Col Owens is a retired Legal Aid attorney who serves on the boards of directors of two health care reform advocacy coalitions: Kentucky Voices for Health and the Universal Health Care Action Network of Ohio.
Republicans have been denouncing the Affordable Care Act (ACA) since before its passage in 2010. They call it a “disaster,” a “failure,” the “ruining of the health care system.”
Nothing could be further from the truth.
It is first worth noting that the ACA, or “Obamacare,” was in fact a Republican idea. Mitt Romney, the Republican presidential candidate in 2012, implemented a virtually identical program in Massachusetts in 2006 while he was governor.
Republicans complain about the individual mandate, that everyone must have insurance or pay a penalty. Yet they want to continue coverage for pre-existing conditions. They fail to acknowledge that these provisions are closely connected, that mandatory participation pays for that coverage.
Ironically, they argue the need for a private sector approach. The ACA is built on the private sector: subsidized insurance for those who can afford to pay partial premiums, Medicaid coverage for those who cannot. It is a balanced approach, based on ability to pay. And providers get paid. It works.
* The U.S. uninsured rate has declined sharply since the ACA was implemented, especially among lower-income Americans, according to the Council of Economic Advisors.
* Enrollees do not have problems obtaining care. The Council has also determined that the decline in the uninsured rate is accompanied by a similar decline in people having problems obtaining care because of cost.
* Hospitals have benefited greatly from the ACA. Uncompensated care burdens have declined from 4 percent of operating costs to less than 2 percent - saving tens of billions of dollars - especially in states that expanded Medicaid. (The ACA requires states to expand Medicaid to the working poor, but the U.S. Supreme Court ruled that an option.)
* National health care spending as a percentage of GDP has declined faster than expected. The average growth in per-enrollee spending has declined from 5 percent in 2000-2010, to 1.5 percenet in 2010-2015. This decline affects hospitals, physicians, and prescription drugs.
* The Kaiser Family Foundation has documented the impact of this spending decline on employer-sponsored insurance. From 2000 to 2010, employer-based premiums rose 5.6 percent per year on average. Under the ACA, that increase has dropped to 3.1 percent.
These findings, well documented and widely covered in the media, should cause all Americans to question the unrelenting Republican attack on the ACA. As Hiltzik concludes, if the above findings are what failure looks like, what would define success?
Why the GOP Opposes It
The truth is that Republicans oppose Obamacare for political reasons. They did not want President Obama to achieve a major success -- more than they wanted Americans to receive health care. The continuing irony, that they cannot agree on a better idea because Democrats adopted their idea in 2010, would be laughable if it were not so tragic.
Like the dog chasing the bus, Republicans have now caught it – and must figure out what to do with it. It’s a tall order. Hiltzik notes that most of their ideas do not decrease costs but instead redistribute them, from government to individuals and families already struggling to pay ACA-subsidized costs.
The fate of Obamacare is one of the most significant issues facing the new Administration and Congress. It took more than 100 years – since Teddy Roosevelt’s earliest attempts - to devise a program that provides health care to all Americans.