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Emboldened by their midterm victories, the GOP and its amen corner have stepped up their war against the Affordable Care Act.  Yesterday, Senate Minority Leader Mitch McConnell promised to file a friend-of-the-court brief in the multistate lawsuit challenging its constitutionality.  In Texas, Republicans are threatening to withdraw from Medicaid, a move which would swell the ranks of the Lone Star State's uninsured to a stunning 40%.  Meanwhile, Rush Limbaugh added a new attack on the health care reform law, declaring that pre-existing condition coverage "is not insurance, it's welfare."

Sadly for GOP's "repeal and replace" campaign, two developments this week will make the Republican rollback effort even harder.

Even as a new Kaiser poll confirmed the overwhelming popularity of most of the ACA's provisions, the CDC announced the ranks of the uninsured had swollen to 59 million.

Just two months after the U.S. Census Bureau reported that 50.7 million people lacked health insurance in 2009, the U.S. Centers for Disease Control and Prevention announced "nearly 59 million Americans went without health insurance coverage for at least part of 2010, many of them with conditions or diseases that needed treatment."  It was only the Democratic expansion of the State Children's Health Insurance Program (S-CHIP) which offset in part the continued decline in employer provided coverage.

The CDC in-person survey of 90,000 individuals didn't just highlight the recession's impact in adding three million more Americans to those who had no health insurance for at least part of the year.  As CDC's Thomas Frieden put it, "Now, the data also allow us to debunk two myths about health care coverage."

"The first myth is that it's only the poor who are uninsured. In fact, half of the uninsured are over the poverty level and one in three adults under 65 in the middle income range -- defined arbitrarily here between $44,000 and $65,000 a year for a family of four -- were uninsured at some point in the year."

And Frieden said many people argue that only the healthy risk going without health insurance.

"In fact ... more than two out of five individuals who are uninsured at some point during the past year had one or more chronic diseases and this is based on just a partial list of chronic diseases," he said.

Among them, it turns out, are 15 million of the people who went without health insurance despite having high blood pressure, diabetes or asthma.

The grim findings from the CDC are just the latest to show the devastating impact of the economic downturn which began in December 2007. Even among those with insurance, Americans are self-rationing; that is, dramatically cutting back on routine health care.  As an August study by the National Bureau of Economic Research (the same group which officially declares the beginning and end of U.S. recessions) found:

Among Americans responding to the survey, they said, 26.5 percent reported reducing their use of routine medical care since the start of the global economic crisis in 2007.

The authors concluded, "We find strong evidence that the economic crisis -- manifested in job and wealth losses -- has led to reductions in the use of routine medical care." That finding not only echoes data from the American Hospital Association, which in June reported that "About 70 percent of hospitals report fewer patient visits and elective procedures as family budgets remain tight and patients continue to delay or forgo care." The NBER study suggests that the uniquely American phenomenon of health care self-rationing is getting worse.

As McClatchy reported in October 2009, a new Consumers Union survey revealed that due to skyrocketing costs and reductions in coverage, Americans are forced to deny themselves needed medical treatment. Among the findings of CU's poll of a 1,002 respondents:

In the new poll 59 percent said that the cost of their health care had increased more than their other expenses over the past two years. Fifty-one percent said they had faced difficult health care choices in the past year. The most common responses were putting off a doctor visit because of cost (28 percent), not being unable to afford medical bills or medication (25 percent), and putting off a medical procedure because of cost (22 percent).

All of which explains the high levels of public support for the patient protections in the health care bill of rights enshrined in the Affordable Care Act.  As Ezra Klein explained the latest Kaiser survey in the Washington Post:

As other polls have shown, there's certainly appetite for a partial repeal, if not a full repeal.

But then you start asking about repealing specific provisions and, well, things become less popular in a hurry.  Everything from the subsidies to the increase in the Medicare tax is popular. The individual mandate isn't, and you might see the GOP focus on that, but tweaking the penalty there is a far cry from full repeal. Eventually, the GOP is going to stop being on the side of health-care repeal and find themselves on the side of allowing insurers to discriminate against the sick and seniors to fall into the doughnut hole.

(See chart here.)

Ultimately, former Bush speechwriter David Frum predicts, the GOP will blink, forcing Republicans to "fall back upon a Plan B, basically a series of stunts":

They'll schedule a vote to repeal the "cuts" in Medicare under health care reform. (Not really cuts -- restrictions on future growth.)

They'll refuse to appropriate funds to implement aspects of health care reform.

They'll call hearings to publicize problems with the law and complaints from those negatively affected.

And at the end of two years, the law will still be there, more or less intact.

For now, at least, Mitch McConnell is undeterred by the realities of either parliamentary process or public opinion.  Republicans, McConnell insisted Sunday, "owe it to the American people" to try to repeal health care reform.

(For more background, see: "The 10 Republican No's on Health Care.")

** Crossposted at Perrspectives **

Originally posted to Jon Perr on Wed Nov 10, 2010 at 11:33 AM PST.

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Comment Preferences

  •  People are definitely avoiding medical services (6+ / 0-)

    A few weeks ago I received a call from my health insurance provider, Kaiser. I had been in for a checkup just a couple months before this. They called to tell me they "noticed" I had high blood pressure(I've had it for years) and wanted me to come in the next day to have it checked again.

