Republicans have had the Affordable Care Act battlefield to themselves for a long time, but the pro-Obamacare forces are coming off the couch. The intense back-and-forth of the past few days is a taste of what’s to come as the most contentious parts of the law start phasing in this fall.
At a White House event Thursday, President Obama was surrounded by people who have received insurance-premium refunds due to Obamacare. He accused Republicans of playing politics and “refighting these old battles” on health care, instead of taking care of national needs such as passing immigration reform and a farm bill.
It was the latest move by the administration and its allies in an escalating campaign to defend the law, sell it, and strike back against ceaseless attacks by Republicans with their eyes on the 2014 midterms and the 2016 presidential race. Another is the new cable TV ad “Hands Off Obamacare,” a play on the classic “hands off my Medicare,” sponsored by the liberal group Americans United for Change.
The friendly group standing with Obama on Thursday did little to take the edge off the pointed criticism he leveled against Republicans who seem bent on going after Obamacare until the last dog dies. The law is increasingly the target of choice for GOP politicians trying to bolster their conservative cred, led by Sen. Marco Rubio, Senate Minority Leader Mitch McConnell, and House Speaker John Boehner, whose House majority voted this week to gut the law “for nearly the 40th time,” Obama said with a chuckle. “Maybe they think it’s good politics,” he added. “But part of our job here is not to always think about politics.”
The mounting intensity on both sides is bound to further befuddle an already confused public.
On the one hand, the House this week voted in the name of what Boehner called “basic fairness” to delay the Jan. 1, 2014 requirement that individuals buy insurance, just as a mandate on employers has been delayed. Boehner attacked the law as a “train wreck, driving up health costs.”
Contrast that with an interview last month on Fox’s Boston affiliate in which Democrat Don Berwick, a pediatrician and former Medicare chief now running for governor of Massachusetts, called the law “a great step forward for the country. It makes health care a human right in America.” Asked about its flaws, of which there are many, he replied: “It’s a little slow if you ask me … I wish we could go a little faster.”
How can those two people be talking about the same law?
And it’s not just the rhetoric that’s confusing. There’s also a bombardment of seemingly conflicting information. Just this week, as Obama pointed out, The New York Times reported that policies on the state’s new insurance marketplaces would cost 50 percent less than they do now. Yet New York policies have been expensive because companies have had to insure anyone no matter their health status, so far without the new law’s requirement that as of Jan. 1, 2014, younger, healthier people also must buy policies. Other states may not see a drop--in fact Ohio regulators issued a preliminary estimate last month of an 88 percent increase in premiums. Yet how much that will hurt purchasers is unclear because many, if not most, could be eligible for federal subsidies to offset their costs. To further complicate matters, as this chart shows, the cost difference between premiums in California and Ohio is only $16.
The upshot is there’s ample backing for all sides of the argument. Combine that with public unease, and the law makes an irresistible punching bag.
It’s the top way in which Rubio, after negotiating a Senate immigration compromise that included a path to citizenship for illegal immigrants, is demonstrating his conservatism to the GOP primary electorate in advance of his widely expected 2016 presidential race. In the past few days, Rubio has called for repeal, defunding or permanent delay of Obamacare in a letter to Obama, at a conservative breakfast, in a bill introduced with colleagues, and in a fundraising pitch for his Reclaim America PAC. (“We need your help to put the final nail in Obamacare’s coffin,” he wrote, using perhaps not the best imagery in a fight against a health law.) He was set to talk Friday with Florida business owners about “the looming burden of Obamacare.”
McConnell, up for reelection and needing to fire up his Kentucky base, pre-butted Obama’s remarks with a floor speech asserting that $500 million in consumer refunds (from a new requirement that insurance companies spend 80 percent of premium dollars on care) would be dwarfed by $8 billion Americans will pay in a new sales tax on health insurance.
The refunds are not headline material for many people, even if they are beneficiaries. Some employers are simply using the money to lower this year’s premiums--a savings for policyholders but far less noticeable than a check arriving in the mail.
The more potent political point, which Obama made sure to cover, is “getting better value for your buck” from insurance companies. They’ve got to spend 80 percent of premium money “not on overhead, not on profits, but on you,” he said. Do opponents of the law “think that was a bad idea to make sure that insurance companies are being held accountable?” he asked.
If Democrats manage to make a decent pitch, health tracking polls by the Kaiser Family Foundation show receptivity to the idea of buying insurance and some room to change opinions.
Many people who will benefit from the law don’t realize it yet, for a start. Among those who report that someone in their household has a preexisting medical condition, four in 10 don’t know the new law requires insurance companies to cover them, and at non-inflated rates.
In addition, young people ages 18 to 25, whose participation is essential to offset older, sicker people in the pool, seem inclined to want insurance. About three-quarters in the Kaiser polls said that it is “very important,” they need it and it’s “worth the money it costs.” Also, among uninsured people aged 18 to 64, only 11 percent said they don’t need insurance.
Obama says the law will allow people buying their own insurance to compare plans “just like you’d compare over the Internet the best deal on flat-screen TVs, or cars, or any other product that is important to your lives.” That’s certainly an accessible way to talk about a very complicated law.
The aspect of his speech with the most impact, however, might turn out to be the air of confidence he conveyed as he spoke of ironing out glitches and plowing ahead through the political noise. It’s going to be a long time before the public comes to a verdict based on real life.
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