Hey, Happy New Year from all of us at OTE!
OK…back to work.
I sort of enjoyed Michael Moore’s oped in today’s NYT about both the shortcomings and attributes of the Affordable Care Act, on the day its coverage officially begins to kick in. By “sort of,” I mean that I think he gets the politics wrong but he gets the policy right in important ways.
Moore argues that Obamacare is “awful,” born of conservative ideology to protect the existing private insurer infrastructure.
What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney’s car. And we knew it.
Now, putting aside “awful,” which Obamacare is definitely not—Moore himself calls the reform a “godsend” a few sentence later—he’s right about a lot of the above.
Political scientists will write tomes on this, I’m sure, but as someone who was there at the time, the relevant question was: do we, a new administration that successfully ran a campaign with a large plank to make major changes to the health care delivery system, try to go around the existing insurance industry or through it? While Moore and many progressives may believe that either path was viable, many others were justifiably convinced that there was no political path around the insurance industry that Congress would support.
That’s Congress. What about the general public? As Ezra Klein points out, if a small minority—about 5% of the population–was deeply upset about not being able to keep their existing plan, why would it have been OK if pretty much everyone now in the private market faced that same transition?
There’s no question that to an extent, an administration makes its own bed in these fights. Their assumptions about what’s possible determine what’s possible. But having been inside that machine for a few years, I think this is a much more conservative country—in the sense of resisting change and being suspicious of government—than a lot of people think.
Meanwhile, the ACA is rolling along, with a couple of million signed up for coverage in the exchanges and millions more signing up for the Medicaid expansion,* the latter of which is reaching folks higher up the income scale than it has in the past.
Other benefits of the new coverage kicking in today:
Starting Wednesday, health insurance companies can no longer deny coverage to people with pre-existing conditions and cannot charge higher premiums to women than to men for the same coverage. In most cases, insurers must provide a standard set of benefits prescribed by federal law and regulations. And they cannot set dollar limits on what they spend on “essential health benefits” for a policyholder.
Moore argues that progressives can plot a course from the ACA to something closer to single payer, by, for example, trying to get an option for publicly-provided coverage (like Medicare for all) in the state exchanges and supporting the single-payer system that’s supposed to start in Vermont in a few years.
I don’t see why not, and if so, that looks more like the incremental path that our political economy usually dictates. As a friend pointed out to me the other day, such progress happens one funeral at a time and the death in this case is a very important one: it is the demise of the notion that the ACA can be repealed. That notion is not dead yet, but it is dying, as each day of increased coverage—however bumpy (and there are more bumps to come)—worsens its condition.
And no, it is not covered under Obamacare.
*The NYT says “hundreds of thousands” have signed up for Medicaid under the ACA expansion; the WaPo says 3.9 million. My CBPP colleagues tell me that, in fact, this number is not knowable yet, though stuff I’ve seen leads me to believe it’s in the millions, not the hundreds of thousands.