Republicans Want to Replace Obamacare with…Obamacare-Lite?

Americans Trust Democrats Over Republicans on Health CareEver since Barack Obama signed the Affordable Care Act on March 23, 2010, the Republicans in Congress have tried to repeal it. This week’s vote was their 50th attempt.

And yet, despite their unyielding opposition, their earnestness rings hollow to most Americans for the simple reason that they have not offered an alternative path to health care reform. Even the party’s own strategists have chastised it for its negative approach, for failing to offer a plan of their own, for obstructing rather than leading.

Finally, their pleas have been answered — in the form of the Patient Choice, Affordability, Responsibility, and Empowerment Act, or “PCEREA,” sponsored by Republican Senators Orrin Hatch, Tom Coburn, and Richard Burr.

At long last, we can answer the simple question that Democrats have been asking Republicans since March 23, 2010: You got a better idea?

Unfortunately, the answer is a disappointing “no.”

The ACA, better known as “Obamacare,” has four major provisions: (1) a ban on price discrimination against sick people, (2) an “individual mandate” requiring everyone to purchase health insurance or pay a fine to the IRS, (3) tax credits for Americans who cannot afford to purchase insurance, and (4) a Medicaid expansion for the poorest Americans who don’t pay enough taxes to qualify for the tax credits.

The PCEREA does away with the first provision right off the bat. The most popular feature of Obamacare, the one that appeals to our basic sense of fairness, is the rule prohibiting insurers from charging different prices to different consumers based on health status. The Republicans would erase this rule, once again making insurance least affordable for the people who need it the most.

With the first provision gone, there isn’t much need for the second one. This is what most people have trouble grasping about the individual mandate: As unpopular as it is, it’s necessary in order to sustain the most popular part of the law. Without an individual mandate, a ban on price discrimination will simply result in insurers charging high rates to everyone, driving all but the sickest consumers out of the market. Insurers can only afford to charge reasonable rates across the board if healthy people are required to buy in.

The PCEREA replaces these two provisions with two new provisions called “continuous coverage” and “auto-enrollment.”

Under “continuous coverage,” Americans would be given a one-time opportunity to buy insurance at prices that aren’t based on health status. So long as they keep this insurance plan for the rest of their lives, they’ll never be discriminated against. If they miss this opportunity — say, by being born after the window passes — they can be discriminated against. If they lose their plan — say, because they change jobs — they can be discriminated against. Basically, “continuous coverage” is a con, a “first come, first serve” lottery that doles out the right to fairness like it’s a privilege, a prize in some twisted game, and then snatches it out from your hands if you fall on hard times or dare to exercise your freedom of choice.

Under “auto-enrollment,” states can sign you up for insurance without your consent, but you can opt out. Basically, the Republicans are assuming that the problem with the insurance market is that Americans are so stupid that they aren’t signing up for insurance that they need and can afford.

Astonishingly, the Republicans have simply taken the provisions of Obamacare and made them temporary — and called it “reform”! We’ll give you fair prices, but only for a little while. We’ll require you to sign up for insurance, but only until you back out.

The third provision confirms this ploy. Just like the ACA, the PCEREA offers tax credits to Americans who purchase insurance on the individual market. The only difference is that the Republicans’ tax credits are far less generous, helping far fewer people.

Finally, the PCEREA addresses Medicaid by restricting its availability to only certain types of Americans, apparently the ones whom the Republicans deem worthy: pregnant women, children, the disabled — but not, for example, working parents. It would also change Medicaid into a block grant program, where it would get a chunk of money every year regardless of how much it needs, leaving most states with tremendous shortfalls during recessions and leaving patients out in the cold when they need help the most.

This last provision is just cruel, but the Republicans can slip it into the bill because the rest of the proposal looks so thoughtful and measured that they’re hoping you won’t notice that it will do almost nothing to address the serious problems ailing our health care system. It is little better than the status quo that existed before Obamacare — and in that sense, they haven’t really offered an alternative after all.

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This op-ed was published in the Huffington Post, and an abbreviated version was published in the South Florida Sun-Sentinel.

Yes, Obamacare Critics, Health Insurance Does Make You Healthier

Michael Barone and Charles Krauthammer have some medical advice for you: Don’t get health insurance, they say. It won’t make you healthier. It’s a waste of money.

Obamacare Enrollment SurgeThey must be desperate. They don’t want to admit that they’ve run out of criticisms of Obamacare. The website is working, enrollments are surging, and millions of Americans are getting affordablehigh-quality health insurance. They couldn’t deny these facts, so they needed a new argument to discredit the law — and they found it tucked away in the New England Journal of Medicine.

