Tag Archives: ACA

The Tangled Web Politicians Weave

When three separate people send you an article, you read it.

That’s what happened to me; three readers of this blog evidently live in or around Florida, and independently emailed a link to this column from the Palm Beach Post.

Here are the pertinent sections:

 The challenge to the Obamacare law was aimed at declaring it unconstitutional. While that didn’t work, foes of the new law were given a small consolation prize by the U.S. Supreme Court — a chance for the states to opt out of the expansion of Medicaid under the new law.

Florida, like 23 other Republican-run states, hung onto that thread and waved it around like a victory flag.

“For all of those who are about fiscal sanity and protecting the taxpayers of our states, the court’s decision on the Medicaid issue was a big win,” Florida Attorney General Pam Bondi said two summers ago at an event sponsored by the Koch-brothers group, Americans for Prosperity.

It certainly wasn’t a “big win” for the estimated 750,000 Floridians who have incomes that fall below 138 percent of the federal poverty wage, which is about $26,000 for a family of three and $15,000 for an individual.

Not only did Florida refuse to accept an expansion of Medicaid that would have used federal dollars to cover health-care costs for these people, but the state did its best to make it as difficult as possible for the rest of Florida’s 3.8 million uninsured residents to purchase plans under the new health-care law.

Umm…Hoosiers, does this sound familiar?

The state refused to set up an insurance exchange, spent no money to encourage citizens without medical insurance to sign up for the plan, and banned federal workers from helping Floridians sign up for insurance at county health departments. Even so, Florida led the nation with sign-ups for Obamacare plans, accounting for nearly 1 million insured state residents……

The state is losing $66.1 billion in federal Medicaid funding over the next 10 years, costing hospitals in the state $22.6 billion in lost reimbursements, the Robert Wood Johnson Foundation reported.

No other state has turned its back on so much money, the foundation found. If Florida invested $5.3 million in Medicaid expansion from now until 2022, it would get back $13.41 in federal funds for every dollar it invested in its citizens’ health care, the report said.

“Every comprehensive state-level budget analysis of which we know found that expansion helps state budgets, because it generates state savings and additional revenues that exceed increased Medicaid costs,” the report said.

Not to mention helping people like Charlene Dill, 32, a working mother of three from Central Florida. Dill died earlier this year from a lingering heart condition.

She worked a variety of part-time jobs and was selling vacuum cleaners when she collapsed and died. Dill couldn’t afford health insurance, but she would have been covered under Medicaid if Florida had expanded it under the law. But unlucky for her, she lived in a state that put her on the losing side of a “big win.”

How do you calculate that cost?

I have watched Republican governors tie themselves into pretzel-shaped knots trying to explain their hysterical opposition to a program originally developed by conservative think tanks and promoted by GOP leaders like Bob Dole and Mitt Romney (pre-presidential campaign). I’ve been amazed by the governors’ willingness to forgo billions of  dollars for their states–not to mention their willingness to let uninsured citizens continue to die–in order to deny President Obama a “win.”

(As Americans have begun to use the program, and warmed to it, some of those Republican governors have begun back-tracking. Indiana’s Governor is a case in point–his version of Medicaid expansion isn’t as inclusive as the real thing, but it’s a start.)

Here’s the thing. I’m one of many people who don’t think the ACA is particularly good public policy, although it is demonstrably better than nothing. If these naysayers proposed a better approach, I think a lot of us would consider it. Instead, we’ve been treated to a particularly ugly expression of high dudgeon–how dare the government use tax dollars to provide medical care to these worthless “takers”? 

I know that everything these days is politics, but shouldn’t there be some games even politicians won’t play?


I Love It When I Turn Out To Be Right…

Way back in 2000, I wrote a column listing all of the reasons the U.S. should reform health insurance. I was advocating adoption of single-payer (Medicare for All), and I still believe that would have been the simplest and most effective policy–but politics, as we all know, is the art of the possible, and single-payer wasn’t going to fly.

I had a long list of benefits I predicted would flow from universal access to healthcare. Down in the “and also” part of that list was the following:

Individuals would save money. Auto and homeowners insurance premiums would decline, because the underwriting would no longer need to take the costs of medical care into account.

Researchers are now investigating the actual costs and savings attributable to the Affordable Care Act (as opposed to the political talking points and hype). Rand has just issued one such study:

The Affordable Care Act may result in lower automobile insurance rates according to a study conducted by David Auerbach and colleagues at the RAND Corporation that was published on April 9, 2014.

Auto insurance providers pay for some or all medical injury claims that are sustained in automobile accidents in the United States depending on the terms of the policy. The dollar amounts involved are based on an analysis of the amounts that all U. S. auto insurance providers paid for automobile injuries in 2007. The total was $35 billion.

The entire cost of auto injury health care will be taken over by health insurance providers according to the terms of the Affordable Care Act.

I told you so.


An Important Clarification

In a recent column in the Pittsburgh Post-Dispatch, Duquesne Law professor Bruce Ledewitz makes an important point about the Affordable Care Act and contraceptive coverage –a point that has gotten lost in all the language of victimization and self-righteousness: religious institutions are not required to provide contraception and other objected-to medical coverage under the Affordable Care Act. Instead, the religious institution is required only to forward a list of its employees to its insurance carrier, which must then provide the coverage itself if the employees want it, without cost to the employer.

That, boys and girls, is what has given rise to the assertion that the employers’ religious liberty is being violated–or “burdened” excessively, to use the terminology of the Religious Freedom Restoration Act (RFRA). RFRA was passed in response to a series of Supreme Court decisions rejecting claims that obedience to laws of general application–laws against drug use, zoning and historic preservation laws and the like– shouldn’t apply in situations where they prevented people from acting on their religious beliefs. (For example, the Court held that Native Americans could believe in smoking peyote as part of a religious ritual, but they couldn’t act on that belief.)

