As we enter the final, feverish days of the midterm campaign, here’s something worth remembering: The Affordable Care Act is not going away, no matter who wins Louisiana’s contested Senate race and no matter which party comes out on top Nov. 4.
“Obamacare,” the derisive shorthand aimed at linking the sprawling law to its lightning rod architect, isn’t going away for structural reasons.
Even if Republicans take the Senate this fall and join the House in voting for repeal, President Barack Obama still has veto power, and he’d clearly nix any bill that would undo his signature legislation. And if opponents are waiting on whoever’s elected in 2016, well, a more diverse presidential electorate and a crop of Senate elections that favors Democrats at least as strongly as this year’s favors Republicans makes an anti-ACA wave unlikely.
It’s also not going away for practical reasons. Because it’s helping people, right now.
Democratic U.S. Sen. Mary Landrieu, who’s caught hell for backing the ACA, is right that it’s far from perfect. But she’s also correct that the law has provided genuine, real-life benefits that recipients would be loathe to lose.
It’s allowed young adults to remain on their parents’ plans through age 26, in an economy in which entry-level jobs with benefits can be hard to find. It’s provided subsidies for many who otherwise couldn’t afford coverage, and it’s allowed those with pre-existing conditions to obtain insurance that was previously unavailable or unaffordable. That last part has given thousands of people the freedom to start businesses or leave dead-end situations. You can’t take all that away without causing widespread pain.
In Louisiana, the ACA would be helping still more people if Gov. Bobby Jindal had worked with the Obama administration — even if he really believed it meant making the best of a bad situation — rather than trying to score political points.
We’d have the Medicaid expansion, which would have provided some 240,000 low-income Louisianans with insurance, mostly financed by federal dollars that are now going to other states. It’s no accident that two leading GOP candidates to succeed Jindal, U.S. Sen. David Vitter and Lt. Gov. Jay Dardenne, have hinted that they’d take the money. They oppose the ACA, too, but get that Medicaid expansion is a good deal.
We’d also have a state exchange, rather than the problem-plagued federal version available to states that refused to set up their own. Yes, some of these online marketplaces have run into big trouble as well, but others are working and actually quite popular. How popular? During a recent Senate debate in Kentucky, Minority Leader Mitch McConnell talked of somehow keeping his state’s exchange even as he vowed to pull the ACA out, “root and branch.”
Jindal too had the chance to set up a workable exchange, which in theory would have bolstered his broad argument that the states can do better than the federal government and that he can do better than Obama. Too bad he didn’t try to prove his point.
Mostly, though, the ACA is not going away because everything wasn’t fine before the law came along. U.S. Rep. Bill Cassidy, a doctor and vocal ACA critic who’s trying to unseat Landrieu, talks of an idyllic relationship between physicians and patients uninterrupted by bureaucrats. But for years, the insurance industry has been in that room too. The ACA imposes new regulations, and some of those have led to higher costs for more coverage, but the idea was always to balance the industry’s profit motive.
Cassidy implicitly acknowledges that changes were needed. Asked at last week’s Louisiana Public Broadcasting debate whether he’d maintain pre-existing condition coverage, he said yes and offered a plan to provide tax subsidies for insurance through companies that don’t discriminate.
That ACA opponents know they need to preserve this coverage speaks to just how far the ball has moved already. Most politicians paid lip service to such benefits before, but now they know they have to do something about it.
Cassidy also proposed laws when he was in the state Legislature to create exchanges and require mental health coverage for small employers. He’s right that those proposals differed from the ACA — he points out, for example, that he wouldn’t have required a defined package of services or mandated coverage — but he obviously understands that there were shortcomings.
And yes, there are problems now, too. The mandated minimum coverage that Cassidy criticizes has indeed driven up the cost of some policies. The specifics on that and countless other pieces of the complex law can and arguably should be adjusted. That’s how major legislation generally works; you look at how things are playing out, listen to feedback, consider unforeseen consequences, and shift course until you get it right.
Realistically, that’s the most voters can expect from Washington once the votes are counted. Anyone who’s promising more is simply posturing.