Obamacare a boon after all

Jeff Madrick

Lo and behold, Mitt Romney says he will now support parts of the Affordable Care Act, which the Republicans disdainfully call Obamacare. The Financial Times called it a u-turn. My prediction is that the word Obamacare will conjure up the same positive connotations as Medicare now does.

Has Obama immortalized himself? It may be.

A lot of progressives profoundly criticize Obamacare.  I fervently disagree with them.   They wanted single payer and so do I, but we weren’t going to get one. They wanted serious cost controls. So do I. Maybe they are still coming.   But what we got was  some kind of healthcare for thirty million people who lacked it, and many more benefits for those who already had it but were being abused by their insurance companies.

According to recent reports, Obama is now going to run his election on these healthcare benefits, trying to divert attention from the high unemployment rate.  My guess is that it will work. And Romney’s recent cave-in—perhaps the beginning of the etch-a-sketch strategy to move to the center—will show what a weak candidate he is.  What it is showing at the moment is what a strong piece of legislation Obamacare was.

Only now are the highlights of Obamacare becoming clear.  This delay is in large part the president’s fault. He seemed to be afraid to talk about it because the Republicans had made it a rallying cry of government interference and their much-exaggerated loss of freedom.  Good health is a great provider of freedom, by the way.   Try to be free with a major ailment.

What does Obamacare do?  It already is starting to close the famed doughnut hole in the senior drug plan.  It is providing preventive healthcare services with little or no co-pay, including contraception and well-being visits for women.  There is no lifetime cap on how much you can be reimbursed for expenses, as so many insurance company plans had.  It allows children up to 26 to stay on their parents’ medical plan.  The Centers for Disease Control and Prevention just reported a sizable drop in the number of young who don’t have insurance as a result. That’s fast work.

In 2014, no insurance company will be able to turn away applicants who have a pre-existing condition. Romney would apparently retain that one.  There will be no annual caps on reimbursement, as there now are in so many plans.And business will get subsidies to provide insurance to their employees—a requirement for those with fifty or more.

Of course, there is also the individual mandate.  This was once a Republican idea, which raises the ire of some on the left.  But this was a political trade-off.  We’d have nothing without it.  And it may work.

Perhaps most important, about fifteen million new individuals will be covered under Medicaid.  Some think Medicaid covered all poor. But it used to be only for families, not individuals. Now it will cover anyone, and the cut-off line has been raised. It used to be on average only 60 percent of the already-low poverty line.

The plan’s main weakness is in cost controls.  But a true public option could be added, once the country begins to actually like Obamacare.   The public option could ultimately offer lower cost full-service insurance, nearly at Medicare rates.  That would be the best method for keeping down prices.

Incentives for preventive medicine could also be strengthened down the road.

Romney doesn’t say, as usual, how he would pay for thoses parts of Obamcare he’d like to retain.  Currently, the package is being paid for with higher payroll taxes on better-off Americans, cuts in provider payments and cuts in the medicare Advantage plans, which are high cost plans for seniors.

I did some work for Senator Kennedy and he had learned in the 1970s that America would not get a single-payer system.   He began to compromise, and he supported Obamacare strongly before his death.

So many are already benefitting from Obamacare that it could be the guarantor of an Obama victory. In any case, I think Romney is now running scared.  But Obama has to be willing to speak boldly about it.   And then he has to build on it.  A jobs program?  Higher minium wages?  A real pre-K system in America? There is so much still to do.   And by the way, The passage of the ACA was in the end an act of bi-partisanship in the real sense.  In other words, a harsh battle that ended in useful compromise.

Kennedy’s dream had been Medicare for all. Few probably know that Medicare for those 55-64 almost made it into the bill.  Maybe next time.

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