No Good Options: Picking Up the Pieces After King v. Burwell

If the Supreme Court rules against the government in King v. Burwell, insurance subsidies available under the Affordable Care Act (ACA) will evaporate in the thirty-four states that have refused to establish their own health-care exchanges. The pain could be felt within weeks. Without subsidies, an estimated eight or nine million people stand to lose their health coverage. Because sicker people will retain coverage at a much higher rate than healthier people, insurance premiums in the individual market will surge by as much as fifty percent. Policymakers will come under intense pressure to mitigate the fallout from a government loss in King. But the Republican-controlled Congress has already ruled out a surgical fix, and recent reporting suggests that Congress will be hard-pressed to develop an alternative reform proposal that could meet with the White House’s approval. Even a temporary extension will meet with fierce resistance from legislators who will see an extension as a tacit concession that the subsidies, in some form, are here to stay. All eyes will turn to the Obama administration and to the states. Yet public debate about their post-King options has been limited. Part of the reason is strategic: the government’s supporters fear that discussing fixes might signal to the Supreme Court that eliminating the subsidies would not do much damage. The Obama administration, for example, has declined to tell Congress whether it even has a contingency plan. And while the ACA’s opponents suggest that the King aftermath might not be so bad, they have generally declined to endorse specific fallback plans. In this Essay, we take a hard look at some potential options available both to the administration and to the states to mitigate the fallout of a government defeat in King. Some are straightforward and noncontroversial; others will face intense political resistance and press up against legal boundaries. Taken together, we believe these options might enable policymakers to moderate, at least somewhat, the consequences of a government loss in King

Predicting the Fallout from King v. Burwell - Exchanges and the ACA

The U.S. Supreme Court\u27s surprise announcement on November 7 that it would hear King v. Burwell struck fear in the hearts of supporters of the Affordable Cara Act (ACA). At stake is the legality of an Internal Revenue Service (IRS) rule extending tax credits to the 4.5 million people who bought their health plans in the 34 states that declined to establish their own health insurance exchanges under the ACA. The case hinges on enigmatic statutory language that seems to link the amount of tax credits to a health plan purchased through an Exchange established by the State. According to the plaintiffs in King, that language means that consumers who buy insurance through federally run exchanges don\u27t qualify for subsidies. The Court\u27s decision to hear the case without a split between appellate courts suggests that at least four justices harbor serious doubts about the IRS rule\u27s validity

Predicting the Fallout from King v. Burwell - Exchanges and the ACA

The U.S. Supreme Court\u27s surprise announcement on November 7 that it would hear King v. Burwell struck fear in the hearts of supporters of the Affordable Cara Act (ACA). At stake is the legality of an Internal Revenue Service (IRS) rule extending tax credits to the 4.5 million people who bought their health plans in the 34 states that declined to establish their own health insurance exchanges under the ACA. The case hinges on enigmatic statutory language that seems to link the amount of tax credits to a health plan purchased through an Exchange established by the State. According to the plaintiffs in King, that language means that consumers who buy insurance through federally run exchanges don\u27t qualify for subsidies. The Court\u27s decision to hear the case without a split between appellate courts suggests that at least four justices harbor serious doubts about the IRS rule\u27s validity

Too Many Cats: The Problem of the Many and the Metaphysics of Vagueness

Unger’s Problem of the Many seems to show that the familiar macroscopic world is much stranger than it appears. From plausible theses about the boundaries of or- dinary objects, Unger drew the conclusion that wherever there seems to be just one cat, cloud, table, human, or thinker, really there are many millions; and likewise for any other familiar kind of individual. In Lewis’s hands, this puzzle was subtly altered by an appeal to vagueness or indeterminacy about the the boundaries of ordinary objects. This thesis examines the relation between these puzzles, and also to the phenomenon of vagueness. Chapter 1 begins by distinguishing Unger’s puzzle of too many candidates from Lewis’s puzzle of borderline, or vague, candidates. We show that, contra Unger, the question of whether this is a genuine, as opposed to merely apparent, distinction cannot be settled without investigation into the nature of vagueness. Chapter 2 begins this investigation by developing a broadly supervaluationist account of vague- ness that is immune to the standard objections. This account is applied to Unger’s and Lewis’s puzzles in chapters 3 and 4. Chapter 3 shows that, despite its popularity, Lewis’s own approach to the puzzles is unsatisfactory: it does not so much solve the puzzle, as prevent us from expressing them; it cannot be extended to objects that self-refer; it is committed to objectionable theses about temporal and modal metaphysics and semantics. Chapter 4 develops a conception of ordinary objects that emphasises the role of identity conditions and change, and uses it to resolve both Problems of the Many. This allows us to diagnose the source of the puzzles: an overemphasis on mereology in contemporary material ontology

