National media have reported that the recent government shutdown was planned by a coalition of Affordable Care Act opponents, among them Americans for Prosperity and the Club for Growth, who were having no luck getting Congress to repeal the act and who, therefore, decided they could stop the act’s implementation by cutting off financing for the entire government.
Some members of the coalition are also looking for ways to make the ACA ineffective, for example, by discouraging young, healthy people from buying insurance. Excluding young, healthy people from large insurance pools that also contain older, less healthy people would drive up the cost of insurance, thereby triggering a consumer revolt against the act, at least in theory.
Peter King, a Republican congressman from New York and no fan of Obamacare, found the whole exercise to be ridiculous. The way to end Obamacare, he said, is to respect majority rule, let the citizenry see how poorly Obamacare works and how bad it will be for the economy, then repeal it and count on political opponents, in their turn, to respect majority rule.
King isn’t talking about the horrible performance to date of the health insurance exchange website. Technical products like that can be and will be repaired with enough time, money and effort. King is talking about the effect of the law on premiums, quality of care, access to care and taxes.
Built into King’s approach is the presumption that the citizenry will turn against the ACA once they’ve lived with it awhile. The actions of the government shutdown crowd demonstrate that they don’t buy into that presumption. Their actions say that they expect Obamacare to work pretty much as advertised, sooner or later. A coalition of right-wing activists, funded by some of the nation’s wealthiest people, doesn’t threaten to crash the global economy if it expects a health care finance law to crumble in short order because it is so bad.
You don’t try actuarial sabotage unless you understand that Obamacare’s effort to cover everyone affordably will succeed if the young and healthy are in the insurance pool. By urging the young not to buy insurance, these guys are showing they know how to break Obamacare, which is to say that they fear Obamacare will work if they don’t break it.
Their fears are justified. The Affordable Care Act will very likely succeed because it has set such a low standard for success.
For all of the talk about its complexity, Obamacare’s major provisions are pretty simple. Insurance companies have to cover everybody, and in return just about everybody has to have insurance. If you don’t have Medicare, an employer’s insurance or some other coverage, you can buy coverage for yourself and your family online. If you don’t have enough money to buy insurance without breaking the household budget, the government will help with tax credits or, in New Mexico and some other states, with Medicaid. Since many people have found that their insurance is just fine until they actually need to pay for care, the act also requires coverage to meet some minimum standards.
Anyone who has followed this issue knows that these concepts either originated in Republican-leaning think tanks or were supported by Republicans for years. Until Bill Clinton attempted to rescue the Democratic Party from its extreme left wing, Democrats seemed willing to settle for nothing less than a single-payer system. Significant opposition to Obamacare before it was enacted came from left-leaning groups demanding Medicare for all, the end of private insurance, or, at a minimum, a government-run insurance option to compete against private insurance.
Bill Frist of Tennessee, the former Republican leader in the Senate, said at the Domenici Public Policy Conference in Las Cruces last month that Obamacare is pretty consistent with Republican free-market principles but that its big problem is that it does nothing to control health care costs. He didn’t say then what would control costs, but he has argued elsewhere that a big step would be to end fee-for-service payment to health care providers. Fee-for-service payment gives providers incentives to deliver more care than is necessary and to waste money, and it provides no incentives to improve health care quality.
Eliminating private insurance, implementing a single-payer system like Medicare for all, or outlawing a payment system that physicians have found to be highly lucrative are all far more complicated and much harder to achieve than anything to be found in the ACA. Attempting any of that would have raised the bar substantially. Had Obamacare attempted any of that, Peter King’s approach would have been much more likely to work.