(Image: Doctor waits via Shutterstock)This summer’s heated battles over the implementation of “Obamacare” are a microcosm of a much larger and longstanding ideological clash over the role of the government in society.
The hard-right is taking a scorched-earth approach, obstructing the law’s implementation by any means necessary and spinning the hiccups and glitches that are inevitable with any complex new system as an unmitigated disaster.
It’s a perfect example of a structural advantage enjoyed by politicians who rail against “big government”: they claim that government is, by definition, hopelessly inept and can’t do anything to improve people’s lives, and when they get into power they have the opportunity to obstruct, cause havoc and ultimately prove the claim.
Meanwhile, the Obama administration, officials in around half of the states and a network of the program’s supporters are desperate to get the new health insurance scheme up and running. It’s shaping up as a particularly ugly fight in an era that’s come to be defined by “crisis governance.”
What does no-hold-barred warfare against a law that’s been settled for three years look like? Some tea party activists are urging Republican lawmakers to shut down the government — or even default on the debt Congress itself ran up — in a quixotic effort to “defund” Obamacare. In refusing to expand Medicaid, legislators in 21 states, most of them “red,” are not only denying their poorest citizens coverage, but also turning away billions of dollars from the federal government. Some members of Congress are refusing to help their own constituents navigate the new exchanges to get the benefits available to them. According to the Washington Post, some state legislators are getting quite creative, “refusing to enforce consumer protections, for example, and restricting federally funded workers hired to help people enroll in coverage.” In Missouri, “officials have been barred from doing anything to help put the law into place.”
And Republicans are refusing to support any efforts to smooth out the law’s rough edges. Even a minor tweak that would fix a glitch in the law that will prevent many church employees from receiving tax credits to help buy coverage — and which may ultimately kill some churches’ insurance plans — is a non-starter. Jim Sargent, the health plan director for the Unitarian Universalist Association, told Religion News Service: “Republicans are trying to undermine it. While that’s going on, there isn’t much you can do to fix the bill.”
The latest strategy to undermine the law’s success is especially pernicious — a major campaign to persuade young people without insurance to pay a penalty, skip the cheap plans they could purchase in heavily subsidized Obamacare exchanges (a young, low-income worker in California will actually be able to get very basic coverage for nothing, according to Sarah Kliff at the Washington Post) and face the risk of a debilitating injury or illness on their own.
The idea is that if young, healthy people can be convinced to stay away from the exchanges, premiums will skyrocket for everyone else and the whole scheme will come crashing to the ground.
Freedomworks is urging people to burn fake “Obamacare draft cards” and post videos of the stunt to YouTube. Dean Clancy, vice president of the group, told the Washington Post, “We’re trying to make it socially acceptable to skip the exchange.” Twila Brase, a conservative health care activist with a group called the Citizens’ Council for Health Freedom, launched a campaign called “refuse to enroll” which likens participating in the exchanges to receiving welfare. The right-wing National Center for Public Policy Research (NCPPR) released a report highlighting how much cash young people might save by paying the penalty instead of buying insurance (and predicting that they’ll stay away in droves).
Conservative columnist Ramesh Ponnuru argues that it’s no big deal to go without coverage. Those who are mangled in an accident or come down with some awful ailment “will be able to buy insurance once they’re sick at the same rate they could have gotten it for when they were well,” he writes. “That’s the part of the Obamacare law that its defenders are usually most keen to emphasize.”
That’s a common but inaccurate belief about the law’s requirement that insurers cover pre-existing conditions: you can just wait until you need insurance to purchase it. FreedomWorks said as much to an inquiring reporter from Bloomberg News. But the reality is that, after this year, you’ll only be able to enroll in the exchanges for a brief period in October and December. There are a few exceptions, like if you lose a job in the middle of the year, but as Adrianna McIntyre remarked, “I accidentally burned my Obamacare card” isn’t one of them.
David Hogberg, author of the NCPPR study says that’s not a problem. “A young person who gets a serious illness in June only has to wait until October to sign up for insurance and then wait until January 1 of the next year to receive coverage,” he writes. But you can’t exactly let a cancer metastasize for a few months or leave a bad injury untreated. And what about someone who gets that serious illness the day after the open enrollment period ends?
This is a strategy that comes with some risk, and not just for young people who might buy the spin. As any pollster can tell you, Americans tend to distrust of the idea of government in the abstract, but are quite fond of most of what it does in the real world. They like public education policemen and environmental protection and Social Security and just about everything else the government provides that makes their lives easier and safer.
That’s why the Republican establishment is so nervous about the prospect of another government shutdown. It’s not only because the effort wouldn’t halt Obamacare, or because polls show that even a majority of Republican voters think it’s an awful idea. It’s because a shutdown would be a vivid reminder that the government provides goods and services that most Americans value and like.
And the reason the right’s war on Obamacare is reaching such a fevered pitch today is that what has long been an abstraction is about to become concrete. Polls show that four years after its passage, many Americans aren’t really sure what the law will do. More oppose Obamacare than approve of it, but almost all of its individual provisions poll very well. And here’s a key finding: the most popular parts of the law are also the least well-known to the American public.
After years of demagoguery and disinformation by opponents, many Americans are fearful of a “government takeover” of the health care system, or death panels, or huge price shocks. But with most of the major benefits of Obamacare set to kick in, the realities of what the law really does are about to become undeniable. Almost 26 million people will be eligible for subsidized coverage, according to a recent analysis by Families USA, but as CNN notes, “most don’t know it.”
That represents an advantage for the law’s proponents. If they can manage to get the bulk of it implemented, even with the Affordable Care Act’s warts, it will provide solid evidence that the government can improve people’s lives. That possibility represents an existential threat to some on the right’s worldview, and it’s driving them into feverish levels of opposition.