Against Representational Levels

Some views articulate reality's hierarchical structure using relations from the fundamental to representations of reality. Other views instead use relations from the fundamental to constituents of non-representational reality. This paper argues against the first kind of view

Quantification and ontological commitment

This chapter discusses ontological commitment to properties, understood as ontological correlates of predicates. We examine the issue in four metaontological settings, beginning with an influential Quinean paradigm on which ontology concerns what there is. We argue that this naturally but not inevitably avoids ontological commitment to properties. Our remaining three settings correspond to the most prominent departures from the Quinean paradigm. Firstly, we enrich the Quinean paradigm with a primitive, non-quantificational notion of existence. Ontology then concerns what exists. We argue that this strengthens the Quinean case against ontological commitment to properties while also newly distinguishing between stronger and weaker forms of nominalism. Secondly, we enrich the Quinean paradigm with the ideology of fundamentality. Ontology then centrally concerns what’s fundamental. We argue that this leaves ontological commitment to properties wide open although Bradleyan regress threatens. Thirdly, we enrich the Quinean paradigm with primitive higher-order quantifiers. Ontology then expands to concern what there higher-order is and what there first-order is. We argue that this naturally but not inevitably incurs ontological commitment to properties

Two Conceptions of Absolute Generality

What is absolutely unrestricted quantification? We distinguish two theoretical roles and identify two conceptions of absolute generality: maximally strong generality and maximally inclusive generality. We also distinguish two corresponding kinds of absolute domain. A maximally strong domain contains every potential counterexample to a generalisation. A maximally inclusive domain is such that no domain extends it. We argue that both conceptions of absolute generality are legitimate and investigate the relations between them. Although these conceptions coincide in standard settings, we show how they diverge under more complex assumptions about the structure of meaningful predication, such as cumulative type theory. We conclude by arguing that maximally strong generality is the more theoretically valuable conception

Tipping in a Low-Dimensional Model of a Tropical Cyclone

A presumed impact of global climate change is the increase in frequency and intensity of tropical cyclones. Due to the possible destruction that occurs when tropical cyclones make landfall, understanding their formation should be of mass interest. In 2017, Kerry Emanuel modeled tropical cyclone formation by developing a low-dimensional dynamical system which couples tangential wind speed of the eye-wall with the inner-core moisture. For physically relevant parameters, this dynamical system always contains three fixed points: a stable fixed point at the origin corresponding to a non-storm state, an additional asymptotically stable fixed point corresponding to a stable storm state, and a saddle corresponding to an unstable storm state. The goal of this work is to provide insight into the underlying mechanisms that govern the formation and suppression of tropical cyclones through both analytical arguments and numerical experiments. We present a case study of both rate and noise-induced tipping between the stable states, relating to the destabilization or formation of a tropical cyclone. While the stochastic system exhibits transitions both to and from the non-storm state, noise-induced tipping is more likely to form a storm, whereas rate-induced tipping is more likely to be the way a storm is destabilized, and in fact, rate-induced tipping can never lead to the formation of a storm when acting alone. For rate-induced tipping acting as a destabilizer of the storm, a striking result is that both wind shear and maximal potential velocity have to increase, at a substantial rate, in order to effect tipping away from the active hurricane state. For storm formation through noise-induced tipping, we identify a specific direction along which the non-storm state is most likely to get activated

Making Sense of a New Transport System: An Ethnographic Study of the Cambridgeshire Guided Busway

An increase in public transport use has the potential to contribute to improving population health, and there is growing interest in innovative public transport systems. Yet how new public transport infrastructure is experienced and integrated (or not) into daily practice is little understood. We investigated how the Cambridgeshire Guided Busway, UK, was used and experienced in the weeks following its opening, using the method of participant observation (travelling on the busway and observing and talking to passengers) and drawing on Normalization Process Theory to interpret our data. Using excerpts of field notes to support our interpretations, we describe how the ease with which the new transport system could be integrated into existing daily routines was important in determining whether individuals would continue to use it. It emerged that there were two groups of passengers with different experiences and attitudes. Passengers who had previously travelled frequently on regular bus services did not perceive the new system to be an improvement; consequently, they were frustrated that it was differentiated from and not coherent with the regular system. In contrast, passengers who had previously travelled almost exclusively by car appraised the busway positively and perceived it to be a novel and superior form of travel. Our rich qualitative account highlights the varied and creative ways in which people learn to use new public transport and integrate it into their everyday lives. This has consequences for the introduction and promotion of future transport innovations. It is important to emphasise the novelty of new public transport, but also the ways in which its use can become ordinary and routine. Addressing these issues could help to promote uptake of other public transport interventions, which may contribute to increasing physical activity and improving population health. © 2013 Jones et al