The grounds for the Republican Party’s opposition to the Affordable Care Act are far from a single coherent argument. It is all the more confusing because one of the health care reform’s key provisions, the individual insurance mandate, has conservative origins. The requirement that individuals be required to purchase health insurance first emerged in Republican health care reform bills introduced in 1993 as alternatives to the Clinton administration’s plan.
That mandate was also a prominent feature of the Massachusetts plan passed under Gov. Mitt Romney in 2006. According to Romney, “we got the idea of an individual mandate from [Newt Gingrich], and [Newt] got it from the Heritage Foundation,” Forbes reports. Furthermore, as Bill Keller argued in an op-ed for The New York Times, the GOP should be “the people who ought to be most vigorously applauding this success story” because the reform of the United States’s “overpriced, underperforming health care system” was done almost entirely with market incentives instead of government decree.
The fact that the idea of the individual mandate developed out of GOP rhetoric proves that the party is not opposed to the thought of making insurance affordable to millions of Americans. “Many states now require passengers in automobiles to wear seat-belts for their own protection,” Stuart Butler, a health care expert for the conservative-leaning Heritage Foundation, wrote in a 1989 brief titled Assuring Affordable Health Care for All Americans. “Many others require anybody driving a car to have liability insurance. But neither the federal government nor any state requires all households to protect themselves from the potentially catastrophic costs of a serious accident or illness.”
So the argument goes that just as legally mandated insurance makes economic sense for automobiles, it makes sense for health care, as well.
Several theories as to why Republicans want to see Obamacare defunded and repealed have been tossed around.
Republicans have said that the health care reform will destroy the economy. “Well, if you don’t believe Obamacare is the biggest job killer in the country, look to the facts,” Republican Rep. Ted Cruz of Texas said during his 21-hour speech on the Senate floor earlier this month. “This year, report after report has rolled in about employers restricting work hours to less than 30 hours per week — the point where the mandate kicks in. The data also points to record-low workweeks in low-wage industries.”
But for most companies, the employer mandate is not a huge burden. The companies that do not provide insurance and will be required to probably employ around 1 percent of American workers.
“You’ve got 5.7 million firms in the U.S.,” Mark Duggan, who served as the top health economist at White House’s Council of Economic Advisers from 2009 to 2010, told the Washington Post. “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. So it’s basically 10,000 or so employers who have more than 50 employees and don’t offer coverage.”
The unconstitutionality of the reform is another argument that has been made. Sen. Orrin Hatch wrote in The Hill’s “Congress Blog” in 2010 that that to come to “any other conclusion” than that the individual mandate is unconstitutional “requires treating the Constitution as the servant, rather than the master, of Congress.”
But given that in June 2012 the Supreme Court upheld the constitutionality of the Affordable Care Act — with exception of the requirement that states expand Medicaid — that argument has lost its validity. The fiscal argument against Obamacare, that the reform would result in tax hikes and a bigger deficit, has also been recently dropped from party rhetoric.
The theory put forward by Keller in his op-ed and by Eduardo Porter in his New York Times piece entitled “Why the Health Care Law Scares the G.O.P.” is that Republicans are worried that Americans will like the benefits of the reform too much. “You have probably figured out that the real mission of the Republican extortionists and their big-money backers was to scuttle the law before most Americans recognized it as a godsend and rendered it politically untouchable,” Keller wrote.
That argument makes sense to some degree. Speaking to radio host Rush Limbaugh in late August, Cruz said that President Obama “wants to get as many Americans as possible addicted to the subsidies, addicted to the sugar, because he knows that in modern times, no major entitlement has ever been implemented and then unwound.”
But in Keller’s opinion, it is too late. Health care reform has already accomplished its first goal of enrolling millions of uninsured Americans, “many of whom have been living one medical emergency away from the poorhouse,” he wrote in the op-ed. The fact that the computer glitches that plagued the first week the exchanges were open for enrollment was evidence of demand for affordable coverage. This demand “is the 90 percent of the story that doesn’t make the headlines,” Sam Glick of the Oliver Wyman consulting firm told Keller.
Data also show demand for reform. Kaiser Family Foundation’s March 2013 health care tracking — the same survey that showed only 37 percent of respondents held a favorable view of the Affordable Care Act — found that a plurality of those surveyed actually support specific provisions of Obamacare.
Eighty-eight percent were in favor of tax credits for small businesses to buy insurance; 81 percent were in favor of closing the Medicare prescription coverage gap; 76 percent were in favor of extending coverage to dependents; 71 percent were in favor of expanding Medicaid; 66 percent were in favor of banning exclusions for preexisting conditions; and 57 percent were in favor of the employer mandate.
The only provision that regularly polled negatively was the individual mandate, but the requirement that all Americans purchase affordable insurance is necessary if excluding those with preexisting conditions is prohibited. To function as intended, the marketplaces need a broad, healthy risk pool to keep staggering rate increases from occurring. The premiums of healthy, cheap-to-insure people cover the big bills for the relatively small number of sick people.
Here’s how the major U.S. equity indexes traded on Tuesday:
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