Nel's New Day

April 9, 2014

The ACA: Hell Freezes Over

I never thought it would happen: hell just froze over! After voting at least 51 times to dismantle the Affordable Care Act, House  GOP members voted to expand coverage choices as part of the legislation that stopped cuts for doctors’ Medicare payments. The bill, passed by the Senate and promptly signed into law, eliminated a cap on deductibles for small group policies in both federal and state exchanges.

The attitude change isn’t permanent, and hell is warming up. Until the ACA, major laws were always tweaked for improvement—Social Security, Medicare, even Massachusetts’ “Romneycare.” All the GOP wanted to do to ACA, however, was eliminate all its benefits. When Mitt Romney’s choice of news source, the extremist far-right Drudge Report, condemned this tweak, Speaker John Boeher’s (R-OH) office tried to explain that the new law actually repealed part of the ACA.

Image: CPAC's Annual Conference in Maryland

[Republican Governor from Louisiana Bobby Jindal at the Gaylord National Resort & Convention Center in National Harbor, Maryland, USA, 06 March 2014. Jim Lo Scalzo/EPA]

Republicans are woefully short on ideas about changing the ACA, as Louisiana’s governor, Bobby Jindal, demonstrates. Almost a year ago, he told the GOP that they had to stop being “the stupid party” before he joined the stupid curve to be considered as a presidential candidate. His new ideas for a healthcare plan are just plain confusing.

Jindal sticks with conservative positions of Medicaid block grants, Medicare vouchers for private plans, and limiting malpractice lawsuits, but he recommends cutting tax breaks for employer healthcare plans and using the revenue to provide deductions for individuals to buy insurance. He also wants to set aside $100 billion for pre-existing conditions with federal funding instead of the current practice of spreading these costs across the market through n insurance mandate.

A Center on Budget and Policy Priorities study of Jindal’s ideas found that replacing the tax exclusion with a deduction “would likely cause employer-based health coverage to seriously erode by encouraging employers to discontinue their coverage.” Conservative health policy experts James Capretta and Tom Miller estimate that high-risk pools aimed at covering up to 4 million people would cost between $150 to $200 billion over 10 years showing how low Jindal’s figure is. The governor’s policy director said that states, already saddled with far more costs than a decade ago, could pay the rest of the money.

Before the GOP turned farther right, Republicans promoted an individual mandate. Only after President Obama supported their model did the GOP reject the idea. Jindal is dreaming if he thinks that the House Republicans would support high-risk pools. Last year, it turned down a bill from Majority Leader Eric Cantor (R-VA) for just $3.6 billion on high risk pools that would be fully paid for with cuts to Obamacare.

Jindal’s plan would repeal the ACA, cancel millions of healthcare plans, do away with more insurance plans by eliminating employer-based care, and erase the ACA financing while at the same time making Medicare into a voucher scheme. Even the ultra-conservative National Review found Jindal’s plan “too disruptive.”

In the House, GOP leaders are avoiding any concrete healthcare ideas. After waiting almost five years, all people  hear is that the plan is being delayed “at least a month,” as Majority Whip Kevin McCarthy (R-Calif.) told Bloomberg News this week. The GOP has an excellent reason for their procrastination. A “congressional GOP health aide” anonymously said that they can’t come up with an alternative that doesn’t look like the existing healthcare plan.

The Republicans know what the rest of the country is learning: people hate the word Obamacare, but they love everything about it. In a discussion about healthcare, they ask if repeal means that the popular parts will be gone. The answer is “yes.”

Rep. Paul Ryan (R-WI) took the bull by the horns and said that the GOP can’t reinstate these popular provisions because they are too expensive. On Bloomberg’s Political Capital with Al Hunt, Ryan was asked about specific provisions: coverage for pre-existing conditions, parents’ insurance covering children until they are 26, the ban on annual and lifetime caps, different rates for people whose jobs include physical labor, etc. He said that these reforms “basically make it impossible to underwrite insurance.” He admitted that the GOP wants to erase healthcare coverage for millions and eliminate consumer protections for the rest of the people who manage to keep insurance.

Popular provisions would be too expensive under GOP policy because they will kill the individual mandate. Under GOP rule, insurance companies could go back to elaborate underwriting forms that demand answers to private details of health histories so that they can discriminate against people with health issues. All the ACA asks is age and tobacco use.

The biggest fears that people have about the ACA is its cost and its ability to refuse people insurance. Ann Coulter tried to tell a horrifying story about a “friend’s sister” who supposedly died of cancer because Obamacare took away her insurance. Politifact rated her tale as “pants on fire,” saying that if Coulter’s story was accurate, then the woman elected to drop her coverage.

A new piece on the internet blames drastic increases in premiums on the ACA. It started with a Forbes column from Scott Gottlieb, connected to the American Enterprise Institute. He refers to a non-existent survey and has no background information for his assertions. No right-wing major newspaper repeated this information, showing that they think it is fraudulent. The only premium increases are “off-exchange” and non-employer plans. PwC’s Health Research Institute reports that the average cost of premiums on ACA exchanges are 4 percent less than employer-provided plans with comparable benefits. Another “pants on fire.”

Yesterday, the Rand Corp. released its study of the ACA’s effect on health insurance coverage:

  • At least 9.3 million more people in the United States have health insurance than in September 2013, almost all of them because of the law.
  • The number of people getting insurance through their employers increased by 8.2 million.
  • Of the 3.9 million people counted by Rand as obtaining insurance on the individual exchange market, 36% were previously uninsured. That ratio is expected to rise when the late signups are factored in. Medicaid enrollment increased by 5.9 million, the majority of whom did not have insurance before signing up.

And this is just the beginning. Experts expect more enrollments as other changes occur.

The Medicaid increase comes from only half the states because the other half have refused to take federal funding for the program to insure their indigent, uninsured people. MIT economist Jonathan Gruber, who helped design the healthcare systems in both Massachusetts and the United States, talked about the conservatives in the states that rejected Medicaid:

“[They] are not just not interested in covering poor people, they are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.”

Gruber described it as “nothing short of political malpractice.” Virginia is a prime example of this evil. Gov. Terry McAuliffe campaigned on Medicaid expansion, but the commonwealth’s legislature blocks these benefits for 400,000 lower-income Virginians in the healthcare coverage gap, those who can’t afford to buy healthcare but make too much money for the extremely low Medicaid qualifications.

charlene dillIn a real story about a real person, 32-year-old Charlene Dill, mother of three who worked three part-time jobs to make $9,000 a year, dropped dead at one of her jobs having no health insurance for her chronic heart condition. She was in the coverage gap. GOP legislators are literally murderers in half the states.

The other evil-doers are the huge corporations who are making money while trying to keep people from having health care. While Koch Industries and other conglomerates are spending millions against the ACA, they are benefiting because the Early Retiree Reinsurance Program pays health insurance costs for those not covered by Medicare. Other companies benefiting from ACA are UPS, Union Pacific Railroad, Altria Client Services, AT&T, Pfizer, and GlaxoSmithKline—all companies that paid to elect anti-healthcare legislators. These corporations are also murderers.

Although a variety of polls show that a little more than half the people support or oppose the ACA, the surveys do not indicate the reasons for opposition. Personally I and many others would opposed it to get universal healthcare. I try to imagine what the polls would have said if the conservatives had not sent billions of negative messages about the ACA.

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