Liberty vs. Equality

On the Right, they are freaking out about the healthcare decision.  It reminds me of a conversation I had recently.  Many political choices seem to boil down to greater liberty against greater equality. The ACA is about helping people who wouldn't otherwise have health insurance. Being asked to buy insurance when you can afford it is a Republican idea.  Right wing opponents want the freedom to not give a shit about anyone else but themselves.

ACA Upheld

I now forgive Chief Justice John Roberts for screwing up the Presidential oath of office.

The best part of the decision was how the Court punked CNN and Fox.

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Update (July 21, 2013):  Republicans like to predict failure, but they're actually afraid that the law will work.

The fact remains that even though some big insurance companies have refused to sign up, states that have created insurance exchanges have seen the "magic of the marketplace"--once a favorite phrase of Republicans--drive down the cost of individual insurance policies.  In New York, Oregon, and California, rates have fallen as much as 50 percent.

Update (July 26, 2013):  Norm Ornstein blasts Republican efforts to sabotage the law as unprecedented. Jonathan Bernstein reports on efforts to discourage people from signing up for health insurance.

Update (August 2, 2013):  Alex Seitz-Wald writes about the insane effort to discourage younger people from signing up for health insurance.

Update (August 3, 2013):  Christopher Flavelle also comments about this offensive campaign.

Update (August 4, 2013):  Ezra Klein calls it a kamikaze mission to stop Obamacare.

Update (September 3, 2013):  A Washington Post editorial tells Republicans to get out of the way.

Update (September 27, 2013):  Kurt Eichenwald collects all the Republican lies about Obamacare in one convenient place.

Update (October 5, 2013):  Eichenwald follows up by explaining how everyone benefits from Obamacare.

Update (October 23, 2013):  So far, state exchanges are working better than the Federal website--which may put pressure on Republican dominated states to start their own sites.

Update (October 24, 2013):  Mike Konczal suggests that many of the problems with the ACA rollout have to do with the added complexity of this "neoliberal" plan.  Which means any reform might move the health care system closer to what one might call a truly socialist plan.

Update (October 29, 2013):  There's a headline about how millions of people are getting cancellation letters for their health insurance.  But the context is that junk policies aren't legal anymore.  Some will pay more, but others will get subsidies for better coverage.

Update (October 31, 2013):  The idea has no traction in the United States, but a single-payer health insurance program would be simpler.

Update (November 2, 2013):  And while the ACA does many good things, a reminder that there's been misplaced trust in the private insurance industry.

Update (November 4, 2013):  Heatlhcare.gov got off to a bad start and no small part of the blame goes to Republican sabotage.

Update (January 7, 2014):  ACA now running relatively smoothly, as long as states are helping, and despite a concerted effort to spread "horror stories".

Update (January 15, 2014):  Turns out people actually want health care insurance.  Who knew?

Update (February 5, 2014):  A report from the Congressional Budget Office concludes that the ACA will be cheaper than expected and will significantly increase the number of Americans with health insurance.  The fact that many people will be able to reduce their work hours or leave their jobs altogether because they don't have to rely on employer provided insurance got reported as "Obamacare will cost 2 million jobs".  It turns out ACA will actually reduce unemployment.

Update (April 1, 2014):  With open enrollment over, ACA reaches the original goal.  And the Republicans hate it.

Update (April 14, 2014):  The Congressional Budget Office now projects that the ACA will cost less than previous estimates.  Also, Jim Newell argues that John Roberts is no hero for ruling that states could opt out of the Medicaid expansion.  That decision gutted the most effective means for reducing the rate of uninsured.

Update (April 19, 2014):  From the White House fact sheet: 8 million people signed up and 35 percent are under age 35.  ACA is now a real success.

Update (June 6, 2014):  Medicaid enrollment is up and so the percent of uninsured is down. Looks like Republicans are giving up the argument over ACA.

Update (July 5, 2014):  The New England Journal of Medicine has a progress report on ACA including a summary of enrollments since the exchanges opened last October 1.

Update (July 11, 2014):  The Commonwealth Fund conducted a health insurance survey:

Unfortunately, 5 million people who could have been covered by Medicaid live in Republican-controlled states.

Update (July 24, 2014):  Simon Maloy makes the point that Republicans are perfectly happy creating havoc with people's lives as long as it means an end to Obamacare.  But a Circuit Court ruling against subsidies (based on a typo) is likely to be overturned.  Meanwhile, 72 percent of Republicans say ACA has helped nobody even as a study shows (on the order of) ten million people have gained health insurance and even as 74 percent of newly insured Republicans express satisfaction with their plan.

Update (August 6, 2014):  ACA seems to be working well in states that aren't trying to fight it.  But that doesn't stop some politicians from criticizing the problems their own sabotage created.

Update (January 7, 2015):  Looks like the law is working.

Update (August 13, 2015):  And still working with 15.8 million fewer uninsured which bring the rate below 10 percent uninsured for the first time in 50 years.

Update (September 17, 2015):  Census data show similar reductions for uninsured in 2014.

Update (November 20, 2015):  Because profits are not quite as high as they'd like, an insurer might leave the ACA exchanges? I'm not sure if there's a real problem or if it's just trying to make the program look bad.

Update (November 23, 2015):  Would an insurer lie about their profits?  I'm shocked. Paul Krugman says it's not all good news, but the law is working.

Update (April 22, 2016):  From the editorial board of the New York Times.

Debunking Republican Health Care Myths

Central to the presidential campaigns of [The Republican nominee] and Ted Cruz has been the claim that the Affordable Care Act has been a complete failure, and that the only way to save the country from this scourge is to replace it with something they design.

It’s worth examining the big myths they are peddling about the Affordable Care Act and also their ill-conceived plans of what might replace it.

