Extremist elements in Congress are preventing reasonable solutions to real problems.
By Andy Cohen
The Affordable Care Act—pejoratively known as “ObamaCare” until its namesake took ownership of it—is happening, despite the best efforts of the law’s opponents to stop it. On October 1, the heath care exchanges set up either by the individual states or by the federal government will begin selling health insurance policies, and there doesn’t seem to be anything that the opposition can do to stop it.
The law is hardly a perfect one, much like Social Security and Medicare before it—social safety net programs that were likewise met with open hostility yet have become a part of the bedrock of American society—nor is it the ideal solution that many Americans would like to have seen enacted. But, as many would argue, and reasonably so, it was the best we could do under the circumstances, and there is always room for improvement. Start with a foundation and make it better as we go along, just like with Social Security and Medicare.
The basic premise of ObamaCare is a simple one: Provide health coverage to the nearly 40 million Americans currently without it; make healthcare something more akin to a right rather than a privilege reserved for those who can pay for it. But while the law falls short of that goal, it does expand coverage to a projected 30 million people. It does this in two ways: Create health insurance exchanges on a state-by-state basis, and provide income based subsidies to ease the sticker shock of purchasing insurance.
The second method is by expanding Medicaid eligibility to those earning up to 133% of the federal poverty level, including single adults with no families (formerly ineligible for Medicaid—or MediCal in California). In the first year, the federal government will pick up the entire cost of the expansion, covering 90 percent of the cost thereafter. It is estimated that if every state implemented the Medicaid expansion, an additional 21.3 million Americans would gain health coverage by 2022 that would not be eligible without ObamaCare.
There are portions of the law, however, that even supporters vehemently disagree with. “The medical device tax is a terrible idea,” said Congressman Scott Peters in an interview with the SDFP. “You don’t ever tax the business people like that on an excise basis—which is not profits—to a point where it could drive away jobs in San Diego.”
He also says that the “Cadillac excise tax” is “a little bit too broad.” Instead of taxing the truly comprehensive, gold plated insurance plans as was intended, Peters says that it will end up affecting nearly 50% of plans, including those of middle class workers. Many unions have come out against this portion of the ACA, as it will end up taxing union healthcare benefits that are governed by the Taft-Hartley Act, which, in part, allows employers to combine into a large insurance pool in order to lower the cost of covering their employees. Some union leaders, in fact, have called for the complete repeal of ObamaCare because of it.
“If the Affordable Care Act is not fixed and it destroys the health and welfare funds that we have fought for and stand for, then I believe it needs to be repealed,” said Terence M. O’Sullivan, the president of the Laborers International Union of North America to the New York Times. But, he said, “We don’t want it to be repealed. We want it fixed, fixed, fixed.”
Put Peters in the “fix it” category, too. While he is a supporter of the law, he readily acknowledges that there are some shortcomings; it’s a work in progress, he says. “I wasn’t there when they passed this law” he said. “But it was passed by Congress, signed by the President, and survived a Supreme Court challenge, and it’s survived 30 or 40 votes to repeal it. So it’s the law of the land, and our job is to make it work.
“If I don’t make it work, that’s where you should criticize me,” he says.
One of the problems, he notes, is that not all states are taking the law seriously and are not willing to participate. This has hampered the development of the insurance exchanges. Another problem, he said, is that some of the smaller states will not see the kind of results in their exchanges that more heavily populated states like California and New York have: New York has seen its insurance rates reduced by 50 percent through its exchanges, with Californians likely to see up to a 29 percent drop in rates.
One solution, Peters says, is to allow the purchase of insurance plans across state lines, but not in the way conservatives advocate. Instead, smaller, less populated states should be allowed to form regional exchanges, all following the same rules for coverage, combining the populations of several states to take advantage of economies of scale; more people and more competition in the exchanges equals lower costs.
Locally, Peters’ office is combining efforts with the San Diego Regional Chamber of Commerce to conduct outreach efforts to inform members of the small business community about what ObamaCare means to them and how it will affect them heading into 2014. Together, they brought in representatives of the Small Business Administration for a seminar with Chamber members. “I think it was productive,” said Peters.
“The forum with Congressman Peters was a good opportunity for businesses to get clarity and guidance on how to implement some of the new Affordable Care Act regulations. These types of events are important, which is why the Chamber is hosting a series of workshops to help businesses—smaller businesses in particular—navigate the new healthcare reforms,” said San Diego Chamber of Commerce president and CEO Jerry Sanders in a statement.
Asked how it’s possible to overcome repeated efforts to repeal and/or defund the law in Congress by Republicans: “They’ve made a bad bet. What’s going to happen in California and New York is the stupid plan’s going to work. That’s their problem. Then what’s Texas going to say? They’re going to ask why you are being so resistant to what’s done so well in California? Because there are ways to make it work.”
“I suspect they’re getting more and more desperate that this is going to turn out better than they said.”
Peters says that his vote to delay the enforcement of the individual mandate was about fairness given that the Obama Administration had already decided to delay the coverage penalties on businesses. “It’s hard to say that you’re going to delay the penalty for businesses and not give a break to individuals.”
“The other thing,” he said, “is that we’re still setting up the exchanges, we’re still setting up these competitive plans where the numbers are coming in well. I don’t mind letting it go another year without a penalty and seeing how it does. I have enough confidence—at least in California—that it’s going to work.”
Still, our national government is going to remain gridlocked—particularly on healthcare—as long as the fringe elements of the Republican Party remain in control of the agenda. “The Tea Party has the place locked up.” He says that there are people of “good will” that would like to work together, particularly among the freshmen in Congress. But “you have those 60 or 80 (Tea Party members) who just don’t seem to care if anything happens at all. But then the rest of the Republicans are scared of these challenges from the right. So you have these districts that are rated very Republican districts where a Democrat will never get elected,” where more reasonable Republicans are susceptible to defeat from extremist elements if they don’t play along by their rules, he says.
“What we need to do is to reward good behavior and punish bad behavior.” One answer, he said, is to defend the more moderate Republicans in the more conservative districts from the Tea Party challengers; defend members who “are trying to do the right thing” from the extreme elements, which he says would allow for more cooperation and compromise, and eliminate some of the gridlock currently plaguing Congress.