The only hope Republicans have now is to try and make Obamacare as difficult as possible for people to like. Consider me your early warning system for pitfalls ahead.
April 30, 2013

Despite what Max Baucus said, Obamacare is not a 'train wreck' rolling toward a head-on collision. But Republicans are trying and will continue to try to make it as hard as possible to implement. This is not unlike what they did with Medicare back in the 60s when it was implemented. In fact, I expect them to take some pages right out of that playbook despite Medicare's obvious success.

Jonathan Cohn has an excellent article in The New Republic this morning outlining the potential pitfalls in implementation. There will be pitfalls. Make no mistake. There is no way to open up this system to everyone without glitches. Remember, there are balky insurers still trying to undermine it behind the scenes, and opportunistic politicians waiting to pounce on any failure, no matter how small, to capitalize in the 2014 midterms.


As even Obamacare’s most ardent defenders have said from the start, the law is far from ideal. The architects of reform had to make all sorts of compromises, just to get the law past lobbyists and obstructionist Republicans. And then, after finally enacting the historic legislation in early 2010, they had to spend most of the next three years fighting repeal. In Washington, Republican congressional leadership has repeatedly blocked funding for implementing the law. At the state level, conservative officials are at best indifferent to its success and at worse outright hostile to it. This last part is no small thing, given the leeway state officials have over the law's implementation. In states like Florida and Texas, officials have already indicated they won't be expanding eligibility for their Medicaid programs—depriving millions of health insurance.

Thank Senator Soon-to-Retire Baucus for that particular car on the Obamacare train. It would have been far easier to implement on a national level, but this is what it is, and it is still good, if not pretty.

Read all of Cohn's article. It's comprehensive and detailed.

What I want is to get the word out, and ask you to get the word out, too. There are some key GOP talking points which Republicans will use as political hay for 2014 that just need to die before they're born. Help me get the truth out ahead of the lies?

  1. Costs - There will be a lot of noise about premium costs going up for everyone. What won't be mentioned is the bump in coverage. Most employers have shifted their employees into low-cost high-deductible plans where most costs come out of the employees pocket. They pair these up with Health Savings Accounts, but most employees do not put much in those accounts. That means people are choosing to forego medical assistance because they don't want to pay out of pocket.

    After January 1, 2014, routine medical visits will be covered. Prescription coverage will be augmented so that co-payments aren't as outrageous. Finally, there will be subsidies to offset the higher costs to families earning less than about $94,000 per year.

  2. Medicaid - This will be confusing at first, since so many states with Republican governors have declined the Medicaid expansion. But for those states that have agreed to it, single residents who earn $15,500 or less are eligible for full coverage under Medicaid. A family of four earning $31,000 or less will be eligible for Medicaid, too.

    Republicans will make hay out of the fact that people who live in Texas, Pennsylvania, and other states will not be eligible for the Medicaid expansion. Remind them that it was the choice of their Republican governor.

  3. Coverage - Under the Affordable Care Act, more coverage will be required than is currently the case, whether or not a person is covered by an individual policy or by a group insurance plan through their employer. Deductibles will be partly subsidized, similar to premiums for those earning between 133 percent and 300 percent of the poverty line. Coverage will include preventive coverage, prescription coverage and psychiatric treatment.
  4. No Pre-existing Conditions Exclusions - That means no waiting period, no exclusions, no nothing. Coverage is guaranteed whether you're a cancer survivor or a healthy young person in the prime of life.

Cohn reminds that it's about expectations management. It might be difficult to implement, there might be a lot of Republican noise around it, there might be glitches and grumbles, but consider this:

The last time government introduced a major new health care program was in 2006, when Medicare began offering a prescription drug benefit through what is called “Part D.” It got off to a notoriously rough start, as seniors showed up at pharmacies only to discover they were enrolled in the wrong plans—or that their plans didn’t cover drugs like they did before. The Children’s Health Insurance Program, which became law in the late 1990s, was slow to attract enrollees. But things got better. As Larry Levitt of the Kaiser Family Foundation noted recently, the end result was that seniors got drug coverage and kids got insurance they never had before. Today, the programs are highly popular, even if they are not perfect.

There is no question that Republicans expect to make the ACA the centerpiece of an effort to repeat 2014 in the midterms. The only way that will happen is if we allow the benefits to be overshadowed by the chaos made by design or by accident.

I'm not up for another two-year round of insanity from House Republicans, so I say let's get the word out now, and keep banging that drum until the wingnuts are sent home forever, accompanied by three cheers for Obamacare.

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