I left off by remarking that hard-core opposition to Obamacare has damaged the program, though not blocked the rollout. Here are some examples, well-known and less so.
In the States
Their unremitting hostility to Obamacare has left a total of 4.9 million of their poorest constituents no chance for affordable health insurance. An additional 1.5 million are in the same boat due to foot-dragging and other factors, e.g., recently-proposed alternatives to something less than a straightforward expansion.
At the same time, a goodly number of states are doing all they can to keep those who could get affordable insurance through one of the exchanges from knowing it’s available and choosing a plan that makes sense for them and their families.
The victims here will be largely low-wage workers, especially those who work for small businesses and/or part-time. Also some people who are genuinely self-employed and others whom employers misclassify as independent contractors.
Meanwhile, it’s highly doubtful that Republicans in Congress will help fix glitches in the law so it works as intended.
One of the more problematic will leave some as-yet unknown number of families with neither affordable employer-sponsored health insurance nor a subsidy to purchase on an exchange.
This is because, as the law is written, a worker whose employer provides health insurance can buy on an exchange instead only if the plan is unaffordable, defined as more than 9.5% of household income.
But the percent applies to the cost of insurance for the worker only — typically just over a third of what a plan for a whole family costs, according to the Kaiser Family Foundation’s latest survey.
The General Accounting Office reports that the affordable standard will affect approximately 460,000 children — perhaps considerably more in 2015, when federal funding for the Children’s Health Insurance Program is due to expire.
Hard to believe Congress intended this. But the Obama administration says it’s “the most defensible” reading of the law as written.
In other words, it’s up to Congress to tinker with the language if it doesn’t want dependent family members uninsured — or workers begging employers to drop their health insurance plans and pay the modest penalty for not having one, if they’re large enough for the penalty to apply.
This isn’t the only glitch that’s come to light. The United Methodist Church and several other large church organizations warn that their health plans could fold because they can’t be offered on the exchanges, where their clergy and other employees could have the costs subsidized.
Washington Monthly bloggers Anne Kim and Ed Kilgore say that, according to most “observers,” the exclusion of the church plans was simply an oversight.
Two Senate Democrats have introduced a fix. But a spokesperson for one of them doesn’t expect a vote because the push to repeal — or more recently, to cripple — Obamacare “has disincentivized Republicans from working with us on this.”
And then, as you may have read, there’s an ambiguity in the law relating to Members of Congress and some of their staff.
They’re required to purchase health insurance on an exchange, although they were covered by their employer (the federal government). Now some Republicans are saying that said employer can’t continue paying a share of the insurance, as the Office of Personnel Management decided it would.
Under ordinary circumstances, Congress would have simply put a little patch in the law to clearly authorize what the best evidence indicates the majority intended.
Instead, a majority in the House and some in the Senate want to force their staffers to pay many thousands of dollars more than the average private-sector worker pays — merely to stir up resentment over a so-called “exemption” that’s nothing of the sort.
We’ve got a somewhat similar problem with subsidies for people who purchase health insurance on an exchange the federal government is operating because their state wouldn’t.
The Cato Institute’s Michael Cannon, who abhors anything that smacks of universal coverage, and Jonathan Adler, a libertarian law professor, claim the subsidies are illegal because the law restricts them to state-run exchanges.
And one can read the law that way, though other legal experts have argued — persuasively, I think — that it’s demonstrably contrary to what Congress intended.
Here again, in ordinary circumstances, Congress would fix what even Cannon and Adler refer to as a “glitch.”
Instead, we’re going to have, at the very least, taxpayer money wasted defending a rule that protects many more Americans from having to go without health insurance because they can’t pay the market rate.
The basic issue here is that any major law, especially one that strikes out into new territory won’t be perfect as initially enacted. Witness the initial limits in Social Security, for example.
But so long as a majority of Congressional Republicans want Obamacare to fail — and there are enough of them in Congress to control what passes — we’re stuck with what we’ve got.