Most progressives and Democrats wanted Medicare for everyone because it was tried and tested, popular, and the least expensive option. In other words, it was conservative and should have faced no major opposition. Unfortunately, Republicans have always opposed Medicare for seniors and are continually trying to find ways to get rid of it. Therefore, the Affordable Care Act (ACA) had to consist of multiple compromises dominated mostly by Republican ideas that were also supported by like-thinking corporate Democrats. It’s not what many of us hoped for, but it is likely the best the nation could get for now. Sadly, all those compromises led to an extremely complicated website.
Conservatives claim to prefer states’ rights over federal power. Therefore, one compromise was for each state to set up its own insurance exchange options and website and for the national government to do the same for those states that thought the feds could do it as well or better.
The “surprise” was that since Republican governors and legislatures really didn’t care whether their citizens got healthcare, they certainly didn’t want the responsibility to set up the exchanges. Combined with the normal glitches you expect to find in website programs, handling the exchanges for so many states helped bring about a humiliating website launch.
The healthcare.gov website debacle was purely serendipitous for the Fox-Republican-TEA Party and not part of their plan. They fear that the ACA will continue its early successes and therefore become quite popular as its main parts begin to take effect. Hence, they probably presumed the website would work just fine at the outset. You can imagine their pleasure when all those people tried to sign up at the same time causing a quick collapse of the website. It was amusing to see their hypocritical pretension of being upset that the site didn’t work.
Now that most of the glitches of healthcare.gov have been ironed out, even Arkansas’s 4th District Republican representative Tom Cotton has admitted that websites can be fixed. If a pure right-wing extremist such as he can admit that, then the rest of his conservative ideologues should be capable of similar rare moments of reason. (Mr. Cotton has earned his bona fides as a TEA Party anarchist-sociopath with such votes as being against relief to victims of Hurricane Sandy, against a farm bill that includes food stamps for children and workers trying to subsist on minimum wages, and against the Essential Air Service Act that makes it possible for airlines like SeaPort to serve small cities like my hometown, El Dorado, Arkansas.)
Earlier Republican proposals were also adapted into the ACA compromise: 1. The Richard Nixon administration’s 1974 plan would have required all American employers to insure their full-time employees and pay 70% of the premiums – small business owners would get federal subsidies to do so. 2. The Ronald Reagan administration supported the Heritage Foundation’s 1988 plan to require all individuals to obtain health insurance, just like most states require automobile insurance, and penalize those who didn’t. In Massachusetts, Governor Mitt Romney introduced with great success in 2006 what became the model for the ACA.
There are current Republican laws that will be utilized and improved by the ACA: 1. President Reagan signed the Emergency Medical Treatment and Active Labor Act in 1986: it created a form of universal health care by requiring hospitals to treat everyone – whether the individual could pay or not; this created the “free rider” problem that led insurance companies to raise the premiums of those with insurance to pay for the treatments of those without. 2. President George W. Bush signed the Medicare Prescription Drug, Improvement, and Modernization Act in 2003: it created a system in which Medicare recipients could obtain drug insurance through various private companies; many plans contained the notorious “doughnut hole,” in which the patient was responsible for all costs after a certain amount, but after the patient spent another certain amount, the insurance would kick back in. That gap will be phased out by the ACA.
The Democrats were able to also get the following into the compromise: 1. Insurance companies can no longer deny coverage for pre-existing conditions. 2. Insurance companies can’t terminate coverage because of a lengthy illness. 3. Insurance companies must spend 80% of premiums on healthcare and not on overhead or CEO salaries. 4. The number of low income recipients of Medicaid will be expanded. 5. Parents can keep their sons and daughters on their family plans up to age 26.
The irony of this hodgepodge of a compromise between both Democratic and Republican proposals was that the Republicans irresponsibly abandoned their role as the loyal opposition. They were so determined to prevent President Obama from having any successes that they opposed everything that was suggested – even their own ideas! It was up to conservative, corporate Democrats like Max Baucus of Montana to assume the role of the loyal opposition to present and push the Republican positions which prevailed in the final bill.
Because the ACA will be implemented by private, profit-making insurance companies, it will be far less satisfactory than a single-payer public option, which President Obama wouldn’t even fight for. However, with strict regulations by the people’s government, it should still be much better than the exclusive and expensive health system we had before.
The main thing to remember is that the reason the Fox-Republican-TEA Party doesn’t offer an alternative to “Obamacare” is that the Affordable Care Act is essentially their plan.
By David Offutt
A version of this essay was published December 27, 2013, in the El Dorado News-Times as a Guest Column.