Millions of people have lost their insurance: In January, Mr. Cruz claimed that “millions of Americans” had lost their health insurance because of the health reform law. He even claimed to be one of them, saying “our health care got canceled” because Blue Cross Blue Shield left the individual market in Texas.

Insurers did stop offering some plans after the law took effect, including those that didn’t provide required benefits like maternity care or that charged higher premiums to older or sicker people. But people with those plans had the opportunity to sign up for others. And over all, the law has drastically reduced the number of Americans who lack health insurance. According to the Census Bureau, the number of uninsured Americans dropped by 10 million between 2010, when the law passed, and 2014. While critics said employers might stop offering health insurance because of the law, three million people actually gained coverage through their employers between 2010 and 2014.

Incidentally, Mr. Cruz never lost his health insurance. Blue Cross Blue Shield did cancel his particular plan, but it automatically moved him and his family to a new one. A Cruz spokeswoman said the senator had been misinformed by his insurance broker.

Millions of people have lost their jobs: Mr. Cruz has called the Affordable Care Act “the biggest job-killer in this country” and said “millions of Americans have lost their jobs, have been forced into part-time work” because of it. This is false. The unemployment rate has fallen since the law took effect, PolitiFact notes, as has the number of people working part time when they would rather work full time. A2015 study using data from the Current Population Survey found that the law “had virtually no adverse effect on labor force participation, employment or usual hours worked per week through 2014.”

Reduce costs by weakening state regulations: [The Republican nominee] frequently talks about his plan to “get rid of the lines around the states” to foster competition among insurance companies. Customers in states where insurance is heavily regulated, the thinking goes, would be able to save money if they could purchase coverage from insurers based in states with fewer rules. Mr. Cruz, too, supports allowing people to buy insurance across state borders — it’s one of the few proposals he’s offered for replacing the health law if it is repealed.

But the biggest obstacle stopping insurers from setting up in more states is not regulation; it’s the difficulty of establishing a network of providers in a new market. And such a structure would destroy the longstanding ability of states to regulate health insurance for their populations. Some states, for instance, require coverage for infertility treatment and others have chosen not to. Allowing cross-border plans would encourage insurers to base themselves in low-regulation states, and the result might be a proliferation of poor-quality plans.

The Affordable Care Act is not perfect. Premiums for plans on the exchanges rose between 2015 and 2016 and are likely to rise again next year. A few insurers have left the exchange market, raising concerns in some quarters that more companies might follow.

But the law has helped millions of Americans, especially low-wage workers like cashiers, cooks and waiters who previously struggled to pay for coverage. In inventing problems that don’t exist and proposing solutions that won’t help, [The Republican nominee] and Ted Cruz show that they don’t care about helping Americans get health care, which has never been their interest. They want to trash the Affordable Care Act, and they’re willing to mislead the public any way they can.

Update (November 5, 2016):  A report from the Centers for Disease Control finds that the uninsured rate is now about 9 percent, down 5 points since ACA took effect.

Update (June 1, 2017):  A study finds that single-payer health insurance saves money.

Update (December 22, 2017):  Despite the sabotage, enrollment for 2018 through the exchanges is down only 4 percent.

Update (January 17, 2018):  About 3.2 million Americans lost health insurance in the past year.

The percentage of American adults who aren't covered by health insurance rose from 10.9 percent in the final fiscal quarter of 2016 to 12.2 percent in the final fiscal quarter of 2017, according to a survey by Gallup and Sharecare.

Update (July 4, 2018):  Jonathan Cohn and Jeffrey Young report that Republican sabotage is working.

[T]he future of the Affordable Care Act remains in the hands of officials and lawmakers determined to undermine it ― and then cite its shortcomings as reason to wreck it even more.

Meanwhile in a widely reported story, a women who was rescued by fellow passengers from having her leg pinned by a train asked them not to call an ambulance because she couldn't afford it. "I have terrible insurance."

Update (July 8, 2018):  Republicans never stop looking for ways to screw people.

Update (August 5, 2018):  New rules on "short term" health insurance plans amount to another form of ACA sabotage.

Update (December 15, 2018):  An "insane" ruling by a federal judge in Texas says ACA is unconstitutional because the fine on the individual mandate was reduced to zero and is therefore no longer a tax.

Update (January 25, 2019):  They couldn't kill ACA, but Republican sabotage helps push the uninsured rate back up.

Update (July 26, 2019):  A study from the National Bureau of Economic Research finds that the Medicare expansion provided by ACA reduced mortality by 0.2 percent. But since the Supreme Court allowed states to opt out of the expansion, 15,600 people died unnecessarily.

Update (August 2, 2019):  Some candidate claimed that Medicare for All would force hospitals to shut down. Turns out most of the rural hospitals in financial difficulty are in the states that refused to expand Medicaid.

Update (December 18, 2019):  The U.S. Court of Appeals for the 5th Circuit upheld most of last year's ruling from Texas that the ACA individual mandate is now unconstitutional. An appeal will to the Supreme  Court. Maybe it should be scrapped to force the issue on Medicare for All.

Update (August 8, 2020):  Fuckface has the gall to propose an executive order "requiring health insurance companies to cover all pre-existing conditions" even as the Administration argues at the Supreme Court to overturn ACA which already requires that.

Update (June 17, 2021):  The Supreme Court overturns the Texas decision 7 to 2.

Instead of a ruling on the constitutionality of the mandate or the necessity of striking down the whole law, rather than parts, the justices limited themselves to the standing question. Since the mandate penalty is now zero, the justices ruled, nobody is suffering an injury that requires the court to act.

First!

It's so refreshing to read a columnist who keeps things in perspective.