The 2014 election will been all about Obamacare, and Republicans will probably have enough ammunition to make another run at slashing entitlements. Despite the mistakes of the White House in handling the launching of the Affordable Care Act, progressives need to defend the principle of equality that underpins Obamacare or suffer great defeats in 2014.
Obamacare has run into real trouble because the ACA did not grant government sufficient powers to head off some problems. Yet, opponents insist Obamacare is a massive power grab. The law did not prevent corporations from dropping coverage or changing and down-grading coverage. The law did grandfather coverage written before its passage, but it did not prohibit insurance companies from simply canceling that coverage. Even if that coverage was skimpy, excluding maternity care, limiting what the company had to spend, and excluding numerous illnesses, it would have stood and been grandfathered in. The companies exercised their option to cancel because the policies would usually be replaced by more expensive ones that met the new standards. Some of these cancellations were anticipated and subsidies were provided to help some meet the added expense. These problems could have been prevented, but then there would have been some justification for all the howling about power grabs and big government.
Barack Obama's Affordable Health Care plan had a very difficult launch on October 1, 2013. Its balky web site, HealthCare.gov, was brought on line on October 1 before multiple flaws were ironed out; it simply did not work properly. The Administration promised that the flaws would be gone by the end of November, but it still does not work perfectly.
Republicans were delighted and called for delays and even discussed scrapping the whole plan. The debacle so damaged the president's popularity that it might prove impossible for him to fix ACA. Multiple hearings were held with a view to embarrassing the administration. Secretary Kathleen Sibelius was mercilessly grilled as though she were the one computer technician who had been sleeping at the switch. Not one Republican at these hearings offered proposals for fixing the problem. On October 14, President Obama appointed Jeffrey Zeints to coordinate fixing the program, he was promptly called to Capitol Hill to answer questions, depriving him of time to address the problem. The press should have reported that there is a 24/7 hot line (1-800-318-2596) to help people resolve ObamaCare problems; and the Democrats should have mentioned it at every turn. It was also found that some people working on the computer code inserted language intended to derail it; Obama's supporters should have mentioned this.
The basic problem was that over 30 states had refused to implement ObamaCare and develop web sites. So far, only 14 have done so, and their sites seem to work. That threw a tremendous burden on the software of the government site, and it was simply overwhelmed from the beginning. Fifty-five separate contractors worked on the program, which was expected to take account of different regulations in all fifty states and to access several different governmental data bases. The goal for the end of November was to have it working well enough that 50,000 people could be on it at a given time. Given the fact that each user us using the site to interact with a number of other sites, it could be that 50,000 is simply too tall an order.
At least as damaging was the fact that President Obama had repeatedly said that people could keep their existing insurance policies and physicians under the Affordable Care Act. The fact is that the act grandfathered for one year policies that were written before it passed. It did not lock in policies written after passage that did not meet minimum standards. On at least two occasions, Obama accurately described these limitations, but for the most part he misstated the situation. Of necessity, the president has been in campaign mode most of the time. He found that the line about keeping old coverage and the family doctor worked well on the stump, and fell into that language to inaccurately describe policy. Those entrusted with protecting his image and anticipating Republican attacks should have prevented him from making such inaccurate statements—often up to weeks before Obamacare's roll out.
The act did not guarantee that people would always retain their physicians, nor did it require plans that did not permit people to keep their doctors. Obama had grounds for assuming that the great majority of people would keep their physicians, but he mistakenly used broad campaign language to inaccurately describe policy. All but a small percentage of people get their health care through employer-financed plans, and there was no reason to assume many of these plans would be dramatically changed. When he said people could keep their physicians, he probably was simply countering Republican propaganda to the effect that ACA would separate them from their physicians. ACA did not require the selection of new physicians, but neither did it stop existing providers from making changes. Companies providing employers with health insurance decided to save money by moving to smaller networks of doctors and providers. Sometimes employers switched insurers, saving money by accepting much smaller provider networks. All of this was out of the control of government, and Republicans would have screamed bloody murder if government had the power to prevent these moves.