In 2008, Oregon conducted an experiment. They held a random lottery. They picked 20,745 names out of a waiting list of 90,000 low-income adults who wanted to sign up for Medicaid. Of the winners, half received Medicaid, and half did not. After two years, they compared the two groups to see if the ones who had Medicaid were any better off.

Barone and Krauthammer claim that the Medicaid group did not have better health than the uninsured group, proving the futility of health insurance, but their conclusion is based on a very narrow, selective reading of the evidence.

It’s true that the individuals on Medicaid did not fare any better than their uninsured counterparts on blood tests for cholesterol, blood sugar, and blood pressure. But it’s also true that the Medicaid patients scored higher on the mental quality-of-life test, experienced significantly lower rates of depression, and reported that they felt healthier.

The Medicaid patients also experienced significantly less financial strain. They were 25 percent less likely to have an unpaid medical bill sent to a collection agency.

In other words, health insurance has significant mental and financial benefits.

In this study, the physical benefits are less clear, but that’s not surprising, given that it only lasted two years and it only measured three simple blood levels. Fortunately, other researchers have measured more than just cholesterol.

A 2008 study in the prestigious medical journal The Lancet, for example, revealed that uninsured patients were significantly more likely to develop advanced-stage cancer because they didn’t receive early screening to detect it.

A year later, Harvard researchers published a study in the Annals of Surgery showing that uninsured patients who arrived at the emergency room with traumatic injuries were almost twice as likely to die in the hospital as patients with insurance, even if they had the same race, gender, age, and severity of injury. Later that year, a similar study was conducted at the Boston Children’s Hospital and published in the Journal of Pediatric Surgery. It found that uninsured children were more than three times as likely to die from traumatic injuries as children with commercial insurance.

And if all that wasn’t enough to convince you, the American Journal of Public Health published a study that same year comparing the death rates of the insured and the uninsured when they had the same education, income, weight, rates of smoking and drinking, etc. They concluded that 44,789 Americans die every year simply because they don’t have health insurance.

That is the bottom line we should be talking about.

If the Oregon experiment were carried out beyond two years, the differences between the insured and the uninsured would accumulate. They found that the Medicaid patients were 70 percent more likely to visit the doctor, 20 percent more likely to have their cholesterol monitored, and for the women, 60 percent more likely to get a mammogram. Those kinds of preventive measures don’t make a huge impact in two years, but in the long run, they can mean the difference between life and death.

Health insurance is so beneficial to your health, in fact, that its effects spillover and benefit those of us around you. Studies have shown, for instance, that companies that offer health insurance are more productive because insured workers take 52 percent fewer “sick days” than their uninsured co-workers.

I have to wonder if Barone and Krauthammer have ever even met anyone on Medicaid. I wonder if they know the terrible fear that uninsured Americans feel when they get sick and they’re forced to choose between astronomical medical bills and untreated illness.

I think they should find out. If they’re so confident that health insurance doesn’t affect your health, then I would like to issue this challenge to them: Give up your own health insurance. Don’t waste another penny on it. Join the ranks of the uninsured.

If not, if they’re unwilling to follow their own advice, then they should stop giving it. They should stop spreading misinformation that can hurt millions of Americans who read their op-ed columns and who depend on the access to lifesaving medical care that only health insurance can provide.

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This op-ed was published in today’s Huffington Post. An abbreviated version was published in the South Florida Sun-Sentinel.

Does Obamacare Infringe on Our Liberty? Or Does It Give Us Even More Freedom?

What right does the government have to make you buy health insurance?

That’s the question that riles Obamacare critics the most. It’s not the premiums or the website or the dropped coverage. It’s the infringement on their liberty.

Does Government Threaten Our Freedom?You hear it all the time: “This is a free country!” That’s what everybody says. But what do they really mean? Do they know what freedom is?

It seems obvious at first. Freedom is lack of coercion. Therefore, anything the government makes you do infringes on your freedom.

But there are different types of coercion, and the government isn’t the only one doing the coercing.

Let’s say that you want your daughter to attend the best school in America. But you can’t afford the tuition. Do you really have freedom of choice? If you choose the school you want, they won’t let you through the front door. If you force your way in, they’ll arrest you.

So you “choose” a more affordable school. You wanted a better school, but they forced you to settle for a different one. Sounds like coercion to me.

Let’s consider another example. You want to retire at the age of 65. You’ve worked hard throughout your entire adult life. Unfortunately, wages haven’t risen, and the bills kept piling up. You saved as much as you could, but it’s only enough to live off for a couple years. Oh, and one more thing: Social Security and Medicare don’t exist.

