Mitch McConnell & ACA

Republican Voters Don’t Want Obamacare, But They Do Want ACA

Senate Republican’s have a major dilemma, some might say a conundrum, as the GOP’s web of lies about ACA is starting to fall apart. Republicans voters don’t want Obamacare, but they do want ACA, or at least most of the things it changed about health insurance in America. That is why the House and Senate replacement plans put forth by the GOP are hovering around 16% approval nationwide. They are tax cut bills, not replacements for the Affordable Care Act.

On Tuesday, the Senate will vote to proceed on a mystery bill. Even Senate Republicans have no idea what they will be voting for. But they know they will vote on it anyway, and most of them already know they really like it. The only things we know for sure is that it will be a huge tax cut for the rich, paid for by the elderly, the sick and the poor. The bill breaks every promise Trump made on healthcare. It will cut Medicaid, throw millions off insurance, and does not offer better coverage for a lower cost.

So why does the Affordable Care Act need to be replaced? Republicans have a variety of talking points for that one., anything from “because we promised” to “Obamacare is failing.” In reality, it is the same reason they say “adoptions” instead of “sanctions” and “economic anxiety” instead of “racism.” They use code words to describe their motives, because their whole narrative on ACA is based on lies. They have two main motivations for repealing Obamacare. First, to remove any trace that a they ever had a black president. Secondly, the GOP has never believed that healthcare is as right. In order to achieve those goals, they spent the last seven years lying about Obamacare. To validate their deception, they pointed to issues in Republican-led states ACA had never been fully implemented, and where they had intentionally sabotage it.

The Myths About The Patient Protection and Affordable Care Act

All of the GOP efforts to repeal are being done under the pretense that the Affordable Care Act is in a death spiral. That myth was started by the Republicans when premium increases for 2017 were announced. It was then further exacerbated by the CEO of Aetna. Last summer, Aetna were planning on expanding their participation in ACA from 15 up to 20 states. At the same time they were trying to get a $34-billion merger with Humana approved. Aetna then tried to use their participation in ACA to extort the federal government into approving the merger, threatening to pull out of the ACA if it wasn’t approved. When the merger was rejected by the Obama administration, Aetna followed through on their threat, pulling out of all but 4 of 15 states.  They claimed it was a business decision. They were simply losing too much money on the ACA exchanges. Later, a court found that to be a lie too. The federal judge ruled that Aetna made its decision in response to a federal antitrust lawsuit blocking its proposed merger with Humana. The CEO of Aetna then claimed Obamacare was in a “death spiral,” something all healthcare experts say was a blatantly false statement. ACA has some problems, but they come nowhere near the definition of a death spiral.

The main issues Ryan and the GOP point to when they falsely claim that Obamacare is failing are the premium increases, and the fact that over 1000 counties are down to only one insurer on the exchanges. What they don’t tell you is that both issues are mostly confined to republican-led states where they intentionally sabotaged the implementation of ACA, refusing to expand Medicaid, or to set up their own exchanges, and defunding risk corridors.

Most republican-controlled states refused Medicaid expansion, because without it they knew ACA would not work properly. In the states that accepted Medicaid expansion, the increase in premiums was generally much lower than the average yearly increases before its implementation. In the 10 years before ACA, premiums rose between 10-20% each and every year, in all 50 states. GOP selective memory is a wonderful thing!

When it comes to the issue of only one insurer on some exchanges,  Ryan and the Republicans always quote that statistic by counties. That is not a coincidence. You may have noticed that during Ryan’s Powerpoint presentation there was no map showing where these counties are. The reason for that is because most of those 1000 counties are in a handful of Republican-led states where they intentionally sabotaged Obamacare implementation. ACA is working where it was implemented, and failing where republicans created a self-fulfilling prophesy by sabotaging it.

Kentucky is the perfect example of a red state where it was implemented, but Republicans still undermined it using disinformation. By expanding Medicaid and setting up an exchange,  Kentucky managed to cut their uninsured rate by half. Their state-run exchange was marketed as Connect, but many people in the state didn’t even realize it was Obamacare. A poll taken recently showed Connect was very popular in KY, but Obamacare and ACA were not. Of course all three are the same thing, but that confusion led Kentucky voters to elect a Tea Party governor who campaigned on repealing Obamacare.

The Facts About The Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act reformed healthcare, and mandated minimum coverage for all healthcare plans. ACA forced insurers to cover pre-existing conditions, no caps, and free preventive care with no deductibles in all plans, both employer and through the exchanges.  This included a wide range of services and procedures like yearly checkups, colonoscopies and cancer screening for women. Most importantly, it put the emphasis on preventive care, which has been shown to be much more cost effective long-term. Over time, this would get healthcare costs in the US down, and more in line with those in other developed countries.

Repeal of ACA means more out-of-pocket expenses, even for those on employer plans. Even if you are one of the few on a Cadillac employer plan that covers pre-existing condition and no caps, without ACA mandates that only lasts while you keep your current job.  The GOP and Trump lied when he said they would keep the good parts of Obamacare and get rid of the individual mandate. Trump told a real whopper when he said he had a secret plan to provide better coverage at a lower cost for everyone. Premiums in a private insurance market are going to vary, depending on what they cover, the amount of co-pays, and amount deductible. The more extensive the coverage and the lower the deductibles, the higher the premiums. The only way to lower premiums without lowering the cost of healthcare in the United States, is the reintroduction of junk policies. These policies were outlawed by Obama because they covered nothing, and were almost 100% profit for the insurance companies.

The Realities Of Healthcare

There is no country in the world that has a successful private, for-profit, health insurance system. Free market health insurance doesn’t work because no insurance company is willing to insure the old and sick unless they are forced to. The only healthcare that works is universal healthcare where everyone pays in through their taxes, and healthy/sick and old/young balance out. Yes, some single payer systems have some issues, like slightly longer waiting lists for surgery, which the Republicans like to highlight. What they never mention is in most countries, the state single payer system is supplemented by a private healthcare system as well. Those who can afford it can buy additional health insurance that gives them shorter wait times in private facilities, private rooms, and elective surgery.

Paul Ryan complains that the healthy are paying for the sick, but that is the very definition of insurance. I have never had a car accident, so I pay for all of those who do, and when my luck runs out, I will be covered. Single-payer universal healthcare works, but you would only know that if you ask someone who has it. Republicans will tell you that Canadians are streaming over the border to use our healthcare system. That is another myth. Occasionally the ultra-wealthy use it to get shorter wait times or elective surgery.  As in all developed countries with universal healthcare, Canadians are more satisfied with their healthcare system than we are with ours. They have lower costs, with better outcomes, and much lower drug prices.

The reason the GOP only have a tax cut for the rich and no healthcare plan to replace Obamacare is because the ACA was based on the Republican plan first proposed by the conservative Heritage Foundation, with an individual mandate, later adopted by Romney in Massachusetts. They only abandoned it when it was adopted by President Obama as a blueprint for the Affordable Care Act. It does need tweaking, as every major piece of legislation does. To do that, however, Republicans would have to admit that they have been lying for the last seven years.

Wil Donnelly

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