“More Than Just A Message”: The Origins Of “If You Like Your Health Insurance, You Can Keep It”
There are good reasons why President Obama’s leading message on health care during the 2008 campaign, often repeated since, was “if you like your health insurance, you can keep it.” That message was created to overcome the fear-mongering that had blocked legislative efforts to make health care a government-guaranteed right in the United States for a century.
Our health is of central importance to our lives, deeply personal to our well-being and that of our loved ones. That concern has translated politically; for decades, people have told pollsters that health care is a top concern. It is why every 15 to 20 years – from 1912 to 2008 – the nation has returned to a discussion about whether and how the government should guarantee health coverage, the debate rising phoenix-like from one spectacular defeat after another. A big reason for those defeats has been that opponents have exploited those deep feelings to scare the public about proposed reforms.
As one of the people who engaged early on in building the effort that led to the passage of the Affordable Care Act, I am keenly aware of this history. I wrote in 2003 that debates over health care turn dramatically when they move from the problem to the solution. Almost everyone agrees there’s a problem, but when a solution is proposed, people’s first question will be, “how will it impact me?”
The extensive public opinion research we conducted from 2006 to 2008 emphasized that same point: people would look closely at how any proposed reforms impacted their lives. Yes, Americans are worried about high health care costs and alarmed at the prospect of losing coverage. Yes, they may be unhappy with the quality and security of the coverage they have. But at the same time, they are desperate to hold on to it, because at least it’s something.
We also knew that those who wanted to block health care reform would play on people’s fears, a lesson learned most recently in the 1993-1994 fight over the Clinton health plan, in which opponents made wild claims about government bureaucrats coming between you and your doctor and denying you coverage.
In that context, it was essential to assure the 85 percent of Americans with health coverage that reform would not be a threat. Hence, “If you like your health care, you can keep it.” That message reassured people and let them be open to the rest of the message: proposed reforms would guarantee quality, affordable coverage to everyone and fix the real problems people were facing. After all, the first part of that sentence, “if you like it,” implies that lots of people would love to improve their coverage by making it more affordable and secure and by ending insurance company abuses.
Hillary Clinton’s campaign understood this early on, and she used the message consistently when she talked about health care reform during the Democratic primaries. Soon after she dropped out, Obama made it a key part of his health care message. But the promise that you could keep your health care was more than just a message; for almost everyone, it was an accurate description of the almost identical reform policies proposed by Clinton and Obama, which became the foundation for the Affordable Care Act.
The ACA preserves (with small but important improvements) the current system of health care financing for the vast majority of Americans: employer-based coverage, Medicare, and Medicaid. Those are the 94 percent of people with coverage for whom the “if you like it, you can keep it” promise is true.
For the 6 percent of insured who buy coverage on their own, the more accurate message would have been, “If you have good insurance and you like it, you can keep it.” The ACA reforms a corrupt individual insurance market. No longer can insurers turn people down due to a pre-existing condition or raise rates and drop people because they get sick. The ACA bans the sale of plans with such skimpy benefits and high-out-of-pockets costs that they are worthless if someone gets seriously ill.
As we predicted, the opponents of reform used fear-mongering – death panels, government takeover of health care, and on and on – to try to kill the Affordable Care Act. They are still at it, including cynically jumping on the website’s enrollment problems and now insurance companies sending letters to customers which hide the fact that companies are being forced for the first time to sell a good, reliable product.
The opponents of reform have used reckless, baseless charges to try to kill reform. I’m glad that President Obama used a slight exaggeration to finally provide secure health coverage for all Americans.
By: Richard Kirsch, The National Memo, November 4, 2013
“Health Care Sabotage 101”: The GOP, Not A Botched Website, Is The Real Obstacle To Implementing Obamacare
It’s the latest chapter of Barack vs. the Health Care Killers, The Continuing Saga of Posturing, Bad Faith, Spite and Ineptitude.
Republicans, who have used every trick in their playbook to gum up the works of the Affordable Care Act, are now holding hearings to investigate how the works got so gummed up.
They could save themselves the trouble by looking in the mirror, just as O.J. Simpson could have done to find his wife’s killer. But that would rob them of the chance to grandstand.
In fairness, they do have one point. The Obama administration botched the debut of its insurance marketplace website so badly that it fairly begged for an investigation. And since Republicans had little or nothing to do with the website, the blame for its failures falls squarely on the president and his deputies.
The screw-up was a gift. GOP lawmakers were calling the law a failure before most of it went into effect, but lacking any evidence they had to rely on mere accusation. Now, finally, they can say that their worst predictions had some validity.
