Republicans Will Continue to Target Obamacare

A couple of months ago, in "Is Obamacare Working? Or Is It a 'Train Wreck?", we wrote that the Affordable Care Act had enough potential problems that it might implode of its own accord. And that was before the disastrous roll-out of the government's attempt at building a health insurance exchange.

Republicans watching the public's exasperation with the balky system from the sidelines are chortling over Obama's fiasco. "#TrainWreck: Skyrocketing Prices, Blank Screens, & Error Messages", was the tweety headline on a press release Friday from House Speaker John Boehner of Ohio. "To our Democratic friends: You own 'Obamacare' and it's going to be the political gift that keeps on giving", said South Carolina Senator Lindsey Graham. "Obamacare will now be the issue for the next few years", wrote the Heritage Foundation's Jim DeMint in The Wall Street Journal. "I will do anything to stop train wreck of Obamacare", says Texas Senator Ted Cruz.

Newly emboldened by seeing the "train wreck" come true, Republicans plan to continue a relentless assault on the beleaguered health care law. “It’s going to be fight every hedgerow, fight every ditch. It’s just like trench warfare in World War I”, was the prediction in Bloomberg/Business Week of Tim Jost, a health law professor at Washington and Lee School of Law.

Only 29% in a Gallup poll favor full repeal of the health care law, but that does not give pause to Conservatives and Libertarians who despise it as government overreach for forcing people to buy what they might prefer not to, and for helping them buy it with a massive program of subsidies that the Wall Street Journal estimated will run to $1.762 trillion over 10 years. The Journal editorial page said, “This is Mr. Obama’s dream of expanding government to create a permanent entitlement state”.

But that manic pronouncement falls apart when one stops to realize that 80% of Americans are already covered either by their companies, Medicare or Medicaid. For them nothing changes.

Republicans in and out of the government are deploying every weapon in their arsenal to defeat the Affordable Care Act (ACA), with tactics that go well beyond their symbolic but futile 40-plus attempts to repeal the Act in the House.

Republicans see an opportunity to gain control of the Senate when four Democratic senators who voted for Obamacare face re-election in 2014. A planned campaign against them will ask them why they voted for the problem plagued law.

Democrats across the states will be similarly targeted. But it doesn't stop there. The conservative faction that led the fight against Obamacare have those Republicans who voted to re-open government and raise the debt in their cross hairs with the intention of replacing them with allies of their cause.

The requirement that companies with over 50 employees must provide their health insurance was put off for a year by the White House, but Obamacare foes can already point to people losing income from widespread cutbacks in hours — 313 businesses and 30,377 workers so far, says National Review — to below the 30 hours a week threshold above which they must pay for their personnel.

Republicans asked why business should have a reprieve and not individuals? Why shouldn't the mandate that we all buy insurance be delayed for a year in parallel?

In Obama's waiver to business Republicans saw an opening to crush the economics of Obamacare. Key to its success is bringing everyone into the insurance pool, with premiums paid by the young and healthier counterbalancing the costs of the older with medical problems. The White House estimates that 2.7 million healthy 18 to 34 year olds are needed to provide that offset. An online system that makes it difficult to sign up for insurance will likely cause the younger and healthier will turn away, whereas the older and sicker will press on to get insurance. Without premium payments from the young, insurers' costs for accepting all with pre-existing medical problems — as mandated by the law — will cause costs to skyrocket.

But the mandate is weakened by penalties for not buying insurance well below the cost of insurance, and nothing in the rules prevents them from waiting to opt in only when and if they become ill at some future date. The Tea Party group FreedomWorks is encouraging Millennials to do just that — don’t buy in until they acquire that pre-existing condition that insurers cannot turn away. Failure is assured for a law that “depends on people acting against their self-interest” is Ramesh Ponnuru’s view at Bloomberg.com. “Since when was free-loading a conservative value?”, asks Andrew Sullivan at The Dish.

The House also tried to prohibit the Internal Revenue Service from involvement in the law. Its role is crucial. Subsidies take the form of tax credits, which the IRS would administer. And it is to act as the enforcer, imposing penalties on individuals and companies who fail to meet the law’s requirements. House Majority Leader Eric Cantor (R-Va) says “The IRS” — in his view all of it, apparently, not just the Cincinnati unit discovered targeting right-leaning non-profits applying for tax-free status — “has been abusing its power” and “the last thing we should do is to allow the IRS to play such a central role in our health care”. The IRS “will have access to the American people’s protected health care information”, said Cantor. That happens to be an absolute falsehood.

These efforts at sabotage, like the votes to repeal, could not hope to survive the President’s veto, but such negativism serves to set the public against the law. Those whose companies pay for their health insurance are happy with that tax-free handout and don’t want anything to change. But as a hypothetical, assume repeal. Some in that group will inevitably will lose their jobs and then discover what an individual’s insurance policy costs absent the new exchanges or that even a minor pre-existing condition gives insurers an excuse to deny them insurance altogether. Out in the cold, these same people would likely realize that their former negative opinion of the health care act was ill-considered.

The group co-founded by Karl Rove, Crossroads GPS, is running an over the top video clumsily called ObamaCareNado that has a tornado causing “a rising tide [sic] of health care costs” with “nobody safe from its wrath”.

Dick Armey’s creation, FreedomWorks, advises everyone to burn their Obamacare cards as an act of protest. But there are no Obamacare cards. FreedomWorks intends to design one that you can print from the Internet, and then burn. (We’re not kidding).

More serious are the scores of law suits around the country that take aim at Obamacare’s particulars. Catholic run organizations want the requirement that insurers must pay for contraceptives struck down. The Goldwater Institute has sued to eliminate the Independent Payment Advisory Board — the “death Panel” that would “ration” care if costs exceed targets. One suit even wants to invalidate the law altogether because spending bills should originate in the House, says the Constitution, but the Affordable Care Act was first passed by the Senate. Another suit says that there is no provision in the Act for subsidies to be issued by the federal exchange — a calamitous defect thanks to faulty wording in the law.

“Almost no law as sprawling and consequential as the Affordable Care Act has passed without changes … known as ‘technical corrections’ ...in subsequent months and years”, The New York Times and others have pointed out, listing a number of examples. But there’s the rub. It is Congress’s job to make such repairs, but Republicans intend to block any fixes whatsoever as their way to bring Obamacare crashing down.

Obama, in an early-August press conference, clearly thinks it is lunacy:

“I think a really interesting question is why it is that my friends in the other party have made the idea of preventing these people from getting health care their holy grail, their #1 priority. The one unifying principle in the Republican Party at the moment is making sure that 30 million people don’t have health care. At least they used to say, well, we’re going to replace it with something better. There’s not even a pretense now that they’re going to replace it with something better. It’s become an ideological fixation”.