The GOP’s Unhealthy Bias Against Obamacare

The Republican frenzy to trash the law has nothing to do with its fundamental purpose: providing health care to those who need it most.

WASHINGTON, DC - OCTOBER 13: Former Alaskan Governor Sarah Palin (R) and Sen. Ted Cruz (R-TX) recite the Pledge of Allegiance at a rally supported by military veterans, Tea Party activists and Republicans, regarding the government shutdown on October 13, 2013 in Washington, DC. The rally was centered around re-opening national memorials, including the World War Two Memorial in Washington DC, though the rally also focused on the government shutdown and frustrations against President Obama.
National Journal
Nov. 13, 2013, 11:32 a.m.

The Up­ton bill sched­uled for a vote in the House, which would give in­sur­ance com­pan­ies the op­tion of con­tinu­ing for a year the health in­sur­ance plans they have just can­celed, is the first sig­ni­fic­ant Re­pub­lic­an ef­fort to re­form in­stead of kill the Af­ford­able Care Act. Of course, it has a ma­jor down­side: The num­ber of those pop­u­lat­ing the ex­changes will be smal­ler, and less healthy, be­cause the in­di­vidu­als who will most want to keep their plans are the ones in­sur­ance com­pan­ies cherry-picked due to their good health. But the bill at least ac­know­ledges the real­ity that Obama­care is here to stay.

Will it be the first of a series of steps to ad­just the ACA? I doubt it. The zeal to trash and sab­ot­age Obama­care is now deeply seated among Re­pub­lic­ans in and out of Wash­ing­ton. That zeal has noth­ing to do with the botched rol­lout of Health­ or the broken prom­ise of the pres­id­ent about the abil­ity of every­one to keep his or her plan, much less the fun­da­ment­als of the act.

A good case study in this zeal comes from the Wash­ing­ton Post colum­nist Charles Krau­tham­mer. In a re­cent column, “Obama­care Laid Bare,” he chal­lenges the en­tire struc­ture of the Af­ford­able Care Act.

Krau­tham­mer does not like Pres­id­ent Obama any more than he likes green eggs and ham, as evid­enced by the fact that he can’t help but make two ref­er­ences to Benghazi and one to the IRS in a column on health policy. He at­tacks the plan for throw­ing far more people off their in­sur­ance than it can pos­sibly be sign­ing up on the ex­changes. He lays in­to the idea that those with in­di­vidu­al health plans will now be forced to pay for cov­er­age they do not need: “So a couple in their 60s must buy ma­ter­nity care. A tee­totaler must buy sub­stance-ab­use treat­ment. And a healthy 28-year-old with per­fectly ap­pro­pri­ate cata­stroph­ic in­sur­ance must pay for bells and whistles for which he has no use.”

Lost in this ana­lys­is is any sense of what the Af­ford­able Care Act does and why, much less any link to the real­ity of what in­sur­ance is and what it does. Ex­hib­it A in the lat­ter case is the set of charges about the rank un­fair­ness of for­cing people to pay for cov­er­age they do not need. My wife and I are a couple in their 60s — and we pay for ma­ter­nity cov­er­age, as we have for dec­ades after we needed it, as part of our group in­sur­ance via my em­ploy­er. When I was in my 20s, I paid — as part of my group in­sur­ance at a uni­versity — for all kinds of cov­er­age for ail­ments that hit those in their 60s but were not at all rel­ev­ant for me. That is what in­sur­ance offered to groups of people does.

That real­ity has al­ways been true for those of us, the vast ma­jor­ity of Amer­ic­ans, who get their cov­er­age through their em­ploy­ers. It is also true that for some very healthy in­di­vidu­als who have not had the abil­ity to se­cure in­sur­ance through an em­ploy­er or group, they could tail­or their cov­er­age to ex­clude items they would not need, or could gamble that they would not need. But for most — in­clud­ing many of those so priv­ileged — the in­di­vidu­al mar­ket has been a jungle.

