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Monday, December 09, 2019 {{ new Date().getDay() }}

The Affordable Care Act

Republicans have tested the limits of hyperbole in attacking Obamacare. You can’t really top then-Minority Leader John Boehner warning that passage of the Affordable Care Act would be “Armageddon.” Well, we’re still here.

These days, the best the GOP can do is echo soon-to-be-former senator Max Baucus (D-MT), who warned that implementation of the law would be a “train wreck.” While the senator was calling for better education and promotion of the law, Republicans — who cut the budget for that to below the amount spent to educate people about the much-less-complicated Medicare Part D — pretended he was speaking about the law itself.

There’s no doubt that this new system that requires a health care marketplace to be set up in all 50 states will be complex and onerous to put in place — especially with Republicans purposely trying to engineer a disaster. But they’ve set expectations so low that there’s a good chance Obamacare will actually impress, especially in the blue states that are taking advantage of the landmark law.

Since Baucus’ “train wreck” remark, there’s actually a been a lot of good news for taxpayers who want to see the law work. As a result, supporters are becoming optimistic. Maybe even too optimistic. “Predictions that Obamacare will be a big political issue are probably right — but not in the way gleeful conservatives imagined,” writes The New York Times’ Paul Krugman.

Could America’s first near-universal health care system end up being the boon for the Democrats Bill Clinton imagined it would be years ago? The fact is we already pay for each other’s health care — just in the dumbest way possible — and the Affordable Care Act is the first serious attempt to fix that.

Here are five auspicious signs for Obamacare.

Great News Out Of California

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California is ground zero for testing how health care reform will work in a huge state that has embraced the law every step of the way, even when Republican Arnold Scwagnegger was governor. Basically, if the law doesn’t work there, it won’t work anywhere — except Massachusetts, where it has basically been law for the better part of a decade.

“During a House Energy and Commerce Committee hearing on Obamacare ‘rate shock’ last week, House Republicans predicted hikes as high as 66 percent for Californians’ premiums based on internal documents from 17 major U.S. insurance companies,” according to ThinkProgress’ Sy Mukherjee.

But the real rates are beginning to come in. Health care expert Jonathan Cohn of The New Republic looked at the rates Californians can expect to pay in their state’s exchanges and saw some good news:

Based on the premiums that insurers have submitted for final regulatory approval, the majority of Californians buying coverage on the state’s new insurance exchange will be paying less—in many cases, far less—than they would pay for equivalent coverage today. And while a minority will still end up writing bigger premium checks than they do now, even they won’t be paying outrageous amounts. Meanwhile, all of these consumers will have access to the kind of comprehensive benefits that are frequently unavailable today, at any price, because of the way insurers try to avoid the old and the sick.

Unfortunately, millions of uninsured and under-insured Americans live in places like Florida and Texas, where there is far less sympathy—and a great deal more hostility—to the idea of Obamacare. It’s entirely possible that the insurance bids in those states will be a lot higher, precisely because state officials there are doing nothing to help and quite a bit to hurt implementation. But if that happens, blame won’t belong with the heath care law or the federal officials in charge of its management. It will belong with the state officials who can’t, or won’t, deliver to their constituents the benefits that California’s officials appear to be providing theirs.

 

Photo: ground.zero via Flickr.com

Medicaid: A Lifesaver For The Working Poor

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A recent experiment tracked working Oregonians who were afforded the chance to enroll in Medicaid and compared them to a control group that remained uninsured. Expanding Medicaid is a key component of the law, designed to get those Americans who earn too much for Medicaid but earn under 133 percent of the poverty level covered and thus less likely to drive up costs by relying on emergency rooms. This experiment has turned into a Rorschach test, with both proponents and opponents of the law seeing things that affirm their worldview. But certain facts are undisputed: Having Medicaid improves the well-being of working families and prevents economic hardship.

The New Republic‘s Cohn explains:

The big news is that Medicaid virtually wiped out crippling medical expenses among the poor: The percentage of people who faced catastrophic out-of-pocket medical expenditures (that is, greater than 30 percent of annual income) declined from 5.5 percent to about 1 percent. In addition, the people on Medicaid were about half as likely to experience other forms of financial strain—like borrowing money or delaying payments on other bills because of medical expenses.