As Ledewitz notes, the claim that having to send a list to your insurance carrier “burdens” your religious exercise strains credulity.

To see how extreme this position is, imagine that the Obama administration had offered yet another compromise: that the religious institution need only offer a list of its employees to the government and the government would provide health insurance ecoverage. If religious employers had really wanted to compromise, they could have lobbied for this option. But, undoubtedly, they would have objected even to this requirement…..

Even closely held for-profit corporations have claimed exemption under RFRA, as if these corporations had religious consciences. The owners of these corporations assert that their corporations are alter egos of their human shareholders, when, in fact, the whole point of the corporate form is to shield the shareholders from the debts of the businesses. When it comes to money, the corporations and the owners are quite separate.

RFRA was never intended to operate in this maximalist fashion. Under the free-exercise-religion claims that RFRA replaced, religious plaintiffs usually lost their cases against the obligations of generally applicable laws. And even today most religious believers find ways to compromise with government programs and requirements with which they disagree. Catholic judges, for example, for years have granted divorces, even to Catholic couples. These judges have not asked for exemptions in these cases.

But instead of compromise and goodwill, the Affordable Care Act has provoked overheated rhetoric and over-the-top objections on the part of religious institutions and individuals, many of whom opposed the act from the beginning and are now continuing their political campaign in the courts.

Commentators have noted the hypocrisy of Hobby Lobby’s assertion of religious objections–it happily does business in China despite that country’s one child policy and forced abortions. Given the tenuous connection of employers to contraceptive coverage availability under the Obama administration compromise, it’s abundantly clear that the objections are motivated by politics, not religion.
But even if the objections were sincere, where would it stop? If your religion teaches that women are to be submissive, can you be exempted from compliance with EEO regulations? If your theology holds that blacks are inferior (as Mormon teachings did until the late 1970s), can you ignore civil rights laws? As Ledewitz warns,
 If RFRA really means what the plaintiffs in the Affordable Care Act litigation claim that it means — that religious believers are free to invoke the protections of the act no matter how minuscule their legal obligations appear to be and despite a commercial and even profit-making context — then RFRA is unworkable and will inevitably be repealed. If that occurs, religious believers will have inadvertently undermined the very religious liberty that they now invoke and that America rightly prizes.

American law has made numerous concessions to religious belief, but this is a bridge too far. As the old saying goes, pigs get fed–but hogs get slaughtered.

Politics Trumps Both Compassion and Common Sense

Apparently, common sense is fairly uncommon, and compassion is just a word in the dictionary.

The Dallas News recently reported that Texas’ refusal to expand Medicaid and participate in the Affordable Care Act (aka “Obamacare”) will cause individual health insurance premiums to rise a whopping 9.3%.

The Texas Observer reports that Texas will not only leave 100 billion dollars “on the table,” but the decision will cause a raise in local property taxes. (The burden of emergency medical care generally falls on property taxpayers in Texas–just as it does in Indiana. When people take Mike Pence’s advice and get their “access to care” through the Emergency Room, property taxpayers pay for that unnecessarily-expensive care. )

Fiscal stupidity is one thing. Essentially telling poor people to f**k off is another.

Nearly 7 million adults ages 19 to 64 would qualify for Medicaid in the 25 states that have not voted to expand it, according to an Urban Institute report. Those 7 million people won’t get Medicaid and they won’t get federal help to buy health insurance.

The refusal to expand Medicaid won’t “defund” the Affordable Care Act, or change any of its provisions. The only “message” it will send to Washington is “we’ll show you–we’ll hurt ourselves!”

The bottom line: Rick Perry, Mike Pence and other Republican governors care more about obstructing Obama than about the health of their economies or their citizens.

That’s politics these days. And it’s not only stupid, it’s despicable.


Excuse Me While I Hit Myself Repeatedly with a Hammer….

A recent post at Maddowblog began with the following observation:

Since so much of the public has no idea what the debt ceiling is, what default is, what bond markets are, or what the full faith and credit of the United States means, polling on the subject just doesn’t tell us much.

The post went on to describe a different sort of poll that proved the point; it asked about the debt ceiling, but phrased the same question two different ways. When asked simply whether Congress should raise the debt ceiling, respondents were pretty evenly split. The second version asked whether Congress should prevent the government from borrowing money in order to pay its debts;  73% of those responding to the question when it was posed that way said such a step would seriously harm the economy, and opposed it. Only 22% approved.

The American people aren’t stupid. When the question is asked using language citizens understand, they resoundingly offer the right answer. The lesson of this–and multiple other examples–is twofold: (1) the public is generally unfamiliar with the language of its own government, with many equating “raising the debt ceiling” with incurring new debt; and (2) polls that politicians reference to “prove” that the American public is on their side of an issue tend to be worthless and/or deceptive.

Thanks to their own extremism and lack of elementary economic knowledge, the Tea Party zealots who have captured one of America’s major parties and the House of Representatives are poised to do substantial damage to the people they have been elected to represent.

Pundits from both Left and Right (even Karl Rove!) predict that the government crisis they are determined to precipitate will create a backlash that can only hurt the GOP, but those warnings are falling on deaf ears. As a friend of mine used to say, you can’t reason someone out of a position they didn’t reason themselves into.

The broad, sane middle of the American public will need to batten down the hatches and prepare for a totally unnecessary period of fiscal and economic misery–brought to us by people motivated by one and only one “principle”–ensuring that thirty million Americans currently without health insurance don’t get access to healthcare.

And to make sure they don’t, they’re willing to plunge the country into another recession.

Excuse me while I go hit myself some more with that hammer….