Wheth­er un­em­ployed, work­ing for an em­ploy­er who does not provide in­sur­ance, or between jobs and no longer eli­gible for CO­BRA, in­di­vidu­als seek­ing in­sur­ance have faced a mar­ket where preex­ist­ing con­di­tions — even as trivi­al as acne — might be enough to deny cov­er­age, or to have cov­er­age sus­pen­ded when the in­sured gets ser­i­ously ill. Find­ing in­sur­ance on the mar­ket was its own night­mare even for soph­ist­ic­ated in­di­vidu­als, as I dis­covered some years ago when I was shop­ping for in­sur­ance for my able-bod­ied son, whose Ivy League de­gree did not bring with it a job that offered health in­sur­ance. I went on ehealth­in­sur­ and found an im­press­ive ar­ray of plans avail­able to him at dif­fer­ent price points. But once I got past the ini­tial para­graph de­scrib­ing the ba­sics, dis­cern­ing what each policy ac­tu­ally covered and didn’t cov­er was vir­tu­ally im­possible. Com­par­is­on shop­ping to buy in­di­vidu­al in­sur­ance was like buy­ing a mat­tress, and there was no as­sur­ance, after pur­chas­ing a plan, that it would ac­tu­ally pay for all the costs that might res­ult from a ter­rible ac­ci­dent or a dev­ast­at­ing ill­ness.

For every un­for­tu­nate story now of an in­di­vidu­al los­ing his or her ex­ist­ing plan — each of whom will get re­place­ment cov­er­age, al­beit some with high­er costs — there are stor­ies of those who dis­covered after it was too late that the cov­er­age was not there when they needed it, or was can­celed be­cause of a real or ima­gined preex­ist­ing con­di­tion. Cre­at­ing a base of cov­er­age to pro­tect those from dis­aster, to en­sure that ba­sics of in­sur­ance routinely made avail­able to those of us in groups are there for those not in groups, is not some hor­ror of big gov­ern­ment run rampant but a ra­tion­al and hu­mane way to cre­ate ba­sic na­tion­al stand­ards. Ex­pand­ing the risk pool by adding the sick or po­ten­tially sick, who are now screwed, and those who have not bothered to get in­sur­ance des­pite the risk of ac­ci­dent or cata­strophe, has a cost, but it is one worth pay­ing.

And for those thrown off their in­sur­ance, for whom Krau­tham­mer ex­presses deep con­cern, all will be able to re­tain in­sur­ance cov­er­age, most at a net cost at or be­low their ex­ist­ing plans, without the holes in cov­er­age they now have. For every one who will pay more, there will be many more who will get cov­er­age for the first time, or who will be free from the bur­den of stay­ing in jobs only be­cause they need in­sur­ance, or who will be lif­ted from the bur­den of ul­tra-ex­pens­ive CO­BRA cov­er­age when between jobs and without in­comes.

There is no ex­cuse, peri­od, for the pres­id­ent’s false com­ments about Amer­ic­ans re­main­ing free to keep their cov­er­age. And there is plenty wrong with Obama­care, partly be­cause it was jerry-built to get around the early and im­plac­able op­pos­i­tion of all Re­pub­lic­ans in both houses to passing any health care bill, or to of­fer a single vote for the plan in re­turn for adding con­struct­ive amend­ments. But the struc­ture, built around ex­pand­ing the risk pools, cre­at­ing a fair mar­ket­place of private in­surers to en­able com­pet­i­tion to work, and premi­um sup­port for those who can’t af­ford cov­er­age, is pre­cisely the one Re­pub­lic­ans ad­voc­ated in the 1990s and right up un­til 2009. In the su­preme irony, it is the same struc­ture Rep. Paul Ry­an of­fers in his pro­pos­al for Medi­care — call it Obama­care for seni­ors.

If you think about it, it would be in the in­terest of con­ser­vat­ives who be­lieve in the ma­gic of mar­kets to make this sys­tem work. If it can be demon­strated that real com­pet­i­tion in a real mar­ket­place of­fers good ser­vices at lower over­all costs, that adds power­ful am­muni­tion to the case for free mar­kets. Let’s face it: The un­re­lent­ing op­pos­i­tion to all parts of the law, as re­flec­ted not just in cri­tiques like Krau­tham­mer’s but also in the more vap­id and con­fused at­tacks by Sarah Pal­in and oth­ers, is far more about Barack Obama than it is about the struc­ture and nature of the Af­ford­able Care Act.

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