The other big finding was that people on Medicaid ended up with significantly better mental health: The rate of depression among Medicaid beneficiaries was 30 percent lower than the rate of depression among people who remained uninsured. That’s not just good health policy. That’s good fiscal policy, given the enormous costs that mental health problems impose on society—by reducing productivity, increasing the incidence of violence and self-destructive behavior, and so on.

Another often-ignored benefit of Obamacare is the role it could play in reducing crime and keeping the working poor out of prison.

“People who are drug-dependent pay for their habits with petty crimes,” Cuyahoga County Common Pleas Judge David Matia told The Cleveland Plain Dealer. “The mentally ill, who are more likely to commit crimes of violence when they are unmedicated, are less likely to harm you, your neighbor, your child or your friend.”

Medicaid expansion won’t just improve the mental well-being and financial conditions of poorer Americans, it will get those who can’t afford it drug treatment, and thus a chance for a life that isn’t spent in and out of prison.

Photo: Joe Shlabotnik

The Biggest Myth About The Law Is Falling Apart

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Republicans like to pretend that businesses aren’t hiring because of the pending implementation of Obamacare. The fact is there will only be additional employer spending required from a tiny fraction of businesses — just 1 percent, according to CNN Money‘s Jose Pagliery:

As of 2010, there were roughly 5.7 million small employers, defined as those with fewer than 500 workers. Some 97 percent of them have fewer than 50 employees. That means Obamacare’s employer mandate applies only to 3 percent of America’s small businesses.

That’s about 200,000 companies.

…nearly all of those businesses already do provide insurance: 96 percent of those with 50-plus workers currently offer health plans anyway, according to government data.

More than 99 percent of those in work-sponsored plans have insurance that meets most Obamacare coverage standards, according to last year’s study by NORC at the University of Chicago.

Putting it all together, the data shows that only a tiny sliver of the nation’s small businesses face the new rules — and even fewer face any changes. Of the country’s 6.5 million workplaces, only 1 percent must actually start providing insurance next year.

 

AP Photo/Jason Redmond

GOP Governors In Purple States Know That Rejecting Medicaid Expansion Is Insane

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Republican governors in Arkansas, Arizona, Florida, Iowa, Michigan, New Mexico, New Jersey, Ohio and Tennessee have all taken steps to accept Obamacare’s extremely generous funding of Medicaid expansion, which was made optional with no threat of penalty, thanks to the Supreme Court. In Arizona, Florida, Michigan and Ohio, Tea Partiers in the legislature have effectively blocked expansion.

But that Republican governors were willing to embrace a law that once was compared to end times is a sign that the prediction that eventually all 50 states will embrace Medicaid expansion may one day come true. Or perhaps, these savvy Republican politicians just don’t want to run for re-election while denying hundreds of thousands of voters subsidized health care.

But certainly no one expected Governor Jan Brewer (R-AZ) — one of the president’s most vocal critics — to shut down her legislature until they passed Medicaid expansion.

Republicans Can’t Hate It Any More Than They Already Do

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Republicans’ real problem is that they’ve won the PR battle on Obamacare so far. The law is still not popular, even as it has afforded health insurance to more than six million students, closed the Medicare donut hole and begun providing millions with free preventive care. They’ve spent years explaining that full implementation is going to lead to cost explosions, mass layoffs, people losing their insurance, their doctors, their FREEDOM!

But the problem Republicans face now is the problem Democrats faced when passing the law: Most people are insured through their employer and are fine with their plans. And for the vast majority of Americans, that won’t change. For the uninsured, things will change vastly, with subsidized insurance or tax credits. For people with pre-existing conditions, affordable coverage will finally be available at no extra cost. Women can’t be charged more than men and onward.

The law is so polarized already — “85 percent of Republicans view the law unfavorably compared to 57 percent of Democrats who view the law favorably” — that the chances of the law becoming any more unpopular are small.

And if the results in California are any indication, it won’t be long before Republicans transition into their last stage of mourning: claiming credit for a law they once opposed.

Photo: Gage Skidmore via Flickr.com

Jeff Danziger lives in New York City. He is represented by CWS Syndicate and the Washington Post Writers Group. He is the recipient of the Herblock Prize and the Thomas Nast (Landau) Prize. He served in the US Army in Vietnam and was awarded the Bronze Star and the Air Medal. He has published eleven books of cartoons and one novel. Visit him at DanzigerCartoons.