“Why are folks working so hard for people not to have health insurance? Why are they so mad about the idea of folks having health insurance? Many of the tall tales that have been told about this law have been debunked. There are still no death panels. Armageddon has not arrived. Instead, this law is helping millions of Americans, and in the coming years it will help millions more.” President Barack Obama, April 1, 2014
Barack Obama was understandably elated. After a rocky start, his signature healthcare law hit its original — that’s original, not revised — goal of signing up more than seven million people through insurance exchanges.
As the president pointed out, that number “doesn't count the more than three million young adults who have gained insurance under this law by staying on their families' plans. It doesn't count the millions more who have gotten covered through the expansion of Medicaid and the Children's Health Insurance Program. It doesn't include the more than 100 million folks who now have better care — who are receiving additional benefits, like mammograms and contraceptive care, at no extra cost.”
The numbers bandied about also do not include millions of newly enrolled people who bought health insurance this year outside of the state and federal exchanges. That number may be in the millions, though the exact figure is unknown at this time.
All people who purchased new insurance policies since the start of the year benefit, as the president indicated, from the Affordable Care Act’s provisions. Those benefits include charging healthy and sick people the same rates and not excluding anyone because of a prior condition. And anyone who has insurance, regardless of whether purchased on the exchanges or outside of them, goes into the same risk pool, meaning that everyone counts when premiums are set for the next year. The insurance companies don’t care what door people use to enter the risk pools; they only care that they get there.
There is evidence the public is beginning to sense the Affordable Care Act is working. A new Washington Post-ABC News poll shows an even split over the law, with 49 percent supporting and 48 opposing it. That’s not a mandate of course, but it is a significant improvement from the results of a similar poll in November, when 40 percent supported the healthcare law and 57 percent opposed it.
All this leaves Republicans adrift on health care. Sarah Palin’s death panels never materialized. GOP predictions of doom and gloom — references to “train wreck” were common late last year when the ACA’s Web site floundered — failed to come true.
Republicans have no viable alternative to Obamacare. Republican leaders continue to call for repeal of the healthcare law, but repeal has little public support. While polls show either an even split on Obamacare or narrow opposition to it, the same surveys indicate the public wants to retain the law with changes to improve it.
Most Americans know what Republican leaders fail to recognize: There’s no going back to the era prior to Obamacare when upwards of 50 million Americans lacked health insurance. A Harvard Medical School analysis in 2009 found that about 45,000 Americans died annually because they had no coverage. It was a national embarrassment — not to say downright immoral — that the United States, the richest nation in the world, was the only advanced industrialized democracy without a national system of health care.
The GOP problem is that market-oriented exchanges — where consumers buy insurance policies in a large pool — are traditional Republican policy; exchanges in one form or another were proposed by Republicans leaders throughout the 1990s. But Obama co-opted the GOP by including exchanges in his reform, and the Republican policy of opposing everything Obama leaves the party with no answers on health care.
Representative Paul Ryan of Wisconsin says of Republicans, “We need to be a proposition party, not just an opposition party.” Unfortunately for Ryan, on medical insurance it’s all opposition, no proposition.
Or to put it another way: You can’t beat something with nothing. And right now on health care, the GOP has a whole lot of nothing.