If you “choose” to retire, you’ll go broke. You’ll go without preventive health care. Your chances of dying early will increase significantly.

So you have a choice: Keep working or die young.

In this case, you actually have less freedom because the government is less involved. Without Social Security and Medicare, you do not have the freedom to choose a long, healthy retirement.

Freedom requires more than the absence of laws and taxes. True freedom of choice requires the capability to make that choice — and the free market doesn’t always give us that capability.

Jobs are scarce. Most of us don’t have the freedom to work anywhere we want. We take what we can get. For many of us, that means working at a company that doesn’t pay for our health insurance. So we “choose” to buy insurance on the individual market.

Before Obamacare, the individual market charged really low rates to healthy people and really high rates to sick people. So the people who needed insurance the most couldn’t afford it. They didn’t have the capability — and therefore the freedom — to buy it.

Obamacare outlaws that kind of discrimination. It requires insurers to charge the same rates to healthy and sick people alike, and that means that healthy people will have to pay higher rates. Some of them won’t want to, so they’ll stop buying insurance. When they drop out, they leave behind the sicker people who are most costly to insure, forcing insurers to raise rates even more. It’s a vicious cycle, a “death spiral,” that results in almost everyone being priced out of the market.

Virtually no one will have the freedom to buy health insurance on the individual market.

And that’s why we have an individual mandate. If the healthy people don’t drop out, there’s no death spiral, and the insurance remains affordable for the people who need it the most.

The government gives them a freedom that the free market cannot. It gives them the capability to purchase health insurance.

If we choose not to buy insurance, we pay a penalty. As Supreme Court Chief Justice John Roberts has written, “it makes going without insurance just another thing the Government taxes, like buying gasoline or earning income.” Those taxes pay for our roads and Army and Navy and Social Security and Medicare — and those things give us the freedom to live a life that we often take for granted. Without those taxes, without those government-funded investments, we could not call ourselves a free country.

In the same way, without Obamacare, without the government making us buy health insurance, we would be condemning millions of Americans to lives without health care. We would be restricting their freedom. And what right do we have to do that?

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This op-ed was published in today’s South Florida Sun-Sentinel and Huffington Post.

Do the Math: People Don’t Choose to Be Poor or Unemployed

Long-Term Unemployment HistoryGod, I wish I were poor.

And unemployed. That’s the good life. Poor and unemployed.

I mean, just look at all the cool stuff you get. Medicaid and welfare. Food stamps and unemployment insurance. And don’t forget public housing.

This stuff is so awesome that it’s like a “hammock that lulls able-bodied people to lives of dependency and complacency, that drains them of their will and their incentive to make the most of their lives.” That’s what Paul Ryan says, at least, and as the Chairman of the House Budget Committee, he’s supposed to know these things, right?

According to Ryan and his fellow Republicans, if I have unemployment insurance, I’ll never want to work again. Senator Rand Paul says it will cause me “to become part of this perpetual unemployed group.” With an average benefit of $269 per week, I’ll be living on Easy Street.

This is a common belief. There’s an email making the rounds from a 54-year-old consulting engineer who makes $60,000 a year and has to pay $482 a month for health insurance under Obamacare, but that’s not his biggest complaint. He’s really upset that his 61-year-old girlfriend who makes $18,000 a year only has to pay $1 a month for health insurance.

He thinks she has it so easy that she can afford to pay more, but he’s wrong.

On average, Americans earning $18,000 a year pay more than $3,000 in taxes, so she really only has $15,000 leftover to pay her expenses. She lives in Monterey, CA, where the average rent and utilities add up to $15,000 a year. So, after paying taxes, rent, and utilities, she’s completely broke. She doesn’t have money for food, let alone health insurance.

The consulting engineer thinks people will choose her lifestyle over his. “Heck, why study engineering when I can be a schlub for $20K per year?” he asks. (Nice way to talk about your girlfriend, by the way.) To which I’d like to reply: If being a “schlub” is so attractive, why don’t you do it? Why don’t you quit your engineering job and join the “$20K per year” club?

For that matter, why don’t we all quit our jobs right now and start collecting unemployment insurance? How far do you honestly think we can stretch $269 a week?

I’ll tell you how far: It would cover less than half of the basic necessities for the average American family.

That’s why unemployment makes you more likely to have to borrow money from a friend, withdraw money from your retirement savings, and have trouble paying your medical bills, rent, and mortgage. It makes you more likely to have a stroke or heart attack, lose self-respect, have difficulty sleeping, and seek professional help for anxiety and depression. It makes you more likely to kill yourself, kill others, and drink yourself to death.

And if you’ve been unemployed for more than a few months, most employers won’t even look at your résumé. It doesn’t matter how qualified you are. It’s like you don’t exist anymore.

