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Somewhere, a scandal

SoVaNow.com / November 20, 2013
After the endless hyperventilating over Benghazi, and Fast ‘N’ Furious, and Solyndra, plus whatever else Fox News has been hyping for the past five years, opponents of the Obama Administration finally have found a real scandal to sink their teeth into — the scandalously bad rollout of the Affordable Care Act, a.k.a. Obamacare.

But stop for a moment and ask yourself the question: When’s the last time a Washington scandal really amounted to all that much?

First, let’s acknowledge the obvious: the debut of the federal health insurance exchange, at http://www.healthcare.gov, has been unbelievably bad. It’s hardly an exercise in partisan hackery to insist that some folks should lose their jobs for botching the main job of the Affordable Care Act: to make health insurance accessible for the broad mass of Americans. The law is intended to overhaul an individual insurance market that can charitably be described as dysfunctional; the outcome was supposed to be policies that are more affordable, stable and reliable. Instead the country has been regaled with stories of people receiving insurance cancellation notices, or facing steep premium hikes, with precious little happening on the opposite end to demonstrate the law’s upsides. With would-be beneficiaries unable to navigate a balky website, is it any surprise that opinion would tilt against the ACA?

That all this should transpire after President Obama made the unfortunate pledge that people who like their insurance can keep it makes the situation all the uglier. (The Affordable Care Act leaves the world of employer-provided health insurance pretty much untouched, but the individual market is a different story). In the battle of anecdotes, the side that is able to tell the clear and compelling story wins. There have been innumerable tales of policyholders who’ve experienced sticker shock over the past few weeks — and while it’s not unusual for the so-called facts of their predicaments to fall apart upon closer inspection, it’s also true that nothing gets people’s attention quite like a quick hit to the pocketbook. The backlash has been swift, and consequential.

Yet so are the law’s benefits: the end of insurance industry discrimination against people with pre-existing conditions; the elimination of lifetime payout caps; the rule that allows young people up to age 26 to stay on their parents’ policies; and, most importantly, the general provision of health care to the uninsured. Yes, this last promise of the Affordable Care Act has been a sore disappointment thus far, owing to the failure to effectively design a system that brings together various federal agencies and insurance providers under a single, functioning website portal. Yet states that have set up their own health insurance exchanges (and websites) have reported better luck: California is nearing 100,000 enrollees, and states such as Connecticut and Kentucky report strong interest.

Then there are new enrollments in the Medicaid program, which has taken on added importance under Obamacare: roughly 400,000 Americans who previously had no coverage have signed up for Medicaid in the first two months. That’s a substantial victory for the Affordable Care Act, and one that could be greatly enhanced if GOP-controlled legislatures would temper their opposition to the state-by-state program expansion. (In Virginia, Gov.-elect Terry McAuliffe has vowed to press through the Medicaid expansion, the cost of which is borne almost entirely by the federal government, despite the stiff opposition of some General Assembly Republicans. Stay tuned).

At some point, likely around January 1, 2014, millions of people will come to see how the ACA directly benefits them, and the political scales should begin to even out regarding the law’s future. There’s no question about what the hostile opposition will do; one of the flaws of the act is the presumption that the various players involved — legislators, state regulators and insurance companies themselves — would act in good faith in making it a reality. (By now, it is well established that some reported instances of “rate shock” are nothing more than insurance industry attempts to sell customers on alternative policies that are not part of the new insurance exchanges, when these same people could pay less by purchasing price-subsidized coverage on the exchange. Chalk up the industry’s early success on this front as another unfortunate consequence of failing to get the website to work.) Assuming, however, that the functionality problems are resolved, and more people sign up, by this time next year the ACA will represent the new normal of the health care world — controversial, perhaps, yet essentially incontrovertible.

Until such time, cherry-picked horror stories and exaggerated claims will be coin-in-realm of the political debate over Obamacare. Last week, a Bracey reader, S. Juhasz, penned a Viewpoint letter that included the assertion that “On June 17, 2010, it was reported in the Federal Registry on page 34,552 that 93-plus million people will lose their health insurance!” Er, no. This is the interpretation offered by one conservative economist and writer, Avid Roy of Forbes magazine, who hasn’t exactly distinguished himself as an honest and reliable arbiter of information when it comes to health care. Roy’s biggest clunker was a recent Forbes column in which he dissed the cost of policies on the California health exchange by making comparisons to the teaser rates advertised on an e-insurance website. Two big problems here: first, only an idiot thinks those teaser rates will be available to anyone who has even the slightest medical issue. Second, Roy conveniently overlooked the impact that tax subsidies will have in lowering the cost of policies sold on the market exchanges. With subsidies included, many Californians (along with other moderate income earners across the U.S.) fare better with ACA-compliant policies than they would by shopping for junk policies on einsurance.com.

Indeed, the tax subsidies are the key to coaxing people to sign up for insurance under Obamacare — a family of four with a household income of $50,000 should be able to get solid coverage for around $250 a month, that is, once all the pieces of the system actually come together. Because this stuff is detailed and fairly complicated, it’s subject to endless misinterpretation and outright prevarication by Obamacare opponents. And to be fair, the law will invite suspicion and, in some cases, outright loathing until it can be made to work properly. But the ACA isn’t going anywhere, and any serious person who pretends otherwise isn’t really all that serious.

The real question is not whether the country will adapt to Obamacare — most people already are well along in that process — but whether Washington has the capability to mend problems that any complicated piece of legislation will inevitably create. One of the criticisms aimed at Obamacare is that the law demonstrates the utter futility of relying on the government as a vehicle for reform. This strikes me as basic nonsense, but it’s certainly true that the Affordable Care Act is much more complicated than a single-payer system like Medicare. Government programs that are simple in design tend to work best, and Medicare is surely a lot simpler than Obamacare. But that doesn’t mean the latter is doomed to failure, either.

People with long memories will recall that the basic concepts of Obamacare were first developed by the conservative Heritage Foundation in the 1990s, and the law was later successfully implemented in Massachusetts under then-Republican governor Mitt Romney. In his reform proposal for Medicare, Paul Ryan, the Wisconsin Republican and Romney ticket mate, has proposed creating an insurance exchange much like the ACA’s, while providing premium support — essentially, a system of tax vouchers much like that found with Obamacare — to help seniors purchase private insurance coverage. Among the supporters of the Ryan bill is Fifth District Rep. Robert Hurt, a fellow Republican. If Hurt and his ilk think Obamacare is such a disaster, why are they trying to foist it upon Medicare beneficiaries?

The scandal that has grown up around Obamacare is all about implementation, not about intent, which means it’s not really much of a scandal at all. It’s only in the cheap world of Washington that such things exist as fodder for point-scoring, rather than problem-solving. In all likelihood, the ongoing impact of the current controversy will be minimal; the ACA already has taken root in ways large and small, noticed and unnoticed, and altered the health care and political landscapes in ways that make a return to the status quo practically unimaginable. A prime example is the law’s ban on insurance industry discrimination against patients with pre-existing conditions: Republicans profess to support this change, but have yet to offer a viable way of paying for it. And that’s okay: the task of reforming America’s incredibly expensive, inefficient and capricious health care system is taking place right in front of their eyes. With luck, soon people will enjoy positive results from the change.





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