Last week, my far more conservative colleague Quin Hillyer and I shared a laugh over our identical takes on Gov. Bobby Jindal’s proposed budget. “What will we agree on next?” I wondered.
“I’ve called for an oil tax hike, a cigarette tax hike and other tax reform to ‘tax the rich,’ ” he wrote back. “It’s your turn to come my way!”
Point taken, I answered. Challenge accepted.
So today, I want to talk about the Affordable Care Act.
Regular readers of this column know that, despite its many shortcomings and rollout snafus, I support President Barack Obama’s health care law.
I believe in many of the policy goals, from vastly expanding affordable health coverage, to protecting people from financial ruin if they happen to get sick, to ending discrimination against people with pre-existing conditions.
I find it appalling, both fiscally and morally, that Jindal and the Legislature have consistently rejected the law’s Medicaid expansion, a key component that the U.S. Supreme Court later declared optional. I’d be willing to bet a significant chunk of change that the next governor, Republican or Democrat, will reverse course and that hospitals now struggling to treat unnecessarily uninsured patients will be grateful.
I admit that the issue is at least somewhat personal. A couple of years ago, I faced a difficult career decision, and the ACA’s guarantee that I’d always be able to purchase insurance despite a long-ago skin cancer scare gave me the freedom to choose the riskier — but right — path. I, too, am grateful.
I don’t have a problem with the idea of reasonable mandates, particularly the requirement that everyone have insurance if they can afford it or pay a penalty. Citizenship carries lots of requirements, and because emergency rooms must treat everyone who enters, those who choose to go uninsured often shift the cost of their care onto the rest of us. That’s one reason conservatives who espouse the notion of personal responsibility not only once backed the law’s general ideas but came up with them in the first place.
And yet …
I do have some problems with the law, and one of them is the requirement that every policy contain certain essential benefits. The list is packed with important things, from mental health coverage to hospitalization to free preventive care, and there are all sorts of arguments in their favor. But the upshot is that government does indeed restrict consumer choice and deprive customers of the ability to select, say, cheaper plans that cover only catastrophic expenses.
“You can’t have all those mandates and keep your policy,” Quin said, and he’s right. The administration badly miscalculated by assuming that everyone would agree that policies with fewer benefits are substandard, and it outlawed options that some customers may well have preferred. Even former U.S. Sen. Mary Landrieu, who spent much of her losing re-election race defending her pro-ACA vote, conceded that offering a wider spectrum of plans might be a good idea.
The limited options not only make for questionable policy. They’ve been a political disaster.
Charitably read, Obama’s promise that people who like their insurance can keep it was based on the notion that nobody would like coverage that the administration deemed substandard. That’s clearly not true, and as a result, his vow was downright dishonest. On that, Quin and I agree as well, although I’d bet that many folks who got those infamous cancellation notices are just fine with their replacement insurance.
And the lack of transparency has only given ammunition to opponents and fueled resentment. Take the much-maligned requirement that everyone, even men, carry pregnancy coverage. Of course, it’s ridiculous on its face, but it didn’t come out of nowhere. Maternity coverage is one of the essential benefits, and the law’s crafters required it to be included in all policies so that women wouldn’t have to pay higher premiums simply due to their gender. There’s a good argument for that, but the flip side is that men now pay more than they would if all the costs were put on women. I don’t think the reasoning behind the policy was fully explained or the pros and cons fully debated.
Not long ago, after listening to a local Republican politician rant about the health care law didn’t do anything for anyone, I told him what it had done for me.
“Oh, I support that part,” he said. “It’s the rest of it.”
Of course, that part didn’t exist before the law was passed, and it’s far from the only thing worth saving.
The good news is that it’s not too late. If Congress would look for ways to improve the ACA rather than just try to kill it and throw millions back off their insurance, maybe it’d come up with something that more people could support.
Hey, if Quin and I can agree on what’s worth re-examining, perhaps there’s hope up in Washington.
Stephanie Grace can be contacted at firstname.lastname@example.org.