September 25, 2013

Early in Ted Cruz's 21-hour campaign advertisement, he worked very hard to position himself as a populist champion for all those minorities who stand to lose their jobs as a result of the Affordable Care Act. He used the fast food industry as a stellar example of how those beleaguered masses could pull themselves up by their bootstraps, if only their hours weren't being forced down in order to keep employers from having to cover them.

How clever he is! Too clever by half, actually. We hear a lot about how Senator Cruz is so smart and so well-educated, yet he seems to have difficulty thinking something through to a logical conclusion. Here are a few facts to chase the rhetoric with.

Most Jobs Added are Full-Time Jobs

Since the Affordable Care Act was passed in 2010, most of the jobs added have been full-time jobs.

Bloomberg Reports has more analysis:

The biggest piece of evidence against Conover comes from the establishment survey's reading of average worker hours. This survey draws from 557,000 businesses counting some 45 million workers. (That’s 750 times bigger than the household survey Conover and Graham used, in case you’re keeping score at home.) And as you can see, there's been no noticeable drop in worker hours, contradicting his argument that more people are being shifted into part-time roles.

This squares with a similar study conducted by CEPR, which concluded there was no evidence of nationwide hourly cutbacks to workers as a result of the Affordable Care Act.

Fast Food Industry Is Strong Case for Obamacare

Cruz went on a bit later in his remarks to use an example of a single mother who rejects welfare and gets a job that pays hourly with no benefits. The kind of job he praises so highly in the video above.

Let's presume for the sake of argument that he's thinking along the lines of a fast food worker who would make little more than minimum wage, if that. He assumes she gets a second part-time job because the first one doesn't give her enough income to pay the rent and bills, and she's a self-sufficient independent single mom, after all. Cruz then argues forcefully that Obamacare will do grave harm to her economic security.

Not so much. Let's assume that said single mom is receiving no assistance whatsoever from state or federal resources. She has child care expenses, rent, food, transportation, clothing and miscellaneous expenses. She prays every day that her child does not get an ear infection or anything else that might cause her to have doctor and prescription expenses.

Assuming she makes the federal minimum wage for a 30-hour week, her gross income from job one is just over $11,000 per year. Let's also assume that her second job pays the minimum wage, and she works a 15-hour week. That would add another $5,600 to her paycheck for a total of around $16,600.

In a state that adopted the Medicaid expansion, that single mom could stop worrying if her child became ill, because she would qualify for full coverage and cost-sharing subsidies for herself and her child under Obamacare.

In a state that does not opt for the Medicaid expansion, that single mom would be able to qualify for subsidized premiums on the state exchange and subsidized cost-sharing.

Mom sleeps better, her child feels better when he's sick, and the money she would have had to cough up to pay for medicine or a doctor is now used for something else.

Subsidized cost sharing really will make health care affordable

There's a lot of talk right now about lower and far more affordable premium costs. But no one is really talking about the second form of federal subsidy, which is the cost-sharing piece for people earning up to 250 percent of the federal poverty level, and that is a huge factor in making health care affordable.

Here's how it works, via Kaiser Health News:

The federal cost-sharing subsidies essentially increase the insurance company's share of covered benefits, resulting in reduced out-of-pocket spending for lower-income consumers. A family of four whose income is between 100 and 150 percent of the federal poverty level ($23,550 to $35,325) will be responsible for paying 6 percent of covered expenses out-of-pocket compared with the 30 percent that a family not getting subsidized coverage would owe in a silver plan. A family with an income between 150 and 200 percent of the poverty level ($35,325 to $47,100) will be responsible for 13 percent of expenses, and one with an income between 200 and 250 percent of the poverty level will be responsible for 27 percent ($47,100 to $58,875).

In addition, people who earn 250 percent of the federal poverty level or less will also have their maximum out-of-pocket spending capped at lower levels than will be the case for others who buy plans on the exchange. In 2014, the out-of-pocket limits for most plans will be $6,350 for an individual and $12,700 for a family. But people who qualify for cost-sharing subsidies will see their maximum out-of-pocket spending capped at $2,250 or $4,500 for single or family coverage, respectively, if their incomes are less than 200 percent of the poverty level, and $5,200 or $10,400 if their incomes are between 200 and 250 percent of poverty.

While you may think the reduced maximum out of pocket is still high, it's substantially less than current insurance offers. Susie Madrak's situation in 2011 is a great example of the difference. I don't know what the deductible was on the high risk pool insurance she was able to get, but let's assume it was between $5,000 and $10,000, since that's the standard for insurance these days.

After January 1st, that could be as low as $2,250 depending on her income levels, and that $2,250 would be an overall limit on copayments, deductibles, and medications. Instead of a $30 copayment under Obamacare she could pay as little as $5, because the difference will be picked up by the federal government.

What harm is being done here?

Cruz and his friends like to talk about how they're saving us all from the abject evil of getting access to health care without discrimination for pre-existing conditions, but why on earth do we want to be saved from lower premiums and help paying our medical bills via cost-sharing subsidies?

Why do we want to be saved from incredibly high COBRA premiums?

Why do we want to be saved from getting a choice about which insurer will cover us and which plans we might choose to purchase?

Cruz really revealed himself during his little "Green Eggs and Ham" riff on the Senate floor. Remember the ending to that book? Yglesias:

Conservatives like Cruz claim that this is wrong. That Americans will taste the green eggs and ham and they're going to hate it. But their actions speak otherwise. They're desperate to repeal the law before it's implemented. And in terms of the 2012 elections, that was fair enough. But they lost in 2012. Now instead of acting like they're confident that the voter backlash to the green eggs and ham will power them to victories in 2014 and 2016, they're engaging in flailing desperate tactics to make sure nobody tries the green eggs and ham. Because deep down they fear that Dr. Seuss was right.

I DO like green eggs and ham.
I DO like them, Sam I am.

And you will too.

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