The old adage that “it’s easier to tear something down than it is to build it” has never been on more vibrant display than during the current debate on implementing the Patient Protection and Affordable Care Act.
The health care law’s critics, who have spent more than three years trying to gut it, are now gleefully predicting that as more of its provisions are rolled out next year, “Obamacare” will be seen as an expensive flop. It’s as if someone spent three years tearing parts off a car and then predicted it wouldn’t run very well.
Last week, President Barack Obama — who has embraced the once-pejorative term “Obamacare” — surrounded himself at the White House with people who already are benefiting from the law and declared that it “is doing what it’s designed to do: (delivering) more choices, better benefits, a check on rising costs and higher quality care.”
Jon Favreau, the president’s former top speechwriter, argues that the uptick in the anti-Obamacare crusade is a result of Republicans’ being “terrified that Obamacare could actually work.” In a July 11 article in thedailybeast.com, Mr. Favreau asked, “If Republicans are so confident Obamacare will end badly, why not just shut up about it?”
It’s a good question, and the answer seems to be that there is still right-wing political mileage in the issue — particularly now, as the immense difficulties of putting the law’s coverage mandates into effect become apparent. Convincing the uninsured to buy health insurance, and requiring employers to offer it, were always going to be the tough part. But thanks in part to Republican obstructionism, it’s turned out to be tougher than the administration envisioned.
Already the employer mandate has been postponed for a year. Businesses with 50 or more employees that haven’t been offering health insurance will get another year to figure out how to navigate the system. The House also voted to delay the mandate that workers not covered by a group plan buy individual coverage. Like the House’s 37 previous votes to delay or repeal the ACA, this one will go nowhere.
Still, designing the individual mandate to make insurance accessible and affordable, particularly to young Americans, has proved to be far more complex than the administration had envisioned. In large part that’s because so many Republican-controlled state legislatures (including Missouri’s) opted not to create their own health insurance exchanges, or marketplaces.
The age trap
The federal government has to do it instead. Affordable health insurance is an easy sell to older workers, who know what medical bills can do to a family budget. It’s far more difficult to sell it to young workers who’ve never been sick. But those young, healthy workers are needed in the pool to make coverage affordable to older workers.
The fact remains that even though some big insurance companies have refused to sign up, states that have created insurance exchanges have seen the “magic of the marketplace” — once a favorite phrase of Republicans — drive down the cost of individual health insurance policies. In New York, Oregon and California, rates have fallen as much as 50 percent.
And while the Supreme Court famously upheld the individual mandate, it ruled that state governments could not be required to expand their Medicaid programs. More than 20 states, including Missouri, have refused to expand Medicaid programs to include the working poor, despite the huge financial windfall it would create. To say nothing of healthier populations and lower costs for the privately insured.
This stubborn refusal is driven strictly by politics, by the perverse hope that by keeping people sick and costs high, Republicans — who still have no better alternatives — can salvage some form of nihilist victory. This is profoundly shameful.
The Affordable Care Act is not perfect and may never be. Inevitably, economics will force it to give way to a single-payer national health care system. But in the meantime, it’s saving lives, saving money and making health care available to those who, as in parable of the Good Samaritan, were left to suffer at the side of the road.
Copyright St. Louis Post-Dispatch. Reprinted with permission.