Repeal, replace, and then what?
December 31, 2013
"If you like the post office and the Department of Motor Vehicles and you think they're run well, just wait till you see Medicare, Medicaid and healthcare done by the government." Arthur Laffer, CNN, Aug. 4, 2009.
Happy New Year! Today the Affordable Care Act is fully implemented. Republicans are still fighting it, but their level of ignorance about the law is staggering, characterized by the quote above. Arthur Laffer, an advisEr to Ronald Reagan, created the Laffer Curve, the debunked justification for supply-side economics. Laffer's ignorance about government-run health care is revealing but not surprising. And personally, I think the post office and DMV do a great job.
The ACA was a Republican idea, created by the Heritage Foundation as an alternative to the Clintons' 1993 health care plan. It was promoted by Republicans as recently as 2008 and implemented by former Republican Gov. Mitt Romney in Massachusetts, where it's a huge success. Then President Obama studied the plan and thought it had merit, so Republicans had to spin 180 degrees, saying this is a dictatorial takeover of the health care system. Ever since, it's been "Repeal and Replace." The fact that health care costs are growing at the slowest rate in 50 years and millions of people are getting insurance is irrelevant. A Democrat passed it, so therefore it's bad.
Another willful misunderstanding is the idea that the ACA has anything to do with delivering health care. It doesn't. It's a program that allows people to access affordable health insurance from private companies. Any restrictions on doctors, treatment, etc., are from the insurance companies, not the government. The ACA mandates certain standards to ensure better coverage. Anyone who thinks pre-ACA policies were never canceled or allowed people any doctor they wanted isn't living in the real world.
I hear people screaming that the ACA will "redistribute" income. Well, duh! It's insurance. The Concise Encyclopedia defines insurance as "Contract that, by redistributing risk among a large number of people, reduces losses from accidents incurred by an individual… By pooling both the financial contributions and the risks of a large number of policyholders, the insurer is able to absorb losses much more easily than is the uninsured individual."
I've paid home insurance for years and never collected. I'm paying to fix someone else's disaster, and that's fine. If something happens to me, I'm covered. I don't know if that's socialism, but I doubt many people would cancel their home insurance on ideological grounds. But that's what Republicans want to do with the ACA.
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They won't succeed in repealing the law, but if they did, what would happen? Under the ACA, insurance companies cannot deny you insurance because you have a pre-existing condition of any kind. They can't drop you because you get sick, as they have done for years. Young people can stay on their parents' policies until they are 26. There are no lifetime limits on insurance coverage. Insurance companies must spend at least 80 percent of their money on actual coverage, not salaries, dividends, etc. Many preventative procedures are now free. The donut hole in Medicare will be closed.
So far, over 1 million people, including Congressional members and their staffs, have gotten health insurance due to the ACA, even with website problems. (The website is a means of accessing the ACA, not the law itself). Over 6 million young people have been able to stay on their parents' insurance. Repeal would take insurance away from all these people, without replacing it with anything.
Repeal would restore the pre-existing condition provision, so people with chronic conditions such as diabetes wouldn't be able to get insurance. Repeal would allow insurers to cancel insurance when someone gets sick. Repeal would restore caps, so people needing long-term care would lose their insurance and not be able to replace it.
The Republicans act outraged that 4 million people had their plans canceled by insurance companies, even though most of these people will be able to get better, cheaper coverage thanks to the ACA. Republicans apparently had no concern for the 40 million people who didn't have coverage and can now afford it. Their outrage varies depending on what Obama is supporting.
Repealing the ACA would take health insurance from millions of people and doom millions more to lose coverage when they most need it. If Republicans have a plan to replace the ACA, they should speak up. Otherwise, they should close their mouths and allow the law to work. Anything else is criminal.
Jeanette Strong is a Fallon columnist.