The Less Affordable Care Act

When this 2010 legislation was crafted, getting it passed required some nasty compromises that aimed to get support from heavy medical industry players. “Competition is bad” was the cry. Under the guise of effective “quality control,” pharmaceutical companies extracted a ban on allowing consumers to buy their prescriptions in places like Canada, France or the UK. They also managed legally to prevent healthcare exchanges, with massive bargaining power based on millions of beneficiaries, from price negotiations with pharmas. To placate private insurance carriers, the bill withdrew a government alternative (the expansion of a Medicare-like system) to lessen competition with private carriers. The government also guaranteed to cover shortfalls experienced by these carriers as they explored setting up new systems under the act, pejoratively referred to as Obamacare.

Since its passage, the GOP-led House of Representatives has mounted 61 separate pieces of legislation to repeal the whole or significant parts of the Act, attached to other proposed bills dealing with infrastructure, our debt limit or the federal budget. The votes have all been political statements with no chance of becoming law under threat of certain presidential veto. Well, one bill did pass, signed into law, that didn’t seem like much at the time but one that threatens to reduce the number of insurers willing to continue participating in healthcare exchanges under the Act unless they charge consumers a lot more. And without private insurers in the mix, having disallowed a governmental alternative, Obamacare could begin to unravel.

As House brinkmanship on approving a federal budget last year moved toward its drop-dead-date, a spending bill finally got the bi-partisan support necessary to send the bill to the president who signed the compromise legislation. However, a young GOP senator from Florida, presidential candidate Marco Rubio, did what no other Republican had been able to do: throw a serious money wrench into the Affordable Care Act with a strategically-placed amendment to the spending bill.  His well-chosen words have left too many carriers with little incentive to continue their participation in many of the healthcare exchange absent significant price increases that would be borne by consumers. Effectively, federal support against insurance carrier losses has been materially reduced. And if the price of such insurance policies soars, the underlying promises of the Act will erode quickly. There are no proposals from any GOP candidate that would create a system with remotely the existing coverage of the Affordable Care Act.

“Mr. Rubio’s efforts against the so-called risk corridor provision of the health law have hardly risen to the forefront of the race for the Republican presidential nomination, but his plan limiting how much the government can spend to protect insurance companies against financial losses has shown the effectiveness of quiet legislative sabotage.

“The risk corridors were intended to help some insurance companies if they ended up with too many new sick people on their rolls and too little cash from premiums to cover their medical bills in the first three years under the health law. But because of Mr. Rubio’s efforts, the administration says it will pay only 13 percent of what insurance companies were expecting to receive this year. The payments were supposed to help insurers cope with the risks they assumed when they decided to participate in the law’s new insurance marketplaces.” New York Times, December 9th.

I have struggled with the underlying heartlessness of those who opposed and continue to oppose opening up healthcare to millions of uncovered Americans, to stem the tide of medical bankruptcies and simply to save lives and improve the quality of life for so many. Sure, young people who believe they are medically invulnerable don’t like the penalty tax, but add on little medical emergency or accident, and not having insurance creates a world of pain, physical and financial. They need the coverage. Businesses are charged with looking after their employees but now have access to reasonable rates from local (or federal) healthcare exchanges. And without such ubiquitous healthcare, pooling what were once individuals in very expensive and harsh insurance marketplace, those in the “gig economy” would be in serious healthcare jeopardy.

I asked myself whether this anti-healthcare bent is a necessary part of a consistent GOP platform, a recent change or just part of the polarization of opposing just about everything the “other side supports,” particularly catering to diehard conservatives, who refer to the bill as “Obamacare,”  and who believe that Barack Obama is a Muslim who was not born in the United States. Historically, one of the most conservative Republican presidents of the late 20^th century was one of the champions, if not an actual architect, of a universal healthcare system that was rigorously debated in the 1970s.

“In February 1971, President Richard Nixon proposed more limited health insurance reform—a private health insurance employer mandate and federalization of Medicaid for the poor with dependent minor children. Hearings on national health insurance were held by the House Ways and Means Committee and the Senate Finance Committee in 1971, but no bill had the support of committee chairmen Representative Wilbur Mills (D-AR) or Senator Russell Long (D-LA).

“In October 1973, Long and Senator Abraham Ribicoff (D-CT) introduced a bipartisan bill for catastrophic health insurance coverage for workers financed by payroll taxes and federalization of Medicaid with extension to the poor without dependent minor children. In February 1974, Nixon proposed more comprehensive health insurance reform—an employer mandate to offer private health insurance and replacement of Medicaid by state-run health insurance plans available to all with income-based premiums and cost sharing. In April 1974, [Ted] Kennedy [D-Mass.] and [Wilbur] Mills introduced a bill for near-universal national health insurance with benefits identical to the expanded Nixon plan, both of which were criticized by labor and senior citizens organizations because of their substantial cost sharing.

“In August 1974, after Nixon's resignation and President Gerald Ford's call for health insurance reform, Mills tried to advance a compromise based on Nixon's plan, but gave up when the conservative half of his committee instead backed the limited American Medical Association (AMA) ‘Medicredit’ voluntary tax credit plan. In December 1974, Mills resigned as chairman of the Ways and Means Committee and was succeeded by Representative Al Ullman (D-OR), who opposed payroll tax and general federal revenue financing of national health insurance.

“In January 1975, in the midst of the worst recession in the four decades since the Great Depression, Ford said he would veto any health insurance reform, and Kennedy returned to sponsoring his original universal national health insurance bill.” Wikipedia. The effort died.

Individual states have embraced healthcare within their jurisdictions, including Massachusetts. In 2004, GOP Governor Mitt Romney (later a presidential candidate) announced a plan that would cover most of the state’s uninsured, signing an implementing bill in 2006. Although he subsequently repudiated his own actions as part of garnering GOP support for his presidential aspirations, the fact remains that the Massachusetts law was his baby… and it worked.

“The state of Massachusetts passed a health care reform law in 2006 with the aim of providing health insurance to nearly all of its residents. The law mandated that nearly every resident of Massachusetts obtain a minimum level of insurance coverage, provided free health care insurance for residents earning less than 150% of the federal poverty level (FPL) and mandated employers with more than 10 ‘full-time’ employees to provide healthcare insurance. The law was amended significantly in 2008 and twice in 2010 to make it consistent with the federal Affordable Care Act. Major revisions related to health care industry price controls were passed in August 2012, and the employer mandate was repealed in 2013 in favor of the federal mandate (even though enforcement of the federal mandate was delayed until January 2015).” Wikipedia.

It does seem as the GOP has had a pretty big heart over the years, but the new Tea Party Evangelical constituency seems rather willing to delete New Testament values like charity, loving your brother and not sitting in judgment of others in favor of smaller government, one that would let a whole lot of Americans twist at the end of a fiscal rope without healthcare and other benefits. I’m wondering when they will release a new version of the New Testament that will in fact comply with their new-found “values”… The one that exists is pretty clear about what the values are and should be.

I’m Peter Dekom, and supporting universal healthcare is not a platform relegated to liberal Democrats… it reflects empathy those who actually have empathy for their fellow Americans, whether they are Republicans, Democrats or independents.