    They have never, I repeat never, done anything like this before. Hell, they don't even bother to call and remind me when I forget to come back and take the lab tests the doctor ordered. But this time they call me because they were all concerned about my blood pressure. The person calling went on to explain that my normal $18 copay would be required but they could see me the very next day.

    They were doing nothing more than soliciting business. They continually ignore the issues I complain about but when the traffic flow at their front door slows down, they start making phone calls. I told them I have the ability to take my own blood pressure and do so regularly. Her response? "I'll let your doctor know that you refused to come in."

    I really hate the health care system in this country.

    Never attribute to malice that which can be adequately explained by stupidity.

    by reflectionsv37 on Wed Nov 10, 2010 at 11:50:21 AM PST

    •  $18 copay is modest. (1+ / 0-)
      Recommended by:

      I pay $25.  I wonder how much others pay.

      Show me the POLICY!

      by Fabian on Wed Nov 10, 2010 at 12:39:02 PM PST

      [ Parent ]

    •  I have a completely different (2+ / 0-)
      Recommended by:
      reflectionsv37, john07801
      interpretation - it looks like the threat of ObamaCare finally has them taking the idea of preventive care seriously!

      (geez, I really do crack myself up sometimes).

      •  Diff is (1+ / 0-)
        Recommended by:

        Lab tests don't create any revenue for a physician/practice.  

        Unless you are a hospital, you send your labs out to a contractor and THEY get the revenue from performing the tests.

        This is good because some testing facilities have been sued when it turned out that they were jointly owned by physicians and well, the good doctors made sure to order tests and send their patients to the facilities they owned.  Skips that extra step of arranging for a kickback.  (Generally facilities with expensive, high tech testing like CRTs, MRIs and the like.)

        So the doc would have no financial incentive to bring you in for a lab test, but they would for an office visit.

        Show me the POLICY!

        by Fabian on Wed Nov 10, 2010 at 03:33:09 PM PST

        [ Parent ]

  •  Until the uninsured vote in larger numbers (6+ / 0-)

    they will continue to get the shit end of the stick.

    Demand Filibuster Reform call your Senators at (202) 224-3121 -AND KEEP CALLING

    by Lefty Coaster on Wed Nov 10, 2010 at 11:58:48 AM PST

  •  My state employer-provided HC ins plan (5+ / 0-)

    is about to be gutted so badly that it won't be any more than catastrophic-only. If the state does what they say they will, I'm thinking about dropping the plan & going back to what I did during my doc program. It was cheaper to up the catastrophic coverage on my car insurance than buy a separate policy.

    What really gripes me about this is I wouldn't qualify for the exchanges because my employer technically does offer coverage. It just doesn't cover anything!

  •  In the interest of accuracy (1+ / 0-)
    Recommended by:

    the CDC never claimed that 59 million persons were uninsured, rather that many at some time during the year. Many of the uninsured losing and then reacquiring their insurance during the year.

    The actual number is most likely some increase to the 40.7 million uninsured Americans that the Census reported.

    •  The Diary Noted Your Point... (1+ / 0-)
      Recommended by:


      Nearly 59 million Americans went without health insurance coverage for at least part of 2010, many of them with conditions or diseases that needed treatment.

      and here:

      Just two months after the U.S. Census Bureau reported that 50.7 million people lacked health insurance in 2009, the U.S. Centers for Disease Control and Prevention announced "nearly 59 million Americans went without health insurance coverage for at least part of 2010, many of them with conditions or diseases that needed treatment."

      You're right that the diary title did not capture the "uninsured for part of the year" dynamic.

  •  Meanwhile, there is the PCIP (1+ / 0-)
    Recommended by:
    The Nose

    This summer, new health insurance programs aimed at people with preexisting medical conditions began accepting applications across the country. The plans target one of the key promises of the health-care overhaul: Everyone, even people with checkered medical histories that may make them uninsurable under the current system, can get coverage.

    Now the plans are up and running in every state. So far, the response has been modest and reviews are mixed.

    Knowledge is power.

  •  After this, I feel like saying... (1+ / 0-)
    Recommended by:
    The Nose
    ...that the Republican party has declared war on all of us. They don't give a rat's ass about average folks like me, and I pray and hope that they experience nothing but hell next year if they pursue this callous, reckless, evil, and despicable agenda during the next two years. If they really think they are on their way to a permanent Republican majority, they are out of their minds. Their fraud will be exposed, outrage will spill into their town halls (remember their Astroturf protests of 2009?), and the blood caused by lives they have permanently ruined will be on their hands forever. The fight isn't over as far as I'm concerned, it has just begun, and may these Republican idiots and their Democratic quisling enablers experience nothing but hell and defeat from here on out.

    "First they ignore you, then they laugh at you, then they fight you, then you win." -Mohandas K. Gandhi

    by alaprst on Wed Nov 10, 2010 at 01:39:10 PM PST

  •  I think it's great politics for the Dems if (1+ / 0-)
    Recommended by:
    Alexandra Lynch

    McConnell keeps up this tack.  Americans don't want to relitigate the health care debate.  Any such debate will have the effect of undescoring the popularity of many of the bill's provisions and also placing the GOP as out of touch with reality and the needs of the people.  Keep it goin' Mitch.  You'll do a better job of selling the health care law than we did!

    Alternative rock with something to say:

    by khyber900 on Wed Nov 10, 2010 at 02:39:20 PM PST

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