The Republican turn against universal health insurance

AlterNet: 10 Reasons Most People Like Obamacare Once They Know What’s Really In It

There are two Affordable Care Acts. There’s the legislation passed by Congress in 2009, and then there’s the mythical Affordable Care Act – the perfidious “government takeover” decried and demagogued by so many conservatives (and quite a few liberals). The former is quite popular, the latter gets decidedly mixed reviews.

Don’t take my word for it. A recent poll by the Kaiser Family Foundation found Americans split down the middle, with 41 percent approving of the law, and 40 percent saying they didn’t like it (PDF). But then Kaiser asked about 12 specific provisions in the legislation, and found that, on average, 63 percent of respondents approved of the nuts and bolts of Obamacare. Of the 12 measures they tested, only one – the controversial mandate to carry health insurance or pay a penalty – received the approval of less than half of Americans (35 percent).

Or consider this divide: while only 12 percent of Republicans had a positive view of the law overall, 47 percent, on average, viewed its specifics favorably.

Follow the link to read the ten reasons…

Ezra Klein: No, ‘Obamacare’ isn’t ‘the largest tax increase in the history of the world’ (in one chart)

No, ‘Obamacare’ isn’t ‘the largest tax increase in the history of the world’ (in one chart)

Since the Supreme Court decision, Republicans have been calling the Affordable Care Act “the largest tax increase in the history of the world.” Politifact rates this false. Kevin Drum’s got a table of the 15 significant tax increases since 1950, and the Affordable Care Act, which amounts to a tax increase of 0.49 percent of GDP, comes in 10th. Austin Frakt took Drum’s table and made a chart:

So no, the Affordable Care Act isn’t the “biggest tax hike in history.” It’s not even the biggest tax hike in the past 60 years. Or 50 years. Or 30 years. Or 20 years.

Federal Government Will Pick Up Nearly All Costs of Health Reform’s Medicaid Expansion — Center on Budget and Policy Priorities

Claims that states will bear a significant share of the costs of the Affordable Care Act’s (ACA) Medicaid expansion — and that this will place a heavy financial burden on states — do not hold up under scrutiny. Congressional Budget Office (CBO) analysis indicates that between 2014 and 2022, the ACA’s Medicaid expansion will add just 2.8 percent to what states spend on Medicaid, while providing health coverage to 17 million more low-income adults and children. In addition, the Medicaid expansion will produce savings in state and local government costs for uncompensated care, which will offset at least some of the added state Medicaid costs.

Pa. Director Of Doctors For America Discusses Health Care « CBS Pittsburgh

I will immodestly say I did really well on this show. Mike is a very fair host and always nice to me.

I also did WESA’s Essential Pittsburgh yesterday, June 28:

http://www.essentialpublicradio.org/story/2012-06-28/affordable-care-act-decision-doctors-perspectives-11596

Cheers,

Obama Health Law Seen Valid, Scholars Expect Rejection – Bloomberg

The U.S. Supreme Court should uphold a law requiring most Americans to have health insurance if the justices follow legal precedent, according to 19 of 21 constitutional law professors who ventured an opinion on the most-anticipated ruling in years. Only eight of them predicted the court would do so.

The Ryan proposal compels Americans to buy insurance—just like Obamacare does. – Slate Magazine

Ryan’s roadmap would reshape Americans’ access to health insurance mainly through two provisions, both of which pressure people to purchase private health insurance to an extent and through mechanisms that are materially indistinguishable from the supposedly toxic Obamacare mandate. One of these Ryan proposals—as yet little noticed by pundits or politicians—is almost an exact copy of a provision in the Affordable Care Act. * It would repeal the current exclusion from employees’ income of employer contributions to their health insurance premiums, thus terminating the subsidized employer-sponsored group health regime that covers nearly 60 percent of all Americans. In its place, the Republican plan would substitute a refundable tax credit, to be provided to individuals who purchase health insurance (or to employers who purchase health insurance for their employees). When this new arrangement takes effect in 2022, the tax credit would be set at $2,300 per adult and $1,700 per child, not to exceed $5,700 per family.

Like this Ryancare tax incentive, the “individual mandate” section of the ACA, which the White House calls the “individual responsibility” provision, constitutes a pay-or-play option. Beginning Jan. 1, 2014, when the ACA provision takes effect, individuals who do not qualify for exemption on hardship or other specified grounds, must either carry health insurance or pay a tax penalty as part of their annual income tax filing. The ACA caps individuals’ penalty liability at 2.5 percent of household income above the filing threshold, or a flat dollar amount ranging from $695 to $2,085, depending on family size.

Under both provisions, the result is the same: People who choose to carry health insurance have a lower tax bill than they would if they chose not to. In terms of their respective potential impact on individuals’ bank accounts and tax liability, the manner in which they affect individuals’ financial incentives, and hence the constraining effect on individuals’ financial choices to either buy or forgo health insurance, the two “mandate” provisions are identical. (Indeed, in most cases, the financial difference for the individual taxpayer made by the Republican tax credit would be greater—i.e., more “coercive”—than the ACA tax penalty.)