The framers of ACA planned to cover 16 million people by expanding Medicaid. The refusal of many red states to cooperate will sharply reduce this number, probably by 5,000,000. Most of them are African Americans in the South. Many of those who will be excluded from coverage will be single mothers in these red states. Some Republican state governments have attempted to sabotage ACA but not punishing insurance providers when they violate regulations. So, Republicans have already been successful in stripping millions of ACA and derailing a substantial part of Obamacare. The fact is that, at best, the country will have two different health care plans in the near future—one in the blue states and another in the red ones.
Hundreds of thousands of people received letters from their insurance companies saying that their insurance was canceled. Senator Rafael “Ted” Cruz, the leading candidate to become the nation's premier demagogue, numbered them at 5,000,000. Some say the actual number could reach 2,000,000, but establishing any figure is exceedingly difficult. An extensive New York Times article on December 1, numbered them in the hundreds of thousands. To make things much worse, the people who received cancellation letters were unable to check on line to see if they could find a comparable or better insurance deal. Only 5% of Americans—or about 18,000,000, have health insurance have it through private contract; the rest have it through employers. How many of that 5% decided to get new insurance—thus sacrificing grandfathered status-- after the ACA was passed is not known. Similarly, it is not known how many of the private policies are deficient. It is clear that the insurance companies canceled as many private policies as they could to discredit Obamacare. It is conceivable that the number of private polices that will be canceled could run into a few millions. These people will be angry and become even angrier if they have problems getting new insurance. For some reason, West Wing strategists did not anticipate this problem, which could cost many votes in 2014.
Republicans heaped on many more distortions, none of which were addressed by most of the mainstream media. The disasters with Obamacare came at a time when CNN was shifting to the right in an effort to garner more conservative viewers. Its criticisms of the program and president went on for days and days, around the clock. It's commentators and many others repeatedly said that the failure of Obamacare would endanger the president's agenda and legacy. That is true, but they rarely added that Republicans had opposed almost everything he proposed, and the prospects of passing much of his agenda had been dim for a long time.
But any way we look at it, Obama had lied. Eventually he offered an adequate apology, but the damage was done and his popularity and that of Obamacare hit the skids. Now only 42% of Americans believe government has an obligation to provide people with health care; that figure was 69% in 2007. Even less popular is the president. In the House of Representatives, 39 Democrats, worried about keeping their seats, joined the Republicans in trying to scuttle Obamacare. Aside from Nancy Pelosi, few Democrats came to the president's aid. The president needs to figure out how to fix the program by executive action. To fix his political problems, he needs to recruit new West Wing operatives who can make government work, anticipate Republican attacks, and fashion a national political campaign for 2014.
President Obama seemed to have no idea how serious the problem was until a painful 90 minute briefling on the evening of October 15. He quickly realized that the web site was not even necessary, but after spending $630,000,000 on it, he could not simply scrap it and probably had little choice but to promise a quick fix. Maybe he should have told the American people that they had expected too much of the site and implemented a plan where most people used the site to get a lot of preliminary information and then conclude their deal by talking to insurance company representatives or human beings trained to help them. Did aides oversell the president on the web site? Did they think most Americans could easily manipulate a complex site, even if it worked well? If the aides thought most Americans would easily manage a complex web site this would explain why the White House has been so inept in defending itself against republican attacks since 2009.
The president has appealed to the insurance companies to help him fix the cancellation problem, and he has agreed to keep policies written before enactment grandfathered for another year. Making this patch work will require the cooperation of state insurance commissioners. Barack Obama can unilaterally extend the application period, but only Congress can pass legislation that would compensate the insurance companies for modifying the policies that were canceled. The House of Representatives would compensate the companies, but only if provisions were added that would badly damage Obamacare.
