The War on Healthcare

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Obamacare

First of all, it's bizarre that they would oppose it[1]. Obamacare is heavily based on a plan put together by a right-wing think-tank (the Heritage Foundation), which was implicitly endorsed by Mitt Romney (R) when he implemented a very similar plan while governor of Massachusetts (aka Romneycare).

That "conservative" plan was apparently acceptable, and yet Obamacare (in Republican eyes) was comparable to fascism. One might think that they could at least have identified the points of discrepancy between the two plans which made this difference, and campaigned to amend Obamacare to address these differences – but that would have meant caring about facts, and Republicans over the past decade have made it abundantly clear that they do not.

Not only did they vehemently oppose Obamacare, flatly and without qualification or compromise and often using false descriptions (e.g. "job-killing"), but also went to bizarrely extreme and yet completely ineffective measures to fight it – voting for its repeal fifty times, long after there was any chance of getting it past Obama's veto, going against their own claims of fiscal conservatism by wasting billions of dollars of taxpayer money towards this effort, and opposing both the will and needs of their constituents.

Since they couldn't remove it (despite numerous challenges on Constitutional grounds[2], they looked for ways to make it even less effective for everyone, both in fiscal terms (so much for Republican fiscal conservatism, yet again) and in terms of serving the public – and unfortunately they succeeded, via those "unelected legislators" in the Supreme Court who made one of their worst decisions of recent years[3] in allowing individual states to reject the Medicaid expansion which was an integral part of ensuring universal coverage under Obamacare.

This allowed individual states to reject the Medicaid expansion portion of Obamacare, leaving those with incomes too low to be able to benefit from tax rebates[4] yet too high to qualify for Medicaid (a threshold which seems to be somewhere in the negative numbers) to pay the full price out of pocket – which is still pretty expensive even with a reasonable income, and simply impossible at the levels of income which should have been covered by the Medicaid expansion.

...and of course many Republican-led states did, in fact, reject the Medicaid expansion – to the benefit of absolutely no-one.

  • Florida Governor Rick Scott (R) declined the Medicaid expansion – and Florida is now suffering financially as a result.[5] Scott then purportedly changed his mind in 2013, citing his recently-deceased mother as justification, at which point he applied for a federal waiver for privatizing Florida's medical system. Once the waiver was granted, he reversed his position and once again opposed the expansion – effectively "lying on his mother's grave".[6]
  • Georgia Governor Nathan Deal (R) rejected the Medicaid expansion, falsely emphasizing the supposed cost to the state.[7]
  • Idaho Governor Butch Otter (R) rejected Medicaid expansion, claiming that Idaho's Catastrophic Health Care fund does a better job and calling Obamacare "misguided".[8]
  • Louisiana Governor Bobby Jindal (R) rejected the Medicaid expansion, making the usual raft of dysconservative arguments.[9] His replacement, John Bel Edwards (D), promptly announced that he would be reversing this policy.[10]
  • Maine Governor Paul LePage (R) vetoed LB-1066, which would have accepted the Medicaid expansion, citing (once again) the cost.
  • Mississippi Legislature Republicans not only blocked the Medicaid expansion but strongly resisted even considering an alternative plan proposed as a compromise by Democrats.[11]
  • Missouri not only declined to expand Medicaid or establish a health insurance marketplace, but also began an active program of non-cooperation by enacting a statute forbidding any state or local official to render any aid not specifically required by federal law towards the functioning of the Affordable Care Act and requiring insurance counselors to get state licenses before they can help consumers navigate the new insurance market. (Again, so much for being against "big government interference".) State Senator Rob Schaaf (R) implicitly reiterated the false claim that implementing the expansion would cost the state money.[12]
  • Nebraska: the Republican-dominated State Legislature filibustered the Medicaid expansion in 2013 and 2014, despite majority support for it[13] and voted at least three times to reject the expansion in 2015 alone.[14]
  • North Carolina's Republican-led General Assembly passed a bill banning Medicaid expansion. Governor Pat McCrory (R) signed the bill and declined to establish a health insurance marketplace.
  • Oklahoma Governor Mary Fallin (R) rejected the expansion, apparently without cause.[15]
  • South Carolina's Republican-dominated State House declined the expansion, opting instead to spend $80m of state money to expand a "hospital incentive program". Governor Nikki Haley (R) praised the decision and repeated a bit of right-wing dogma in support: "If history has proven anything, it's that there is no such thing as a temporary entitlement program."[16]
  • Tennessee's State Senate has so far failed to pass Medicaid expansion, despite support from Governor Bill Haslam (R).[17]
  • Texas Governor Rick Perry (R) and the Republican-majority state Legislature rejected both the expansion and the insurance exchanges as "brazen intrusions into the sovreignity of our state", describing Obamacare as a "power grab" and Medicaid as "a broken system that is already financially unsustainable [...] a system of inflexible mandates, one-size-fits-all requirements, and wasteful, bureaucratic inefficiencies" but did not offer any suggestions for a better system.[18]
  • Utah: Much as in Tennessee, State House Republicans rejected Medicaid expansion despite support from Governor Gary Herbert (R)[19]
  • Virginia's Republican-dominated State House has so far rejected all expansion proposals.[20]
  • Wisconsin Governor Scott Walker (R) rejected Medicaid expansion, advocating an alternate plan.[21]
  • Wyoming's Republican-dominated State Senate voted down a bill which would have expanded Medicaid.[22]

