Here’s Why America’s Health Care War Is Far from Over

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“Normally, this would be pretty straightforward. A lot of people don’t have health insurance. A lot of people realize they should get health insurance. But let’s face it, it’s been a little political, this whole Obamacare thing,” noted President Barack Obama during his discussion with former President Bill Clinton at the Clinton Global Initiative Health Care Forum on Tuesday in New York. Describing the debate that has hounded the Affordable Care Act as “little political” is rather an understatement.

At 2:41 p.m. Tuesday afternoon, Republican Senator Ted Cruz of Texas began speaking on the Senate floor, announcing that, “I intend to speak against Obamacare until I am no longer able to stand.” By 10 a.m. EDT on Wednesday, Republican Senator Ted Cruz of Texas had been speaking for 19 straight hours. It will be one of the last political maneuvers in the chess match playing out in Washington over the future of the health care reform, a match that has been dominated by the campaign of several Tea Party-backed conservatives to defund the law in order to prevent its implementation.

Ironically, the beginning of enrollment for the Affordable Care Act’s key provision — the individual insurance exchanges — and the first day of the new fiscal year are on the same date: October 1. Since Congress failed to pass the 12 regular appropriations bills that fund government activities in fiscal 2014, lawmakers must now either approve a temporary spending bill or allow a widespread shutdown of federal agencies. The timing of the beginning of the fiscal year and the opening of the exchanges gave Republicans one last opportunity to throw a roadblock in the way of implementation. For months, Tea Party-backed conservatives have been pushing their colleagues to vote against any spending bill that funds the health care reform.

Ted Cruz’s speech was the keynote event in the campaign. But technically, his speech is just that a that — a speech — not a filibuster because the day’s session had already been adjourned. According to the Senate’s procedural rules, the vote on the House of Representative’s temporary spending bill, which will fund the federal government for the upcoming fiscal year if discretionary spending for the Affordable Care Act is eliminated, was scheduled for Wednesday without any possibility of delay.

But that reality did not in any way stop Cruz from pulling an all-nighter. He discussed the American revolution, explaining that, “Obamacare isn’t working,” and at 8 p.m., he read Dr. Seuss’ “Green Eggs and Ham.” Once finished with the recitation, he offered up a comparison between the story and the health care reform that ignored the ending of the book. “‘Green Eggs and Ham’ has some applicability, as curious as it may sound to the Obamacare debate,” he said. Americans “did not like green eggs and ham, and they did not like Obamacare either. They did not like Obamacare in a box, with a fox, in a house, with a mouse,” he explained.

Even though bill pushed through by Republicans in the House of Representatives last Friday funds the government in the new fiscal year and defunds Obamacare, Cruz has urged his colleagues to block the bill in the Senate. His fear is that Senate Majority Leader Harry Reid will add an amendment to the continuing spending resolution that will counteract the provision that prevents the health care reform from being funded. Many Republicans in the Senate have shown little support for the strategy. “We’d all be hard-pressed to explain why we were opposed to a bill we were in favor of. And invoking cloture that defunds ObamaCare, doesn’t raise taxes, and respects the Budget Control Act strikes me as a no-brainer,” Senate Republican Leader Mitch McConnell said Tuesday.

Some Republicans are also dubious that the campaign to defund Obamacare has any chance of succeeding. Both President Barack Obama and Democrats in the Senate, where the party has a majority, have made clear that legislation would not progress any further than the House of Representatives, which of course makes a government shutdown likely unless someone gives up.

Without that resolution, significant parts of the government could shut down on October 1, and within several weeks, the United States could default on its federal debt for the first time in history. Republicans are worried the party will take the blame in the event of a government shutdown, as Republican Senator Orrin Hatch of Utah has said.

The CNBC All-America Economic Survey of 800 people across the country found that Americans oppose defunding the Affordable Care Act by a margin of 44 percent to 38 percent. Not only are a plurality of Americans against defunding the health care reform, but respondents’ opposition increased when asked if they supported defunding at the cost of a government shutdown. To that query, 19 percent said that Obamacare should be defunded even if the government is shut down as a result, while 59 percent answered no and 22 percent were unsure. Still, the fight over Obamacare has done much to create fear and very little to ease the uncertainty and doubt that Americans have expressed in survey after survey.

The fallout from battle in Washington will by no means end once enrollment begins. In the coming months and years, economists, government health officials, and the American public will begin to understand exactly how the new system will work, and The Wall Street Journal’s Holman Jenkins, Jr. argues that the war over health care will have an unexpected outcome.

Already, the balance between the two types of subsidies in the health care system are tipping dangerously, and Trader Joe’s decision to cancel insurance coverage for part-time workers proves that point. Companies do not have to provide coverage to employees who work fewer than 30 hours per week to be in compliance with the Affordable Care Act’s employer mandate, so instead, Trader Joe’s gave its part-time workers $500 each to buy health insurance on an individual exchange. That is actually a better deal for employees because the subsidy they will receive from the federal government and it is a better deal for employers.

According to a recent Stanford study, it makes financial sense for about 37 million people to “trade in the tax benefit for employer-provided insurance in favor of Obamacare’s direct tax credits,” wrote Jenkins. The shift would represent an additional annual cost of $132 billion for the federal government, and it is just one of the “accidental features of the bundle of liberal compromises that make up Obamacare,” he added. Plus, Obamacare contains “a large implicit subsidy for the old,” regardless of income, because the system prevents insurers from turning away those with pre-existing conditions, many of whom are proportionally older, at the expense of younger and healthier (meaning cheaper to insure) enrollees.

Then there is the problem of Medicare. Jenkins postulates that many of those future enrollees in that health care program will realize what millions of Medicare users have already discovered. If you can afford it, private insurance is a better option than fee-for-service Medicare. The fact that the Obama administration has indicated that reimbursements to doctors and hospitals will be trimmed will further affect the quality of the program.

In conclusion, Jenkins wrote that if Medicare and the tax subsidy for employers declined in importance, what would be left would be the Obamacare exchanges plus Medicaid, which “sounds a lot like the alleged GOP cure for our health-care system,” he wrote. In his opinion, the Affordable Care Act was not a reform, but a “piling on of subsidies” meant to slow down the rising cost of health care in the United States. But that system will likely only make the situation worse.

In effect, “you end up paying for your own subsidy and aren’t better off,” Jenkins said. “You are also worse off because of the perverse incentives engendered by diverting yours and everyone’s health-care spending through a common pot.” Together, those problems show “nothing has been solved, nothing has been fixed, due to ObamaCare.” And that is why America’s so-called health care wars have a “long way to run.”

Follow Meghan on Twitter @MFoley_WSCS

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