Another choice open to Obama is to permit the companies to directly market to consumers in the red states that lack exchanges. In thirteen states, Republicans passed “navigation” laws to make it exceedingly difficult for health care advocates from helping people sign up for Medicare. It is unclear how these laws would effect representatives of insurance companies. In any case, buying the insurance directly from the companies will raise costs.
Today critics on all sides insist that the breakdown proved that the Obama administration was guilty of inept management. To a degree that was true, but accepting the full indictment means Barack Obama, Kathleen Sibelius, and other ranking officials should have understood a great deal about computers and web site design. There were strained relations between White House personnel and Health and Human Services personnel. In addition, the Health and Human Services people did not gt along well with the contractors. Someone in the White House and the Secretary of Health and Human Services should have identified this problem early on and done something about it and told the president. The people who failed the president here should be disciplined and even forced to walk the plank.
On the other hand, there were multiple technical questions involved that neither Obama nor Sibelius could have been expected to understand. The various contractors dealing with different parts of the program barely communicated with one another. The people who managed Medicare should have appointed someone to coordinate how its data was made available to others. The Medicare people decided to use a database provided by MarkLogic, which was one many of the contractors' technicians did not understand. Much f this was just plain bad luck. How were Obama and Sibelius to understand such matters or head off these problems?
The time has come for a reboot in the Obama Administration. The advisers who did not warn him of the impending Obamacare disasters need to be replaced with people with administrative skills and the ability to make governmental machinery work. Those who permitted him to continually misrepresent the program must be replaced by sharp political operatives who can protect the president from such mistakes wile fashioning messages that appeal to most voters, especially white workers who have come to dislike Democrats.
The problems with the roll out of the website and reports of cancellations of policies came a time when a few Republican governors were reconsidering their ideological opposition to Obamacare. They were finding its financial incentives attractive and were having second thoughts about deliberately injuring poor and marginalized people in their states for purely political purposes. ObamaCare is working well in 16 states, but the public perception is that it is a bust and its popularity and that of the president have fallen sharply. Given this situation, it is doubtful that any more red state governments will abandon their plans to sabotage Obamacare. The likelihood is that a few will join the wrecking crew.
The disastrous roll out of ACA came at a time when the Congressional Republicans were quietly debating whether to abandon their long term quest to slash entitlements and settle for working for sharp cuts in discretionary spending. They were moving in the latter direction and even accepting defense cuts without too much grumbling. But the problems with Obamacare have given the enemies of entitlement new life. People like the Paul Ryan and the Kochs and others who fund and manipulate the Tea Party see one more opportunity to slash entitlements and repudiate the principles of the New Deal.
The 2014 election will be about Obamacare; but the subtext will be entitlements in general and whether government can function effectively.
Silence on the part of Democrats with respect to Obamacare will imply agreement with the Republicans on Obamacare ane entitlements and this cowardly position will not win them votes. Many progressives will not turn out to vote for Democrats who turn their backs on Obama, and conservatives are unlikely to reward the Democratic turncoats for their treachery. The fight will be about equality, and Democrats need to link the Obamacare debate to Republican plans to trim Medicare, Medicaid, Social Security, and Republican plans to strip college people, the poor, and Blacks of the franchise through Voter ID laws. What some see as attacks on big government are really parts of a broad assault on many government efforts that benefit the general population rather than corporations and people at the top. The efforts to dismantle the Post Office and divert public school funds to private schools or for-profit schools are examples. Simply put, caring about other people is considered a dangerous idea by people on the Right. That is one big reason Obamacare is under assault.
