now already do in order to be covered by Medicare once we hit age 65), the ACA mandates that everyone pay a profit-seeking, scumbag insurance company to provide coverage.  Those who are really broke-da-broke are exempt from the individual mandate, and those who are merely broke will be getting subsidies to help pay for it if they’re not covered by an employer.

Ultra-conservatives hate the individual mandate because it is part of Obama’s secret conspiracy to turn the United States into a communist playground for former members of the Soviet politiboro.  But here’s the thing: the people complaining about the individual mandate all have health insurance.  The Republican Congressmen and talk show hosts foaming at the mouth about the individual mandate ALL have health insurance – and plenty of it – they just don’t like being told they have to have it. None of these rich bastards are affected by the individual mandate; they just want to whine about it.

2. The provision preventing scumbag insurance companies from rejecting you because of a preexisting condition was upheld.  Nor can they exclude you for being transgender, your gender, your age, etc.

3. The Medicaid expansion provision was upheld, but its teeth were pulled out.  The way this provision of the ACA works is that Georgia (and other states) will be given federal $$ if they expand Medicaid to those up to 133% of the federal poverty level ($14,856 for 1 person; $25,390 for a 3-person household), but if the state of Georgia chooses not to expand Medicaid, the state suffers no penalty.  Expanding Medicaid as required (under the ACA as written)/suggested (under the ACA as interpreted by the Supremes) would cover an additional 650,000 Georgians.

This here is the fight going forward.  The ACA is set up so that any rational state will snatch up the opportunity to expand Medicaid – knowing that the expansion of Medicaid coverage imposes an additional cost on the state, the ACA makes it so the federal government will cover almost 90% of the state’s additional cost.  But the state of Georgia, as we know, is not necessarily a rational actor.

So…I will be going to queerfit tomorrow because:

1. The decision, National Federation of Independent Business v. Sebelius, is 193 pages long.  Sitting down to read it has squished the discs in my spine.  Your discs are jelly donuts, and your spine goes vertebrae, jelly donut, vertebrae, jelly donut, vertebrae, jelly donut, vertebrae… When you sit, you replace the natural curve of your spine with an C-curve, which squishes the front halves of those jelly donuts. Squish them hard & long enough and that jelly gets squeezed out as a bulging or herniated disc.  Tomorrow’s workout will include some active un-squishing for your discs.

2. It’s going to hit 100 degrees tomorrow. It will be 91 degrees by 10:00, so ten points for bad-ass-ery.  But do bring water.

3.  The Urban Institute estimates there will remain about 19 million people still uninsured after the ACA takes effect, 25% of these folks being undocumented immigrants and another big chunk (16%) being people who are so broke they are exempted from the individual mandate.  For these folks, it’s about remaining healthy by any means available. Queerfit is available.  Come on, ya’ll!