The last time it was this bad, with long-term unemployment close to 3 percent of the workforce, was the peak of the 1980-81 recession. Back then, the federal government kept extended unemployment insurance in place for almost two more years, until the long-term unemployment rate fell close to 1 percent. In fact, that’s been standard operating procedure for every recession in the modern era, including 1990-91 and 2001. But now, with long-term unemployment as high as it’s been since World War II, Republicans have killed the emergency unemployment insurance program, and they’re fighting Democrats’ efforts to restore it.

They don’t seem to care that there are 2.9 applicants for every job opening. They don’t seem to care that people on unemployment insurance actually spend more time searching for work than their fellow unemployed who are ineligible for benefits. They’re sticking to their story.

On the 50th anniversary of the War on Poverty, many Americans are still operating under the assumption that people choose to be poor and unemployed, that they’d rather be lazy than rich, that they can afford the basic necessities of life. But the numbers tell a different story.

I don’t wish I were poor. Or unemployed. And I sure don’t wish it on anyone else. If you did the math, neither would you.

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This op-ed was recently published in the South Florida Sun-Sentinel and the Huffington Post.

Good News: Obamacare Clearly Isn’t Stifling the Economy

Part-Time Employment Before and After ACA

The latest GDP numbers are bad news for Obamacare critics.

You’d think that everyone would be happy when the Commerce Department announced that our economy grew by a whopping 4.1 percent in the third quarter of this year. But according to the naysayers, that wasn’t supposed to happen.

One of their biggest complaints against Obamacare was that it would stifle the economy. Penalties and fines would raise the cost of doing business. High premiums would impoverish middle-class families. Forcing businesses to offer health insurance to full-time employees would make them switch to part-time employees — or stop hiring altogether.

And yet, the more of the law that’s implemented, the better the economy seems to perform. How can that be?

Well, for one thing, the cost of Obamacare has been greatly exaggerated. The law states that companies with more than 50 workers must offer health insurance to their full-time employees or pay a fine of $2,000 per employee. That may sound like a lot, but it’s a heck of a lot less than most companies are already paying for health insurance, which costs an average of $15,073 per worker.

“You’ve got 5.7 million firms in the U.S.,” says health economist Mark Duggan. “Only 210,000 have more than 50 employees. So 96 percent of firms aren’t affected. Then if you look among those firms with 50 or more employees, something on the order of 95 percent offer health insurance.”

When you add it all up, the “employer mandate” probably affects less than 1 percent of the workforce. Definitely not enough to make a dent in the economy.

So it shouldn’t come as a surprise that there is no evidence that Obamacare is turning us into a “part-time” economy. Since President Obama signed the law, the economy has added millions of full-time jobs, while part-time jobs have actually declined. A lower percentage of workers are part-time than they were under President Reagan in the 1980s. Over the past year, there has been a significant decline in the number of people working part-time “for involuntary economic reasons.” And when you look at the part-time definition of “less than 30 hours per week,” the number of workers who fall just below that cutoff has been growing slower than the number of workers just above it.

And it makes even less sense to argue that the employer mandate would cause employers to drop coverage. If they’re offering coverage, it’s because their employees want it, and they want to attract and retain good employees. They’re not going to stop just because the penalty costs less than the insurance. If they wanted to drop coverage, they could have done it before Obamacare, when there wasn’t a penalty at all. In fact, in the years after Massachusetts enacted an employer mandate, their employer-based insurance coverage actually increased while the rest of the nation’s decreased.

What’s more, those small businesses that do offer coverage will receive a sizeable tax credit. For the small businesses that already offer coverage, this is a huge windfall. For the ones that don’t, the tax credit may make it profitable for them to do so. And since they fall under the 50-employee cutoff, they won’t be penalized if they don’t offer coverage.

The only remaining question mark is exactly how the employer mandate will affect insurance premiums. Since it doesn’t go into effect until the beginning of 2015, we’ll have to wait until the end of 2014 to find out. Just like this year’s fiasco, there will probably be a lot of complaints about dropped coverage and raised rates, and then those complaints will fade away as people realize that most of them can get better coverage and, on average, rates are going down.

And, as an added bonus, those Americans who do lose their employer-based coverage now have the comfort of knowing that they won’t be denied coverage or charged discriminatory rates on the individual market, thanks to the individual mandate and the online marketplace that are now in place. They will get affordable insurance, and they will live healthier lives, and they will continue to contribute to the rising productivity that is making our economy grow so fast.

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This op-ed was published in the Huffington Post, and a slightly edited version was published in the South Florida Sun-Sentinel.