The second, however, is less personal and more oriented toward policy. The prime mantra of conservative thought on economic issues is that the private sector is nearly always superior and that government regulation of the marketplace is ineffective, if not counterproductive. The main thrust of the policy argument against the Affordable Care Act, both before and after its passage, was that it constituted an intolerable interference by the government into affairs best handled by private business, which would create marketplace distortions and lead to worse health care outcomes. Should the law succeed, however, it would put the lie to idea that government is incapable of solving problems, and allow progressives to use the law's success as a prime argument for further regulation and consumer protections in other economic sectors. The first rationale may explain the histrionic reaction of tea party groups pushing for a government shutdown to defund the exchanges; but the second, I thought, would explain why the deep pockets with longer-range strategic goals would go so far as to encourage young people to go uninsured, rather than sign up for the exchange available in their state.
As it turns out, though, that may not be necessary. Follow below the fold.
In addition to the popular consumer protections mandated by the law, the Affordable Care Act works by creating state-based health insurance exchanges with a sliding subsidy scale, dependent on annual income, to assist with monthly premium costs. To offer the same opportunities to residents in the thirty states that did not create an exchange, however, there will also be an exchange offered by the federal government. The marketing effort for the federal exchange, however, will be woefully underfunded as an intentional product of Republican intransigence. Meanwhile, the state plans are being sold and marketed under names specific to each. Plans offered under the California exchange are being sold through an entity that will be known as Covered California, while Kentuckians will shop for plans from Kynect.
The early years of these exchanges are the most crucial, as Joan McCarter summarized when discussing the irony of Kentuckians signing up for Kynect without realizing that it is a part of the dreaded "Obamacare" system:
That's absolutely why Republicans are frantic to try to find a way to stop Obamacare from starting. As the message about its benefits get out, as people sign up and start receiving those benefits, they're going to forget all about being scared of it and they're going to like it.In short, the state-based insurance exchanges will be branded at purely state programs, and the federal exchanges will likely have much slower adoption rates because they are not being marketed at all. The message about the benefits will get out, especially in the states that have set up exchanges and received more generous federal funds to market them. People will benefit, even those who were vociferous opponents of the Affordable Care Act to begin with. But when the messages about those benefits start spreading, will the beneficiaries realized that it is the Affordable Care Act that provides them, or will the branding of the plans make it such that people may subscribe to plans created by the law without realizing they have done so?
But it's not a slam-dunk, and the public education effort is key because Republican lies have taken hold with plenty of people. Erin Hoven, an outreach worker with Kentucky Voices for Health, and her efforts to do outreach and education on Obamacare faces those lies—repeated regularly by both of the state's Republican senators, Mitch McConnell and Rand Paul—at every turn.
Meanwhile, the example of Idaho shows that even people who have experienced the abject failure of the free-market, anti-government methodology they love to espouse will not change their ideological stripes, despite the evidence staring them in the face:
On election night, Bill McCarrel Jr. watched teary-eyed residents crowd into his historic bar, The Gathering Place, after President Obama won a second term. His customers worried aloud about losing access to their guns and having to accept the federal health law that many revile as socialized medicine.It is foreseeable that the Affordable Care Act will be a great success and do wonders to help people get insurance who would have stood no chance of doing so without it, yet the people it helps will not realize that it is the federal government that has helped them, and will experience no change in their perception of the role of government, or realize the failure of conservative free-market fundamentalism. The ultimate irony is what the promoters of Kynect have experienced: the more that people know that these plans they like are actually "Obamacare," the less likely the law is to succeed.
Like most people in this fiercely Republican state, McCarrel opposes Obamacare — even though he's uninsured and can't find affordable coverage as a result of his artificial hip and knees. But the former junior high principal is looking forward to shopping in the law's online insurance marketplace, also called an exchange, starting in October to see if he can get a plan he could afford.
Sometimes, helping people is a thankless job.