Nevertheless, Republican “outrage” over the glitches is hard to take seriously. If they’re really looking to find what went wrong — and there was plenty — one suspects it’s only so they can clone the virus. Then anyplace where the law is working, such as Kentucky, Washington and Oregon, they can infect the system, watch it crash, shake their heads and snicker.
Come on, folks. Republicans want to “fix” what’s broken here as much as they want to “protect” women by targeting their reproductive rights and “defend” the vote by obstructing it. But because Healthcare.gov went live on the same day that the party crazies shut down the government over the law’s funding, they were too deep in their own morass to capitalize on it. Worse, they had to fold on the shutdown without getting anything in exchange. No wonder they’re pouncing on the chance to grill the people whose job it was to enable what they’ve called the worst law in the history of man.
Yes, the administration deserves to be on the hot seat. There was more than enough time to make sure the website worked properly and there is no excuse for its failure to do so.
Mr. Obama had to know that the first weeks would set the tone for public perception. If he had wanted to raise doubts about the program or shoo people away, he couldn’t have done a better job of it.
Once again, we have to wonder what goes on in his mind. This legislation is only the most important accomplishment of his presidency. He put everything on the line for it. Millions of people are counting on it for coverage they cannot otherwise afford. If he can’t get the introduction right, well, let’s just say it’s a good thing he won’t be running again.
But then there’s that pesky caveat called perspective. A botched website, which can and will be repaired, is nowhere near the biggest obstacle to the success of health care reform. That distinction goes to the program’s sworn enemies, who have been conducting a misinformation campaign of false claims and scare tactics since the law was passed. To hear them tell it, “Obamacare” will turn people into devil worshipping socialist homosexual vegetarians who want the terrorists to win. So of course they will do everything they can to stop it.
Exhibit One: The quickest and easiest way for states to enact the law’s reforms is to expand Medicaid, which would trigger a huge infux of federal dollars for the first several years. Yet Republican governors in 26 states have refused to do so. The primary excuse is that they won’t be able to afford it once the federal money stops. The subtext is that they’d rather sabotage the president than help their own citizens get the treatment they need. Thanks to them, according to a New York Times analysis, the new law will leave out two-thirds of the nation’s black citizens and single mothers, and half of the low-wage workers who currently lack insurance.
In addition, GOP governors (including our own Tom Corbett and, regrettably, a few Democrats) have refused to create insurance exchanges that would facilitate reaching the uninsured. Instead, those people will have to go to the federal exchange.
They’re also refusing to assist applicants and blocking the use of so-called “navigators,” whose job is to help people understand the law and sign up for its benefits. When a constituent calls with questions, they are making sure they’ll get no answers.
Then there was the government shutdown, during which Republicans offered more than 40 measures to cripple the law. They failed in every sense, but it still cost the country $24 billion.
It doesn’t take a genius to see where the real obstruction lies. For all its screw-ups, the Obama administration is trying to make health care reform work. And for all their public posturing, Republicans are trying to ruin it. But the law was duly passed, it’s here, and it’s not going away. They should save the fake righteousness for a cause that isn’t already lost.
By: Sally Kalson, Pittsburg- Post Gazette, October 26, 2013
“One Reform, Indivisible”: Republicans Who Deluded Supporters Into Believing Obamacare Wouldn’t Happen Will Pay Personal Price
Recent political reporting suggests that Republican leaders are in a state of high anxiety, trapped between an angry base that still views Obamacare as the moral equivalent of slavery and the reality that health reform is the law of the land and is going to happen.
But those leaders don’t deserve any sympathy. For one thing, that irrational base is a Frankenstein monster of their own creation. Beyond that, everything I’ve seen indicates that members of the Republican elite still don’t get the basics of health reform — and that this lack of understanding is in the process of turning into a major political liability.
On the unstoppability of Obamacare: We have this system in which Congress passes laws, the president signs them, and then they go into effect. The Affordable Care Act went through this process, and there is no legitimate way for Republicans to stop it.
Is there an illegitimate way? Well, the G.O.P. can try blackmail, either by threatening to shut down the government or, an even more extreme tactic, threatening not to raise the debt limit, which would force the United States government into default and risk financial chaos. And Republicans did somewhat successfully blackmail President Obama back in 2011.
However, that was then. They faced a president on the ropes after a stinging defeat in the midterm election, not a president triumphantly re-elected. Furthermore, even in 2011 Mr. Obama wouldn’t give ground on the essentials of health care reform, the signature achievement of his presidency. There’s no way he would undermine the reform at this late date.
Republican leaders seem to get this, even if the base doesn’t. What they don’t seem to get, however, is the integral nature of the reform. So let me help out by explaining, one more time, why Obamacare looks the way it does.
