This week, as the Supreme Court weighs whether or not to yank subsidies that help at least 6 million Americans gain health insurance, we got some extraordinary news.
For the first time, the Urban Institute finds that our uninsured rate may be below 10 percent, Forbes‘ Dan Diamond notes. In states that have accepted Obamacare’s Medicaid expansion it’s 7.5 percent. No survey is perfect but it seems that the number of people without coverage is at a historic low.
But surely there’s been a huge cost to this big government intervention in our health care system!
There are still quibbles you can make with the overall implementation of the. It has been far from perfect. And we’re still the only first world nation that allows millions of our fellow citizens to go uninsured.
But its kinks and need for improvement aren’t unique to Obamacare. Social Security, Medicare and Medicaid have all required constant tweeking and enhancements to provide care and support at costs far lower than could have been achieved by private industry. And this law still needs big improvements — like a Medicare buy-in for all.
But this law is working — extraordinarily.
Let’s be clear what’s working here. We added new taxes to the rich and super rich to expand coverage to working people with a guarantee of coverage provided by government regulation. This is everything Republicans hate in one. And this proof of concept means that we could and should do more things like this to provide universal pre-K, debt-free college and paid family leave, for instance.
There’s been some talk that Republicans are beginning to fear that the Court will make their dreams come true and gut the law in the reddest states in America. The “dog will catch car” or “Wile E. Coyote going off the cliff” analogies all make sense in a rational world. But in many of these states, Republicans have already proven that they can get away with figurative murder — or maybe not so figurative, if you believe in sins of omission — by denying millions Medicaid expansion.
Taking away something is much harder than denying it in the first place. And denying subsidies while leaving the individual mandate and rules that mandate guaranteed coverage even to those with pre-existing conditions, will literally wreck these states insurance markets. So that even those who aren’t losing tax credits will be paying a tax on the Republicans lust to destroy this law.
The Washington Post’s Greg Sargent has warned of the effectiveness of “GOP Fog Machine.” I simply say that “One Republican lying is a joke, all Republicans lying is a strategy.”
If the Court gives the GOP what they want, there are only two ways this will turn out.
Either it will turn out like the Stimulus where Democrats ran from their own huge success, cowed by the GOP’s message discipline. Or it will be like Ted Cruz’s shutdown where the disingenuousness of the Republican argument — “Obama wanted a shutdown!” becoming “Obama should be blamed for taking away your Obamacare” — is so transparent that it’s obvious that the media can’t even ignore it.
And this becomes more likely with reports like this that show that the main plaintiff has a VA card and has been led to believe that he’s not petitioning to take health insurance from millions, though he clearly is.
Democrats should not underestimate the right when it comes to tricking the middle class into voting against its own interests. I understand the fear of swaying the Court with improper politicking. But as soon as Democrats can they need to get in public with Americans who could lose their coverage, especially Americans with pre-existing who would not have coverage if not for the law. This makes it clear who wants these people to have subsidies. And Democrats need to settle on a simple message now like: Republicans can fix this with a one-sentence bill today. This is a far more reasonable demand that what the GOP will start with: Full repeal.
Republicans — who are just months away from a primary — will refuse to remove this shiv they’ve put in this law for a simple reason: Fixing it acknowledges that the law was working. Even conservatives who have ACA coverage and like it cannot admit that without shattering their worldview.
Any actual resolution to the mess that’s on the magnitude of what Court could unleash won’t be simple and it won’t be easy. But the message has to be: We want this to work and they’d let you die to see it fail.