ACA Coverage Begins, and Michael Moore Has Mixed Feelings About It

January 1st, 2014 at 10:31 am

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.

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8 comments in reply to "ACA Coverage Begins, and Michael Moore Has Mixed Feelings About It"

  1. Rima Regas says:

    The ACA has extended to many millions of people the right to purchase private health coverage. That is widening existing markets, and not how healthcare is delivered. It’s an important distinction to make. The ACA only works for those who can qualify for the maximum amount of subsidy, or those who can afford to pay just above slightly better rates than, say, COBRA. It still leaves millions out of reach of coverage.

    Moore is correct in the sense that the Heritage plan was always Big Insurance-friendly and not user-friendly in its original intent. Evaluated against the other options, the ACA is a bad choice. In an environment where lobbyists hold more sway over legislators than the voters do, and it is impossible to pass the public option, the ACA is the next best thing. That doesn’t make it good. It just makes it all we can do, short of doing the right thing.

    Is it better than not doing anything? Of course it is! Does it make it good? No. Does it make it a change in how we deliver healthcare? No. Only universal healthcare/Medicare for all will do that.

    Just my $.02 as a newly covered California resident.

  2. Rethinkecon says:

    I think you forgot the last part of your key sentence: “try to go around the existing insurance industry or through it given that there wasn’t a large scale movement pushing for single payer?” There were folks who’re mobilizing for it, but nowhere near the scale needed to take on the very powerful insurance industry, Big Pharmacy, and all the other healthcare players who benefit from the fact they aren’t negotiating with a single payer.

    Or to put it another way, in 2008 Clinton and Obama were in a fierce, closely contested battle for the nomination. If progressives didn’t have enough sneakers on the ground to push one of them towards single payer during the primary, why would anyone expect we’d be able to convince/drag Obama into fighting for it once he was elected?

    So, a 2014 New Year’s resolution for our side: to stop waiting for a Man/Woman on a White Horse to save us and start holding ourselves accountable when we don’t fight hard enough to win the things we want.

    • Jared Bernstein says:


      • urban legend says:

        It also seems to me that phrases like “the very powerful insurance industry,” usually with the implication that it will be dominated in the ACA context by for-profit companies, is misleading. My impression is that not-for-profit companies are dominating the offerings in many areas, and profiteering is also heavily constrained by the 80/85% rule (as well as actual competition). I think the Obama team made a huge unforced error in failing to emphasize these features and allowing this mistaken perception from the left to fester. For example, Rahm Emanuel made a blunder of historical proportions by deliberately ridiculing and pissing off the Democratic base, and thereby directly causing the 2010 debacle because the base didn’t have the heart knock on doors. The extra 15-20% who tell poll-takers they dislike Obamacare because it is not single-payer or doesn’t have a public option made it easier for real opponents to claim the ACA is “disliked by the American people.” If the steady early figure had been more like 55% in favor and 40% against — which is about where it would have been if half the left-side opponents had been convinced to give even reluctant or qualified support — the whole dynamic would have been different.

        • fausto412 says:

          I didn’t even know there were non-profit insurance companies or that they were in the exchanges…now that’s new to me and that is huge. Where have you seen information comparing nonprofit vs for profit insurance rates in the exchanges?

          • Ara Rubyan says:

            Just to be clear: “non-profit” does not mean “not for profit.” It simply means any profits are not to be distributed to the owners/shareholders.

  3. Michael says:

    What people forget (or never learned in history class) is that the legacy of history is that nothing is set in stone. We don’t have slavery not because slavery can’t exist but because people make (present tense) a conscious effort to repeal efforts to bring it back. it is the fatal flaw of Democratic and Liberal advocates to believe that simply because something has been passed or enshrined or even been said to be legal or constitutional, that we have achieved something.

    Think about the abortion debate. What happens if Democrats and Progressives don’t stand fast and allow conservatives to stack the Supreme Court? Roe V. Wade will be overturned and it will be done constitutionally, and then women’s rights will have turned back to the 1900’s. Nothing says the effects of the New Deal have to last forever: all the protections and safety guidelines that were enshrined into law were just that, enshrined into law, an institution that is simply the will of whoever is in charge.

    Don’t ever stop thinking that the worst can’t happen, because I can guarantee you right now that people are working very hard to ensure that very thing. Call it the slow boiling frog syndrome, call it greed creep, call it whatever you want. But there is nothing in the ACA now that has to exist. We had a system where people could be denied coverage for pre-existing conditions, be driven from their homes for medical bills, have their homes taken for unconstitutional reasons and practices, and have no recourse to justice. Nothing that has been won is assured. And if you are complacent to think it can’t be taken away, you haven’t been paying attention. Look at how much of the New Deal has already been taken away. The ACA is like a homeless man winning a judgement in court against the person who robbed him of $10, ignoring the fact he’s still homeless, without insurance, and barely surviving as it is.

  4. doverby says:

    I still think a public option is feasible in both the state exchanges and the federal exchange. I guess we’ll see over the next several years.