After the frenzied finish of the first enrollment period under the Affordable Care Act, the Obama administration on April 1 triumphantly announced that more than 7.1 million Americans had signed up for private insurance plans through the federally sponsored marketplaces. That surpassed the Congressional Budget Office’s original projection, even with the “disastrous” launch of HealthCare.gov that sidelined the website in October and much of November. As Eric Boehlert notes on page 10, the corporate media had echoed the Republican line that it would take a miracle for the marketplaces to enroll 7 million but conservatives remain in denial that the federal health reform has hit its stride.
Even before the White House announced the numbers, Sen. John Barasso (R-Wyo.), chairman of the Senate Republican Policy Committee, on March 30 had accused the administration of “cooking the books,” a conspiracy theory that other Republicans quickly took up. After President Obama claimed the credit in the Rose Garden, House Budget Chairman Paul Ryan (R-Wis.) called the 7.1 million signups a “slow rolling fiasco” and “a Pyrric victory” and others continued to express doubt about the numbers. Senate Minority Leader Mitch McConnell (R-Ky.) adopted the GOP line that enrollees don’t count until they’ve paid their first month’s premium. “We don’t know of course exactly what they’ve signed up for, we don’t know how many have paid,” McConnell said. Rep. Tom Price (R-Ga.) agreed in a conference call with reporters, “Clearly we still don’t have information on how many of those individuals have paid their premiums.”
If many new enrollees haven’t paid their first premiums yet, it may be because the insurance companies failed to increase their staff to handle the rush of new business and get out the invoices.
Other Republicans claimed the law also forced the cancellation of millions of policies, so many of the people enrolling in the new marketplaces were simply being forced to buy a different plan. “The bulk of the people who are signing up had insurance to begin with, and they probably had their insurance canceled because of Obamacare, said Sen. Ted Cruz (R-Texas), having no numbers to back up his claim, but then again Fox and Friends hosts rarely press their Republican guests. “It is abundantly clear this thing isn’t working,” Cruz added. Republican National Committee Chairman Reince Priebus, GOP Virginia Senate candidate Ed Gillespie, Rep. Paul Broun (R-Ga.), and Sen. John Cornyn (R-Texas) all expressed similar sentiments, Sy Mukherjee noted at ThinkProgress.org.
Remember that under the old “let the buyer beware” insurance system to which Republicans would like to return, three quarters of medical bankruptcies happened to people who thought they were covered until they got sick and found they were underinsured.
The Rand Corp. on April 8 poked a big hole in the Republican argument that millions lost insurance when it reported that at least 9.3 million more Americans have health insurance than in September 2013, virtually all as a result of the law. And that’s a net figure, accommodating the less than one million Americans who lost their individual plans because of cancellations. That’s less than 1% of the US population age 18-64, Rand noted.
And most of those people lost their old, low-cost insurance plans because the plans offered junk coverage that left policyholders vulnerable in case of a real health emergency. Among the ACA’s benefits are that it requires insurance companies to stop excluding coverage for “pre-existing conditions”; it requires that policies provide free preventive care; it does away with annual and lifetime caps on coverage; it provides subsidies to help small businesses provide insurance for workers; it provides discounts on prescription medicines for seniors; and it allows people to quit dead-end jobs and start their own businesses with the assurance that they can get affordable coverage.
One of the misconceptions of the Affordable Care Act is that it was based on the individual mandate plan embraced by Republicans in the 1990s, as insurance companies allied with conservatives to successfully sidetrack Hillary Clinton's attempt to reform health care. The difference was that the Heritage Foundation's original plan in 1989 merely proposed that people be forced to buy insurance, without the standards that the Affordable Care Act required for insurance coverage 20 years later.
And in those states where the insurance plans have not proven to be affordable, due to a lack of competition among private insurance companies, states can and should develop their own public options. The law allows states in 2017 to seek “innovation waivers” to try their own paths to universal health coverage, such as statewide single-payer plans. Vermont already is developing a single-payer plan. Under Section 1332, which provides for the waivers, states must cover as many people and offer coverage as comprehensive and affordable as the old system. Qualifying states would receive the same federal funding that would have been available under the ACA.
Republicans have been reluctant to actually produce an alternative to the Affordable Care Act, knowing that anything short of expanding Medicare to cover everybody is going to illustrate the benefits of Obamacare. Ryan admitted as much in an April 4 interview with Bloomberg News’ Al Hunt. Asked if Republicans would maintain the pre-existing conditions regulations, dependent coverage extension, and other rate requirements if they replaced Obamacare, Ryan said, “You dramatically crank up the cost. And you make it hard for people to get affordable health care.”
Louisiana Gov. Bobby Jindal on April 2 unveiled a conservative health care alternative which health analysts said it would cost millions of Americans to lose their existing health care plans and hurt the middle class and working poor.
Jindal’s “Freedom and Empowerment Plan” would repeal Obamacare and treat employer-sponsored coverage and nongroup insurance equally in the tax code. Repeal would cause at least 10 million people who have signed up for insurance through the new marketplaces, Medicaid expansion and the remaining individual market to lose their insurance. The substitute plan would lead many businesses to stop offering coverage altogether, Igor Volsky noted at ThinkProgress.org (April 2).
Volsky noted that the 149 million nonelderly people who obtain coverage through their jobs don’t pay taxes on their benefits. The tax subsidy, which dates back to World War 2, encourages employers to offer health insurance. Jindal proposes to eliminate the tax-exempt status of employer-sponsored plans — treating employer-sponsored benefits as taxable income — and replace it with “a standard deduction for all forms of health insurance,” which would encourage individuals to buy coverage independent of their employer plans.
Volsky noted that sicker and lower-income people would be most disadvantaged by what Jindal is offering. If the ACA’s insurance regulations were fully repealed, individuals who lost their employer-sponsored insurance would turn to the individual market, where insurers would be able once again to cherry-pick the healthiest enrollees or charge more for pre-existing conditions.
And the Republicans’ proposed tax deduction would primarily benefit people in higher tax brackets and would be worth little (or nothing) to the vast majority of uninsured, who are in the 15% tax bracket or less and would reap few, if any, rewards from Jindal’s proposal.
As Americans become more familiar with the benefits of Obamacare and realize that Republicans have been lying about it for five years, and we see working-poor Americans dying because they are shut out of Medicaid by Republican governors and legislators who compose the real death panels, voters need to ask the Republican naysayers why they never lifted a finger when they were in power to help working people get affordable health care. In the meantime, progressives around the country should follow Vermont’s lead in promoting single-payer plans in their states as the next step toward affordable universal care. — JMC
From The Progressive Populist, May 1, 2014
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