Conservatives are betting big on the failure of the Affordable Care Act. They seem to think that if they can sabotage the health reforms, not only will it cause the general collapse of liberalism, but they also hope that health care in the United States will revert to the corrupt old system that allowed insurance companies to deny coverage to people with chronic health problems, cancel policies of people as soon as they were diagnosed with expensive illnesses, sell junk policies with little practical coverage for the unwary, and distribute excessive profits to their shareholders.
We aren’t going back. As of Jan. 1, regardless of whether the Obama administration ever gets HealthCare.gov glitch-free, millions of working poor people will start getting coverage through Medicaid. Millions of others will start getting subsidies to pay for private insurance through the federal marketplace. Those insurance policies will have to meet minimum standards for the first time. Insurance companies no longer will be able to deny coverage for people with pre-existing conditions. Annual and lifetime limits on coverage will be outlawed. And profits will be limited.
Progressives should frame the insurance reforms that are contained in the Affordable Care Act as the last chance for insurance companies to show they can provide health coverage without swindling their customers. But those bad habits are hard for insurance companies to give up.
The reforms will be rough for some — particularly for those in the middle class who buy their own individual insurance policies but whose income is too great to qualify for subsidies. Some of them have junk policies that seem like a good deal until they actually get sick; others might have gotten relatively good, inexpensive coverage because they had a good health history, but even those able-bodied middle-classers probably won’t have to look far to find a friend or relative who has been going for years without health care because they have a pre-existing condition or they just never could afford the insurance premiums.
Insurance companies have been sending out letters to several million of their customers telling them that they have to cancel their plans because of the Affordable Care Act. In many cases, the letters try to steer the customers to higher-cost plans, and because HealthCare.gov has been balky and the customers might not know they can get the information by phone, they might not know they could get a better deal from the federal healthcare marketplace — particularly if they earn less than four times the federal poverty rate (that would be $45,960 for a single person or $94,000 for a family of four) and qualify for a subsidy..
Enough people are howling about rate shock that President Obama was forced to concede that insurance companies should be allowed to continue selling junk insurance policies to existing customers for one more year, to make good on his promise that “If you like your health plan, you can keep your health care plan.” At least under Obama’s terms the insurance companies are required to notify customers of their options under the Affordable Care Act.
That wasn’t good enough for Republicans who want to dismantle the ACA by any means they can. So the House, on a 261-157 vote that included 39 panicked Democrats siding with the Republicans and four Republicans siding with the rest of the Dems, passed the Swindlers’ Relief Act, sponsored by Rep. Fred Upton (R-Mich.) on Nov. 15. The bill would allow insurers to maintain existing substandard policies but also would let them offer those plans to new customers, which would undermine the new system, and would exempt the insurance companies from some of the consumer protections.
If the insurance mandate fails to provide a financially viable private insurance market, the next step for Congress should be passage of the Expanded and Improved Medicare for All Act (HR 676, sponsored by Rep. John Conyers Jr., D-Mich.), which would simply expand Medicare to cover everybody.
Passage of that bill will remain a long shot, even if Dems regain the House majority and neuter the Senate filibuster, but single-payer advocates can pick up the slack at the state level. The Affordable Care Act provides for “state innovation waivers” to be granted beginning in 2017, allowing states to implement creative plans they believe would work best for them. With this in mind, organized single-payer movements have taken root in Colorado, Hawaii, Illinois, New York, California, Oregon and Vermont. Vermont passed a law in 2011 setting the state on the party toward its own single-payer program.
Canada moved to a single-payer health care program starting at the provincial level with Saskatchewan in 1946. The United States might have to get the momentum going at the state level too.
In the meantime, enrollment in healthcare plans is surging in many states. In California, where only 31,000 people enrolled in October, nearly twice as many had enrolled in the first two weeks of November, the Los Angeles Times reported Nov. 19. Several other states, including Connecticut and Kentucky, were outpacing their enrollment estimates. In Minnesota, enrollment in the second half of October ran at triple the rate of the first half, officials told the Times. Washington state also was on track to easily exceed its October enrollment figure.
The 36 states that depend on the federal website, many of whose Republican state officials declined to build their own exchanges, lagged far behind, but the Centers for Medicare and Medicaid Services reported in mid-November that HealthCare.gov was working for 90% of users who have tried to sign up. The agency has sent out 275,000 emails to people who had started to create accounts but couldn’t get through the process. As of mid-November, more than 50,000 people had selected an insurance plan — up from 27,000 in the entire month of October, the New York Times reported Nov. 19.
Joan McCarter noted at DailyKos.com Nov. 19 that many people are likely still in window-shopping mode. Enrollments should pick up even more — both on the state sites and the federal site — in the last week or two before the Dec. 15 deadline for insurance to be in place on Jan. 1. Then it will pick up again in February and March before the final deadline. The experience implementing Massachusetts health reform provides the best model for enrollment patterns, and in the first four months of enrollment just about one-fifth of the uninsured population enrolled.
“The people will come. They’re not freaked out over what most people perceive as inevitable: a problematic new government program. They’re not abandoning support for the program in droves. They’re not calling for an end to the program. They’re patient enough to give it time to work, even if Republicans and the traditional media are not.”
States found it easier to enroll low-wage residents in the expanded Medicaid programs. Under the law, the federal government picks up nearly the entire cost of that expansion for the first several years. That wasn’t a good enough deal to convince Republican leaders in 26 states to give five million working poor a break, but in the other half of states, nearly 400,000 new people already qualified for Medicaid coverage in October. In Oregon, whose marketplace has had problems, the state reported that it signed up 70,000 new people for Medicaid.
Meanwhile, in Texas, where Rick Perry has failed in 15 years as lieutenant governor and governor to take any action to address the health-care crisis for the one-quarter of Texans who are uninsured, not only has Perry denied Medicaid expansion to cover one million working poor Texans who are uninsured; his heir-apparent, Attorney General Greg Abbott, has moved to prevent “navigators,” many of whom work for non-profit organizations, from helping potential customers find the insurance plan and federal subsidy that’s right for them.
Next year, when the benefits of “Obamacare” become apparent to all Americans, we hope Democrats can make the Republicans pay for their hostility to working people. — JMC
From The Progressive Populist, December 15, 2013
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