Health Care – Carrots and Sticks
Tuesday is election day in America. This year’s midterms have become a referendum on the Republican control of government, and on President Trump in particular. One of the great “failures” of Republicans in the last two years is their inability to “get rid of Obamacare.” After fifty-four attempts to end the Affordable Care Act while Barack Obama was President, once Republicans gained Congressional majorities and the Presidency, they couldn’t get it done. It came down to a single vote, the famous middle of the night “thumbs down” of Republican Senator John McCain.
The Affordable Care Act was a compromise of proposals among the Congressional Democrats in 2009. Many wanted to create a “single payer” system – Medicare for all; but were unable to gain a majority. So in the “sausage factory” of Congressional legislation, the ACA was created.
There were lots of “carrots:” items that made the ACA palatable to American citizens. Insurance companies were required to cover people with pre-existing conditions without charging them additional fees, and parents were allowed to maintain coverage of adult children until they were twenty-six. The ACA also allowed for a major extension of government health coverage for low income folks; the Medicaid expansion provided health coverage for millions. And the ACA provided for insurance independent of employment, so that folks could change jobs and maintain coverage, without the extreme fees of “Cobra.”
But with “carrots” there had to be “sticks.” All of the above benefits certainly increased costs; in order to offset them, the ACA expanded the “pool” of folks required to have health insurance to – everyone. This meant that those who were healthy and had a high enough income to pay taxes and chose to go without insurance, now were required to either buy insurance or pay a tax: the “individual mandate.” On an actuarial level they were less likely to need coverage, so that their payments went to offset the additional costs.
Insurance companies didn’t lose all their profitable perks. They were able to keep insurance coverage on a state-by-state basis, limiting the “size of the pool” for ACA insurance. They also maintained the 80% of coverage that was privately based through employment, though they had to follow the new ACA regulations. And, of course, they could withdraw from offering ACA coverage in areas that weren’t profitable.
President Trump, through executive action, was able to end the individual mandate. By doing so, he removed the “stick” of the ACA. He used the time worn excuse for cutting government benefits: he was “freeing” people from government regulation. It allowed the healthy to go without insurance. Costs for ACA insurance increased, as the “pool of insured” grew smaller and sicker. Republicans then claimed that the ACA didn’t work, was too expensive, and had to be abolished.
It’s two days before election day. I have had the opportunity to travel in the past couple of weeks: Ohio, Pennsylvania, West Virginia, North Carolina, South Carolina and finally Florida. In this tense election season, there has been commercial after commercial for hotly contested House and Senate campaigns. Republican after Republican now claim to support insurance for pre-existing conditions without additional costs, as well as many of the other “carrots” of the ACA. But they offer no plan to cover the costs, the “sticks” that made the ACA work. They simply say: “I’m for pre-existing insurance coverage.”
President Lincoln said: “You can fool all the people some of the time, and some of the people all the time, but you cannot fool all the people all the time.”
The American people are pretty good at knowing the truth, even through all of the political hyperbole of campaign ads. And most Americans know too, that politicians will often say what’s popular rather than what’s true. But – if we look at what they “do” rather than what they “say,” Republicans have done nothing to protect those with pre-existing conditions, and the proposals they have made allow insurance companies to raise prices, making insurance unaffordable.
So don’t be fooled by the new Republican line. Look at what they done – everything to make health care what it was before 2009. If healthcare is the issue – then Democrats are the answer in 2018.