Eleven Alternatives to Obamacare’s Individual Mandate – Businessweek

The short version:

1. Relabel the mandate to escape the high court’s scrutiny. Give people a tax credit if they do carry insurance, which is functionally the same as penalizing them if they don’t. Sound like a sly evasion? It’s essentially the approach advocated by House Budget Committee Chairman Paul Ryan.

2. Increase subsidies, such as the law’s existing set of tax credits for low-income Americans, to induce more people to sign up voluntarily. This would be along the lines of the enticements in Medicare Parts B (doctors’ and outpatient services) and D (prescription drugs).

3. Use government funds to compensate insurers for the cost of “adverse selection,” in which only sick people sign onto their plans.

4. Have the government and/or employers enroll people into health plans automatically, but with an option to drop insurance. Count on inertia and procrastination to keep them in the system.

5. Require people who go without insurance to sign a form acknowledging that they won’t be able to get back in for five years, even if they have an accident or contract a costly disease and want to get covered right away.

6. Leave it to the 50 states to enact their own mandates under state law, which would not be subject to Supreme Court review.

7. Penalize people who delay enrolling. Charge them more or strip them of the right to buy insurance at a standard rate regardless of preexisting conditions. There’s a precedent in Medicare: People who enroll in Medicare Part B after age 65 pay a 10 percent penalty on their Part B premium unless they have employer-provided health insurance.

There are more, but these are the more reasonable ones…

Money or Your Life – NYTimes.com

Critics of the Affordable Care Act argue that many Americans neither want nor need health insurance, and that it forces them to pay for coverage against their will. But just as the government collects taxes to pay police officers and firefighters, the individual mandate compels Americans to pay for a service they may not immediately want but could at any time desperately require.

Much of the debate has focused on the role of government in everyday life. I don’t discount the value of that question, but my focus is on real needs. I treat patients with $20,000 chemotherapy injections or monthly doses of IV immunotherapy that cost $10,000 a bag. If they don’t receive these drugs my patients will die, so to me, the most pressing issue here is compassion. Without change, the patients will resemble the man with leukemia, human beings without insurance terrified that their lives aren’t worth what it will cost to save them, all because of a broken but fixable system.

Crowds at conservative rallies have, astoundingly, cheered the idea that uninsured people should, if they become ill or badly hurt, be left for dead. It’s easy to imagine such a thing in the heat of a rhetorical moment. But the reality is, I hope, harder to embrace. Because reality means a real person — you, me, someone we know — condemned to a possibly preventable death because, for whatever reason, they don’t have insurance.

My patient with leukemia is dead. He got the best care money could buy, but his disease only briefly went into remission and he went home on hospice care. Should he, because he did not buy insurance, have been denied this chance for a cure?

The Affordable Care Act is not the health care solution everyone wants, but when patients wish for death panels as a response to leukemia, something needs to be done, and soon. This plan would help any patient facing a tough diagnosis not view treatment as a choice between his money or his life.

Theresa Brown is an oncology nurse and the author of “Critical Care: A New Nurse Faces Death, Life, and Everything in Between.”

I have had similar discussions with those who are not in healthcare as their profession. They cannot seem to see the distinction between cutting people off who did not buy insurance, for whatever reason, and actually carrying out this virtual death sentence. We, as medical professionals, just cannot do this. Therefore, we need to figure out how to have universal access to care and universal insurance coverage. ObamaCare is a very good start.

Sorry, The CBO Did Not Say Health Reform Kills 800,000 Jobs | The New Republic

From Jonathon Chait on the “job killing” myth:

Other provisions in the legislation are also likely to diminish people’s incentives to work. Changes to the insurance market, including provisions that prohibit insurers from denying coverage to people because of preexisting conditions and that restrict how much prices can vary with an individual’s age or health status, will increase the appeal of health insurance plans offered outside the workplace for older workers. As a result, some older workers will choose to retire earlier than they otherwise would. (CBO)

In other words, people who are only working because they desperately need employer-sponsored health insurance will no longer do so. They’re not going on the public dole — they’re just people who have the means not to work full-time and will be free to make employment decisions that aren’t premised upon an individual health insurance market that shuts them out. Some workers will choose to retire early because they now have the ability to buy their own health insurance. This is what Republicans call “destroying jobs.”

Now, CBO does show a very minor effect of higher taxes discouraging the work incentive. But this is a very small portion of what is a fairly small effect to begin with. Basically the analysis shows the effect of giving workers with preexisting conditions access to a health care system that doesn’t lock them into the employer-provided system. Apparently, in the conservative view, being chained to your desk at some big company until you’re 65 and unable to retire or start your own business because the individual market is rife with adverse selection is defined as “freedom.”