Start with the goal that almost everyone at least pretends to support: giving Americans with pre-existing medical conditions access to health insurance. Governments can, if they choose, require that insurance companies issue policies without regard to an individual’s medical history, “community rating,” and some states, including New York, have done just that. But we know what happens next: many healthy people don’t buy insurance, leaving a relatively bad risk pool, leading to high premiums that drive out even more healthy people.
To avoid this downward spiral, you need to induce healthy Americans to buy in; hence, the individual mandate, with a penalty for those who don’t purchase insurance. Finally, since buying insurance could be a hardship for lower-income Americans, you need subsidies to make insurance affordable for all.
So there you have it: health reform is a three-legged stool resting on community rating, individual mandates and subsidies. It requires all three legs.
But wait — hasn’t the administration delayed the employer mandate, which requires that large firms provide insurance to their employees? Yes, it has, and Republicans are trying to make it sound as if the employer mandate and the individual mandate are comparable. Some of them even seem to think that they can bully Mr. Obama into delaying the individual mandate too. But the individual mandate is an essential piece of the reform, which can’t and won’t be bargained away, while the employer mandate is a fairly minor add-on that arguably shouldn’t have been in the law to begin with.
I guess that after all the years of vilification it was predictable that Republican leaders would still fail to understand the principles behind health reform and that this would hamper their ability to craft an effective political response as the reform’s implementation draws near. But their rudest shock is yet to come. You see, this thing isn’t going to be the often-predicted “train wreck.” On the contrary, it’s going to work.
Oh, there will be problems, especially in states where Republican governors and legislators are doing all they can to sabotage the implementation. But the basic thrust of Obamacare is, as I’ve just explained, coherent and even fairly simple. Moreover, all the early indications are that the law will, in fact, give millions of Americans who currently lack access to health insurance the coverage they need, while giving millions more a big break in their health care costs. And because so many people will see clear benefits, health reform will prove irreversible.
This achievement will represent a huge defeat for the conservative agenda of weakening the safety net. And Republicans who deluded their supporters into believing that none of this would happen will probably pay a large personal price. But as I said, they have nobody but themselves to blame.
By: Paul Krugman, Op-Ed Columnist, The New York Times, August 18, 2013
“His Instincts Fail Him Again”: John Boehner Is Weak In The Face Of Pressure From Right-Wing Ideologues
House Speaker John Boehner (R-Ohio), two months ago:
Republicans’ efforts to undo President Barack Obama’s health care reform law appear to have come to an end, as House Speaker John Boehner described it Thursday as the “law of the land.”
In an interview with ABC News, the nation’s top elected Republican seemed to indicate that Congress wouldn’t engage in the type of repeated repeal votes the way it had in the past two years.
House Speaker John Boehner (R-Ohio), three days ago:
“This week, the House passed Republicans’ balanced budget that fully repeals and defunds ObamaCare to protect families, workers and seniors from its devastating consequences. The House will continue working to scrap the law in its entirety….”
Note the amount of time that’s elapsed: we’re not talking about Boehner changing his mind over the course of three years; we’re talking about taking wildly different positions over two months. In January, the Affordable Care Act is the “law of the land,” and Congress has better things to do than to waste time trying to repeal a law that isn’t going anywhere. And in March, Boehner reversed course entirely — congressional Republicans have already voted several dozen times to repeal the reform law, and the Speaker sees no reason to become more constructive now.
I don’t know Boehner personally, but I suspect what he said in January was sincere — the guy probably doesn’t want to be known as the Speaker who pointlessly spun his wheels, voting repeatedly on health care for no particular reason, so as the new Congress got underway, he envisioned a more productive session for governing. And then the Speaker was reminded what party he’s in and how little his caucus cares about constructive legislating.
But the larger point gets back to something we talked about on Thursday: I suspect Boehner’s instincts aren’t as ridiculous as his caucus’.
Pressed for an answer, before he has time to do the full political calculation, Boehner reflexively takes a sensible line on everything from taxes to energy to immigration. Even in 2011, during the debt-ceiling crisis he didn’t want to instigate — his instincts told him this was a bad idea — Boehner’s gut told him to take President Obama’s offer for a “Grand Bargain.” He had to reverse course when his allies balked.
When the Speaker’s followers tell him to change his mind, he puts his head down, and does what he’s told to do.
The problem isn’t necessarily that the House Speaker is a right-wing ideologue, but rather, that he’s weak in the face of pressure from right-wing ideologues. It might help explain why Boehner struggles in his post — he’s not allowed to follow his own instincts, which would otherwise serve him well, because of the radicalization of his caucus.
By: Steve Benen, The Maddow Blog, March 25, 2013
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