The Expense Myth

A major part of the Medicaid expansion under Obamacare was that the federal government would basically pay all expenses for three years starting in 2014 and no less than 90% of the added expenses in subsequent years. In other words, the expansion costs are minimal and deferred, and basically a huge bargain for the states which accept it.

The Rising Premiums Canard

Another frequent claim against Obamacare is that health insurance premiums have gone up since it was imposed. These claims tend to ignore two important things:

  • Health insurance premiums were going up a lot more before Obamacare. They have continued to go up, but not quite as fast as before.
  • Many of the insurance plans available before Obamacare were basically chrome-plated plastic junk -- the insurance equivalent of snake-oil. If you make a claim of any size, they cancel your insurance ("rescission")-- no matter how many thousands of dollars you had already paid in, even if it was more than enough to cover the claim and make a profit for the insurer. Obamacare outlawed junk insurance, so naturally the insurance companies "had to" raise rates when they were no longer allowed to sell you a stack of unenforceable paper and call it "insurance".

Footnotes

  1. ...except, of course, as part of their strategy of being against anything Obama supports, no matter how much it might align with the Republican platform.
  2. See Wikipedia: Constitutional challenges to the Patient Protection and Affordable Care Act
  3. See Wikipedia: National Federation of Independent Business v. Sebelius
  4. You can't get an income tax rebate if you don't owe any income tax. If your income is high enough to pay some income tax but not very much, even a full refund will only make a dent in the price of health insurance.
  5. 2015-05-08 The Atlantic Florida Struggles to Pay the Tab for Rejecting Obamacare
  6. 2015-05-18 The Week: Rick Scott lied on his mother's grave – and blew a hole in the GOP's anti-ObamaCare argument
  7. 2013-01-17 Office of the Governor: Deal speech: 'Free' health care will cause a crunch
  8. 2013-01-07 Office of the Governor: STATE OF THE STATE AND BUDGET ADDRESS
  9. 2013-07-23 The Times-Picayune [http://www.nola.com/opinions/index.ssf/2013/07/gov_bobby_jindal_why_i_opposed.html Gov. Bobby Jindal: Why I opposed Medicaid expansion
  10. 2016-01-14 Los Angeles Times: Obama celebrates expansion of Obamacare in Louisiana
  11. 2013-06-28 MSNBC: Mississippi lawmakers save Medicaid, but GOP blocks expansion
  12. 2013-08-03 The New York Times: Missouri Citizens Face Obstacles to Coverage, via Wikipedia
  13. 2013-06-04 Omaha.com: 22 Nebraska senators pledge to keep fighting for Medicaid expansion
  14. 2015-04-08 Associated Press via Washington Times: Nebraska Medicaid expansion proposal defeated once again
  15. 2013-09-26 The City Sentinel: As allies send nuanced messages, will OK Gov. Mary Fallin stick to her guns on Medicaid expansion?
  16. 2013-03-12 Independent Mail: S.C. House Republicans reject Democrats' effort to expand Medicaid program
  17. 2015-02-07 The Tennesseean: Insure Tennessee's swift failure surprises Haslam Warning: auto-play video
  18. 2012-07-19 Office of the Governor: (letter to) The Honorable Kathleen Sebelius (PDF)
  19. 2014-10-14 The Hill: ObamaCare Medicaid expansion dies in Utah
  20. 2014-12-15 The Washington Post: Virginia Gov. McAuliffe to renew push to expand Medicaid
  21. 2013-02-14 Wisconsin State Journal: Scott Walker rejects Medicaid expansion, proposes alternate plan to cover uninsured
  22. 2015-02-06 Reuters: Wyoming Senate rejects Obamacare Medicaid expansion

Further Reading