The Obama administration announced late yesterday that 800,000 people have signed up for new health insurance so far in March. That brings the total under the Affordable Care Act to over 5 million and makes it likely that 6 million will have enrolled by March 31, the last day to sign up before getting a fine. That 6 million number would meet a projection made by the Congressional Budget Office. So what are we to make of those numbers?
To a degree, targets like these are arbitrary when we’re judging the law’s success. It isn’t as though we’ll say that if 5,999,999 people signed up by the end of the month then the law has failed, while if 6,000,001 sign up then it has succeeded. Nor does that number include the millions of people who have been enrolled in Medicaid, many of whom are getting health coverage for the first time. And the number of people signed up will continue to rise, particularly since the fines are quite small in the first year but get larger over time. But it’s worth remembering that for all the time we spend gaming out the political winners and losers of Obamacare, there are real people’s lives at stake.
If you were just watching political ads, you’d think that there were precisely zero Americans who had actually been helped by the ACA, since for some rather strange reason, the law’s advocates seem reluctant to actually tell the individual stories of those who have gotten covered for the first time, or can now get coverage despite a pre-existing condition. Meanwhile, the law’s opponents have spent millions of dollars blanketing the airwaves in states with upcoming elections, telling horror stories of people whose lives have allegedly been devastated by the ACA. And yes, nearly every one of those stories turns out to be utterly bogus when it is examined. But how many voters know that?
Another reality works against the administration: It’s now easy to blame everything that goes wrong in anything having to do with health care on the ACA. Sure, premiums have gone up every year for as long as anyone can remember. But this year’s increase? Obamacare! Your boss decided to cut back your benefits to pad his bottom line? Obamacare! And did you know that under Obamacare, people will continue to fall ill and even die?
And Republicans work like dogs to undermine the law and make sure it helps as few people as possible, then hold up their success at denying the law’s benefits to their own citizens as evidence that the law was misconceived in the first place. Nowhere is this more evident than on the issue of the expansion of Medicaid, where most Republican-controlled states have said no to the federal government’s offer of billions of dollars in what is essentially free money to get coverage for poor Americans.
Most cruelly, many of the states that have refused to accept the Medicaid expansion are those where Medicaid benefits are most stingy to begin with. Each state sets its own eligibility levels, and not too surprisingly, states run by Republicans tend to set them extremely low. So for instance, if you’re a single parent in Alabama with two kids and you earn a princely $3,221 a year, the state considers you too wealthy to get Medicaid. In Texas, which has more people living without health insurance than any other state, that figure is $3,737. Millions of the working poor could have gotten coverage from Medicaid through the expansion, but their state legislators and governors quite literally believe that it’s better for a poor person to have no health coverage at all than to get coverage from the government.
By one analysis, 5.2 million Americans who could have gotten Medicaid if their states had accepted the expansion will remain uninsured. And if you asked those people in a poll whether Obamacare had helped them, they’d quite reasonably say no.
So Republicans in those states can laugh all the way to election night. They got to screw the poor, which, let’s be honest, they were inclined to do anyway, and in doing so they also did political damage to the Obama administration. Quite a trick.
Republicans may well get political benefit from the issue in this year’s election, particularly if Democrats continue to do such a weak job of defending the law. But that doesn’t really matter in the long run. The law isn’t going to be repealed, something Republicans know as well as Democrats. For all its complications and the difficulty of implementation, the ACA has already done an extraordinary amount of good for those millions of people. If Republicans took their newfound concern for (some) people’s access to health care and used it to actually work to make the law work as well as possible, millions more might be helped as well. If only.
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