Strategies for Defending the Affordable Care Act

January 18, 2017 diana No comments exist


>>>We know that Republicans can use reconciliation to repeal parts that are budget-scoreable–like the subsidies and Medicaid-expansion funding–but not unscoreable parts like the consumer protections–and the two types of parts are interdependent. We also know that Republicans can’t use reconciliation to enact a modification/replacement package on their own–particularly if it contains any unscoreable regulations. Therefore, if we hold out for a package that’s equivalent to Obamacare in terms of protections, assistance, and overall coverage–both current and projected–the Republicans will be faced with presiding over a collapse of the private insurance market which will cost a lot MORE people than the 22 MILLION newly-insured their health care. THIS IS OUR LEVERAGE. That being said, I have 5 specifics to offer:

1. We MUST MAKE THE CASE that there’s a REASON we held out for “comprehensive” reform–that the reforms are inter-dependent, and the consumer protections–i.e., the pre-existing conditions ban–and the financial assistance–i.e., the subsidies–are a PACKAGE DEAL–neither will work without the other. In fact, Paul Krugman described the guarantee-issue/subsidies/individual-mandate package as a “three-legged stool”–ALL 3 LEGS must be present or the stool falls down–back in 2010.  ALL DEMOCRATS SHOULD CITE HIS ANALOGY (cf. “The Obamacare Replacement Mirage”, New York Times 4/11/2016, ““) (see note 1).

2. We must also argue that catastrophic-only health-care which excludes coverage for preventive care will not work–as catastrophic is the most expensive kind and it’s PREVENTIVE CARE that saves patients money over the long term.

3. WE MUST PUT A HUMAN FACE ON THE 22 MILLION NEWLY-INSURED. Last year, I urged Hillary to have at least 5 people on hand who owed their ability to get insurance–each preferably for a different reason–to the ACA, and to trot them about at rallies, town halls, and (especially) the debates. She didn’t, and most Democrats didn’t, for some reason. That was a MISTAKE. We have to show that the percentage of Americans who are uninsured has been cut by over a third, and that the beneficiaries are ordinary, hard-working people–not lazy free-loaders. Every Democrat should have 5 or more Obamacare-dependent people in his/her state/district that can be cited by name come 2018, if not sooner.

4. We must go to great extents to make sure that any “replacement” plan is scored for coverage and any plan that covers “too few” people or guarantees “inadequate” insurance is viciously shot down. (Yes, we must come up with an easy-to-explain threshold for what qualifies as “adequate”.)

5. FINALLY, BUT BY NO MEANS LEAST, we must ALL speak with one voice and a single, well-defined narrative. ALL POLITICS IS *NOT* LOCAL ANYMORE, and politicians–EVEN THE “BLUE DOGS”–are more likely to be judged as Democrats for what their PARTY is doing than as individuals for their own personal actions. Therefore, it actually makes more sense to toe the line of the leadership–even if the positions are less popular back home. “Swing voters” are practically non-existent, so WE NEED MAXIMUM DEMOCRATIC TURNOUT in 2018 and 2020. There’s no way around it; make sure the “Blue Dogs” get that.

>>>Good luck! (see note 2)


>>>NOTE 1:The following except is particularly useful:

“But on the right, is there a more free-market, more privatized system that could replace the Affordable Care Act without causing the number of uninsured to soar? No, as some of us have tried to explain many times.

“Once again: a useful starting point is the problem of people with pre-existing conditions. How can they be offered affordable insurance? You can prohibit insurers from discriminating on the basis of medical history — community rating. But if that’s all you do, only sicker people will sign up; many will wait until they get sick to buy insurance; and so costs will be high due to a bad risk pool.

“So non-discrimination must be combined with an individual mandate, the requirement that everyone get insurance. But what about people who can’t afford it? There must be subsidies to lower-income families, so that they can.

“What you end up with, then, is community rating + individual mandate + subsidies — that is, with Obamacare. There’s nothing arbitrary about it, and you can’t pick and choose from the elements: it’s a three-legged stool that needs all three legs to stand. And it can’t be made cheaper, either — the subsidies are already on the low end, requiring that the allowed policies can involve higher deductibles than they really should.”

>>>NOTE 2: Our current coalition is much more progressive, and much less patient, than our coalition in the 1990’s. They’re not so prepared to sacrifice principle, progress, and people in the name of political victory. Therefore, WE CANNOT AFFORD TO DO WHAT WE DID BACK THEN–where we “dropped” the issue of universal health care and let it fester for a generation. WE MUST FIGHT TOOTH AND NAIL for everyone of those 22 million newly-insured Americans and the new rules that enabled them to get it–even if it risks short-term electoral loss. What’s more, if our “base” doesn’t turn out in the 2018 midterm, we’re “toast” anyway.

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