Stealing a page from the Denver Broncos’ Super Bowl playbook from last year, the Democrats have spent the fall campaign hiding from the most successful federal government program since Medicare. In spite of all the obstacles thrown up by Republicans in Congress, state governments and the courts, the program has insured far more people than expected, and health care cost growth has slowed much more sharply than anticipated.
Yet rather than boast about having the foresight and courage to support a program that passed without a single Republican vote (one Republican member of the House voted yes after the bill already had a majority), the Democrats have mostly hidden from the Affordable Care Act (ACA). In fact, they have done their best to convince voters that they have nothing to do with this program; interestingly, so have many Republicans.
Yet rather than boast about having the foresight and courage to support a program that passed without a single Republican vote (one Republican member of the House voted yes after the bill already had a majority), the Democrats have mostly hidden from the Affordable Care Act (ACA). In fact, they have done their best to convince voters that they have nothing to do with this program; interestingly, so have many Republicans.
The Democrats might have taken a cue on the popularity of the ACA from Senate Minority Leader Mitch McConnell. After spending the last four and a half years demanding that the ACA be repealed, McConnell in his re-election campaign has insisted that Kentucky’s Kynect has nothing to do with “Obamacare.” Kynect is Kentucky’s state health care exchange, which was created with federal dollars because of “Obamacare.”
Almost 100,000 people in Kentucky have signed up for private insurance through Kynect, with another 400,000 getting insurance through the ACA’s expansion of Medicaid. This means that close to 500,000 people in Kentucky, out of a population of 4.4 million, are now getting insurance in Kentucky through “Obamacare.”
Kentucky has been among the national leaders in expanding coverage. This is in part because it previously had an unusually high proportion of uninsured people. However, the expansion of coverage is also in large part due to the fact that Kentucky’s Democratic Gov. Steve Beshear accepted ACA funds to expand Medicaid in addition to aggressively promoting Kynect.
Whatever else can be said about McConnell, the five-term senator is an astute politician. He is not confused about where Kynect came from. He is insisting that the exchange has nothing to do with “Obamacare” because he knows that health care insurance is popular with voters in Kentucky. He is also hoping that there will be enough confusion among the public that he can get away with being the unwavering leader of the opposition to “Obamacare” while being a friend of its real world manifestation in his home state.
He has reason for believing that he can get away with this deception. After all, many tea party conservatives angrily demand that the government keep its hands off their Medicare, apparently unaware that Medicare is a government program. And of course, if the Democrats are scared to correct the record, then McConnell’s task becomes much easier.
He is not the only Republican who recognizes the popularity of the existing “Obamacare,” in spite of what people say about the program in focus groups and public opinion polling. When Senate Republicans drew up the economic agenda they would pursue if they take control of the Senate, they left the repeal of the ACA off their list. House Republicans have voted for repeal 47 times. “Repeal and replace” had become a virtual mantra among Republican members of Congress. But on the eve of the first election since “Obamacare” has been up and running, Republicans apparently no longer want to be identified with this position.
To be sure, “Obamacare” is far from a perfect program. It would have been far more efficient to establish a universal Medicare program that would have directly provided coverage to the whole population in the way the existing Medicare program insures people 65 or older and the disabled. This would have given us close to 100 percent coverage and saved the country tens of billions of dollars each year that are wasted running insurance companies.
But there was insufficient political support to pass such a program over the opposition of the insurance industry and other powerful interest groups. That is why Americans got the hodgepodge system of “Obamacare.” It is far more complex and wasteful than any health insurance program that a sane person would design working from scratch, but it is a vast improvement over the prior system.
In fact, the most important benefit of “Obamacare” has gone largely unmentioned: While covering millions of previously uninsured people is a great step forward, the more important aspect of the program is that the tens of millions of people currently insured through their employers now can still have coverage if they lose or leave their jobs.
Hundreds of thousands of young parents have already taken advantage of this fact. They are now choosing to work part time. (We know it is voluntary because that is what they say.) They have the option to spend more time with their kids because they no longer need to work at a full-time job to get insurance through their employers. In the years ahead, millions more will take advantage of this freedom to retire early, start their own businesses or leave jobs they dislike.
It will be important to improve “Obamacare” in the years ahead. This could mean offering Medicare or Medicaid plans in areas with limited private insurance, negotiating lower drug prices with the pharmaceutical industry or pursuing state single-payer options, as Vermont is now doing.
But it will first be necessary to ensure the survival of the program and to make the politicians who tried to keep people from getting insurance pay a price. The Republicans are fully aware of the danger they can face because of their opposition to extending health care insurance. Unfortunately, the Democrats have yet to catch on.
