Rocky is probably the kindest word that has been applied to the rollout of the Affordable Care Act during these last two months. The image that comes to my mind is that of a roller coaster, a roller coaster composed of blue cars and red cars. The people in the blue cars are screaming. Their screams sound frightened, in fact, almost hysterical.
They are headed straight down at breakneck speed and their cars are going to fly off the rails and there will be carnage everywhere. The people in the red cars are also screaming, but their screams seem thrilled, almost giddy.
Like the blue cars, the red cars are headed straight down at breakneck speed, and, again like the blue cars, these red cars are going to fly off the rails and there will be carnage. But, the carnage will not affect those in the red cars as they will land in the gentle hand of public opinion, take flight, and regain the majority status that is rightly theirs. All the casualties will be among people in the blue cars.
As Maxwelll Smart might have put it, “Not so fast, Chief.” If you are a blue car person – like me, obviously – things are nowhere near as bad as they are being made out. If you are in a red car, like Governor Walker, things are nowhere near as good as they are being made out.
Start with the blue car folks. Why did we want the Affordable Care Act in the first place? First of all, remember all those people who didn’t (don’t) have access to medical insurance – the purpose of which is access to medical care. For both practical and especially for moral reasons, we wanted to change that. The Affordable Care Act already has. In every state in which political leaders shared the goal of expanded coverage, we have it. The principle vehicle so far has been the federally funded – that’s the ostensible reason we don’t have it here in Wisconsin – expansion of Medicaid that has brought thousands of new recipients to medical services in states all around the country. Think where we might be if the Supreme Court hadn’t given states the option to deny that Medicaid expansion. Then there are the state run medical insurance exchanges. Every one of them, including the very successful exchange in Kentucky, has worked and they are all signing people up at an accelerating rate, a rate, by the way, that matches the rate experienced almost a decade ago by the ACAs prototype in Massachusetts.
Also, despite the efforts of some of the wealthy men who pay for the tickets on the red cars, young people are signing up at the state exchanges in percentages very similar to their percentages in the populations of those states. The federal exchange is something of a mess and makes an inviting target for those people over in the red cars, but it is only part of the story. Beyond our desire to reach many more people with insurance, we wanted to tell insurance companies that there were some practices they could no longer engage in. No more lifetime limits, denial for pre-existing conditions, bouncing young people from their parents insurance at 22, or charging women more for the same policies.
Such things are a violation of the law, and, not coincidentally, some of the reasons for the cancelled policies that have red car folks so up in arms. No, the blue cars are not at some calm finish line, but we are not going to fly off the rails any time soon.
Just as blue car people ought not to be engaged in quite so much hand wringing, red car people ought to reconsider the constant high fiving. In the first place, to dismantle the superstructure of this roller coaster they will have to win control of the Senate and the Presidency. Barack Obama is going nowhere until January 2017 and he does have the veto power.
The Senate is vulnerable to a Republican takeover and if they do they will apply the new filibuster rule to policy as well as appointments. But neither house will hold a veto proof majority, so there will be three years of the ACA before they can kill it. Then, of course, since they have offered no alternative and clearly have no intention of doing so, they will have to run on the platform of going back to where we were before the law. Remember the “Republican Autopsy” performed right after the 2012 election? The party leaders concluded they needed to reach out more to African Americans, Hispanics, women and younger voters. To do so they have gone hell bent for more restrictions on reproductive rights, voting rights, marriage rights for gays and lesbians, and on and on. Now add in getting rid of the ACA and replacing it with the old system, and the Presidency looks like an uphill climb. As many commentators suggested, the Republicans greatest fear was not that the ACA would fail, but that it would succeed and people wouldn’t want it dismantled, any more than they really want Social Security or Medicare dismantled.
It might be instructive to ask ourselves if there has ever been a smooth rollout of a government sponsored health care initiative. The one word answer is, Yes. Medicare and Medicaid had their coming out parties in 1965 and 1966 and though there was more beer than champagne, there was some making of toasts and clinking of glasses. Of course, Medicare and Medicaid were rolled out in the days of paper forms, pens and typewriters, and telephones with people to answer them. Maybe the old technology was the best. Or, maybe, just maybe, Medicare and Medicaid came out so smoothly because the government was the sole provider of the insurance in question.
Enough out of me.