October 1 marks what should be an important milestone in the implementation of the Affordable Care Act (ACA), informally known as “Obamacare.” Sadly, this has been overshadowed and even threatened by irresponsible and reactionary posturing by Republican members of the US House of Representatives.
Today was supposed to be the day that a signature element of the legislation was realized – the opening of Web-based “exchanges” through which individuals without employer-provided health insurance could purchase it from private insurance companies with progressive government subsidies based on income. Together with federal funds for the expansion of Medicaid, the patch-quilt of state health insurance programs for the poor, the goal of providing affordable (get it?) insurance to nearly all citizens was to be achieved. Instead, the news is filled with talk of a government shutdown or even a default on repaying federal debt, either of which would be a completely avoidable, self-inflicted wound to our prosperity.
A few observations seem in order.
First, the ACA has been phasing in since its passage over 2 years ago. Several important elements are firmly in place, such as the mandatory expansion of commercial coverage for dependents up to age 26, and the implementation of a variety of Medicare payment reform experiments. The opening of the exchanges is a milestone for sure, but hardly the beginning of Obamacare. In addition, the actual coverage for insurance purchased through the exchanges doesn’t begin until January 1, 2014.
Second, for all the current ranting by Republicans, the use of exchanges, where individuals could buy private health insurance, was a fundamentally Republican idea, developed years ago as a “free market” alternative to an expansion of government provided insurance like Medicare. More liberal policy wonks have always favored an expansion of government payers, leading ultimately to a “single payer” solution.
Third, the current “tactics” being used by House Republicans, as well as the offensive remarks by Texas Senator Ted Cruz, seem like petulant acts by a bunch of “bomb-throwers,” and are not worthy of individuals entrusted to act in the public interest. They also conveniently ignore that the bill was debated, passed, signed, and challenged in the courts and upheld, and that the President for whom it was derisively nick-named was handily re-elected last November.
I think it is way past time for the losers to get over it and get back to the people’s business.
What do you think?