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
Norm Ornstein
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Norm Ornstein
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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