The Wall Street Journal recently noted that the costs of Obamacare are likely to be lower than expected. Defenders of ACA should also note that due to ACA cost containment provisions, health care costs since 2010 have gone up at a third of the previous rate of increase. Medicare costs have not increased, and Medicaid expenses have actually declined a bit. These are simple facts and stand in stark contrast to the claims of the ACA's detractors. Defenders should also point out that Obamacare begins to close the famous Medicaid doughnut hole and will have it completely closed by 2020. ACA strengthens Medicare in many other ways and does not reduce coverage under Medicare Advantage one iota.( For useful facts: http://obamacarefacts.com/... )
A rational defense of Obamacare and explanation of what went wrong would probably produce slim results. Nevertheless it must be undertaken by Democratic members of Congress from safe districts. This is a matter of equality and the fundamental dignity of all human beings. If progressive politicians cannot risk all in this cause, there is no need for a progressive party. The job will be very hard in part because the Republicans have been so successful in spreading falsehoods about ACA. Progressives need to repeatedly remind people that the only Republican plan there is is a system that gives insurance companies free reign, often excludes the very ill from coverage, and shuts out tens of millions of poor and from income Americans. The fundamental principle behind RepublicanCare is that only those who can care deserve health treatment. The rule that everyone who shows up in an emergency room must be treated has been eroding for years and will eventually simply mean making the last moments endurable.
Voters have great difficulty dealing with complexities, and many now think that all the Republican misrepresentations of ACA are true. For some time, there has been a quiet debate within the GOP over whether to continue to shrink entitlements or to quietly give up on that and focus on “starving the beast” by slashing discretionary spending, including defense. So great has been the success of the Republicans in the Obamacare battle-- and conversely the failures of the administration, that those like the Kochs and Paul Ryan may be encouraged to take another shot at cutting many entitlements.
Advocates of health care reform knew all along that the most efficient and cost-effective way to accomplish their goals was through extending Medicare or implementing some other single payer system. The political realities of the situation required them to swallow hard and accept a much more complex system built upon previous Republican proposals. Now there are problems, and the media functions so poorly in this country that few voters grasp that this a problematic compromise from the beginning. It was never the liberal plan to expand government that some propagandists suggested. Other healthcare systems in the world were implemented much earlier than Obamacare at times when it was relatively easy to erect national health insurance schemes. That meant they were being built upon relatively simple medical care systems. Obamacare had to be built atop the most complex system in the world and it had to be done in a way that rewarded the existing insurance industry and took into account the complexities of a federal system with 50 states. The federal website was never intended to be the centerpiece of the system; it was supposed to be run through fifty state sites.
The first effort to bring national health care to Australia was Medibak in 1972; it was repealed in 1981 because it was opposed one party, the physicians and some states. In 1983, Australian Medicare was created, and it succeeded because it was a relatively simple system built upon a relatively simple structure. A problem few commentators are noting, is that Obamacare is being built upon a the base of a very complex system, which means it has to be complex. Hence, it will be hard to operate at first.
The Australian experience shows that a national health plan can be repealed. It also demonstrates that
a public ravaged by recession can demand and get another shot at national health insurance by electing people committed to restoring it. Whether American voters these days are as influenced by bread and butter concerns as the Australians were in 1983 is another matter. There is a great deal of evidence to suggest that many white workers are more concerned with racial antagonism and hot button issues than looking after the physical welfare of their families.
The president's misleading remarks and the website failure will make Obamacare the main issue in the 2014 election. Even though the public was unhappy with the 16 day government shutdown engineered by the Republicans, the Republicans now seem to have a slight but growing advantage over the Democrats in the coming elections. The voters have short memories, and have not shown a strong interest in punishing Republicans for shutting down government or injuring the nation's credit. Few can grasp that sequestration substantially slowed economic recovery or that the recent shut-down has also hampered job creation. It would be even more difficult for most to understand that continuing the old health care system, which leaves many uncovered and costs 18% of the GDP, imposes a terrible burden on our economy and ability to compete in the world.
There is still time to educate voters about Obamacare and its alternative, Republicancare, which returns the nation to the situation before the passage of ACA endangers lives and the economy. In a more fundamental way, it will go far to establish the idea that what Americans call democracy does not include the full equality of all people or the recognition of their equal dignity. At the moment, the Republicans have a head of steam and the advantage. If they win big in 2014, they will have scored a great victory for the principle of inequality, and we can expect serious reductions in Social Security, Medicare, and Medicaid.