With the Supreme Court having upheld the constitutionality of the Affordable Care Act (“ACA”), the majority of Americans have made clear that they want to move beyond the debate over health care reform and let the law be implemented. Republicans, however, have apparently not gotten the message, as they have continued their incessant and unfounded attacks on the ACA. For example, we have witnessed:
* 31 House Repeal Votes: House Republicans took their 31st vote since January 2011 to repeal, defund, or dismantle health care reform, with no proposal to replace any of the significant benefits of the law. All 31 votes were, of course, pointless as repeal legislation would not pass the Senate or, even if it did, it would be vetoed by President Obama. Yet House Republicans continue to hold these votes, with one GOP Congresswoman Marsha Blackburn saying that she wished the House would vote to repeal the ACA every day.
* Rejection of Medicaid Expansion: At least four GOP-run states – Texas, Louisiana, South Carolina, and Florida – have announced that their states will not accept the expansion of Medicaid provided for as part of health care reform, even though the federal government would be picking up 100% of the cost from 2014 through 2016, 93% of the cost for 2014 through 2022, and 90% of the cost thereafter. Under the ACA, Medicaid is to be expanded to cover people whose income is up to 133% of the poverty line, and the increase in coverage is expected to save states billions of dollars by reducing spending on uncompensated care. Yet these GOP-run states are proposing to forgo these benefits, even as those states have some of the highest rates of uninsured people in the nation.
* Refusal to Set Up Consumer-Friendly Health Insurance Exchanges: A number of Republican-led states, such as South Carolina, Georgia, Texas, Florida, Wisconsin, Ohio, Louisiana, and Oklahoma, are refusing to or delaying the set up the health-insurance exchanges (through which consumers who are not covered by the government or through businesses with more than 50 employees can purchase coverage). While the ACA provides that the federal government will create health care exchanges in states that fail to do so, conservatives are now arguing that people living in states without state-created health care exchanges will not be eligible for the tax subsidies that the health care reform law provides to make insurance affordable for families earning under $88,000 per year. We’ll have more on this topic in a future post.
* A Quarter-of-a-Billion Dollars in Anti-Reform Spending – Conservatives have spent approximately $250 million on advertising attacking health care reform, compared to only $75 million in pro-reform advertising.
The GOP’s continued, over-the-top opposition to health care reform can only be described as pathological. The law passed by Congressional Democrats and President Obama eschewed the liberal dream of Medicare for all and instead took an idea developed by the conservative Heritage Foundation and melded it with moderately progressive ideas about regulating the insurance industry, making insurance more affordable, and curbing escalating health care costs. Yet the GOP has treated the ACA as if it were a socialist plot that they must battle to the death.
The question one has to ask then is why is the GOP so pathologically obsessed with stopping health care reform. Partisan gain and hatred of President Obama certainly play a role. But we think that the primary factor motivating the GOP here is fear of the fact that health care reform will work to improve the lives of tens millions of average Americans and, therefore, undermine the entire ideological basis for today’s Republican Party.
Over the past few years, the GOP has entirely internalized Ronald Reagan’s infamous statement that “government is the problem” to the point where much of the GOP agenda thrives on the rejection of government as a source of social good. And incompetent governance under President W. Bush, unprecedented obstructionism by Congressional Republicans during the Obama Administration, and budgetary cutbacks to important government services have led many people to buy into the GOP’s anti-government message. At the same time, most of the ways that government directly improves our lives – environmental regulations, workplace safety rules, Social Security, Medicare, infrastructure investments, etc. – have been around so long that many Americans simply take these things for granted, rather than realizing the importance of the progressive politics and policies that make those programs possible. Combined, the GOP’s consistent painting of government as the enemy and the lack of concrete new reminders that government often can be a useful tool for improving society has created a large political opening for the GOP.
Health care reform, however, threatens to change that dynamic. Before health care reform, our health care system was broken,with 50 million Americans uninsured, excessive costs for not great levels of care, and widespread abusive insurance company practices such as denying coverage to people with pre-existing conditions, and cutting off people’s benefits as soon as they get sick. Health care reform certainly will not fix all of those problems, but it will vastly improve health insurance and care in numerous ways that directly benefit tens of millions of Americans by, for example:
* Forbidding pre-existing condition exclusion policies
* Forbidding annual and lifetime caps on benefits under health insurance policies
* Preventing recissions, which is the industry practice of accepting your premiums for years on end, but then cancelling your coverage as soon as you get sick
* Requiring insurance companies to spend at least 80% of your premiums on providing health care services, which has led to $1.3 billion in refunds to consumers
* Requiring health insurance companies justify rate increases of more than 10%.
* Closing the Medicare prescription drug coverage doughnut hole
* Eliminating co-pays for preventive care services
* Requiring insurance companies to cover under their parents’ policies adult children until they reach the age of 26
* Expanding health insurance coverage to 32 million more Americans through providing tax credits to make coverage more affordable for families earning under $88,000 per year and small businesses, and by expanding Medicaid
In short, the GOP tells people that government is the problem. But the tens of millions of people who will be able to get affordable insurance, who will not have to worry about coverage if you have a pre-existing condition, or who detect a disease at an early, more treatable stage due to free preventive care services will experience first hand that government can be a tool for improving the lives of average Americans. And that is what scares the GOP so much about President Obama’s health care reform.