June 23, 2018
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Affordable health care — invented by Republicans

By Rufus Wanning, Special to the BDN

There are only three ways this country could move toward universal health care. We could extend Medicare to the entire population, having the government pay for it; we could require employers to insure their workers, with government picking up the bill for the rest, or we could have an individual mandate. The individual mandate is the most politically conservative plan, and it is the plan Obama and Congress chose when they enacted The Affordable Care Act.

The plan was first proposed in 1989 by the conservative Heritage Foundation. In 1993, a similar bill was proposed by prominent Republican senators. In 2005, another such bill was proposed by Mitt Romney as governor of Massachusetts, which became law the next year. All these reforms included an individual mandate, which somehow was never a big issue. Romney even said, in a 2008 Republican primary debate, “I like mandates.”

Now Romney calls the Affordable Care Act “an assault on freedom.” You explain this; I can’t.

The Massachusetts bill became the model for Obama’s Affordable Care Act, passed in 2009. From what I’ve heard, the Massachusetts bill has been fairly successful, although a little more expensive than hoped. Massachusetts is the only state in the Union where the individual mandate is NOT a big issue, because they already have it.

But with three choices, why did Obama choose the the Heritage Foundation plan with its requirement for individuals to buy private insurance? He really had no choice. Liberals, led by Ted Kennedy, had been trying to pass Medicare for All for at least 40 years, and got nowhere. Clinton had proposed an extremely complicated employer mandate, which got killed by heavy business lobbying and the famous Harry and Louise ads, sponsored by the insurance industry. The Heritage Foundation plan, with an individual mandate, was the only plan Obama had a chance of getting enacted.

The main part of the Affordable Care Act squeaked through the Supreme Court, while an important component was found unconstitutional. That was the part requiring the states to extend Medicaid to a larger population than before. Ironically, the Supreme Court held that Medicare for All would have posed no constitutional problems.

Medicare for All is not dead; the state of Vermont has passed a version of it. Perhaps this is how Medicare for All will come to America: state by state.

Meanwhile, Republicans are spitting fire and pledging to repeal Health Care for All if they come to office. What would that mean?

It would mean that children who are permitted to stay on their parents’ policies up to age 26 will be dumped, and left to find insurance on their own. Insurers will no longer be required to cover preventive services, such as mammograms. Likewise, they will once again be allowed to charge extra to women, and deny coverage to people with pre-existing medical conditions.

Most important, repeal would deny health insurance to 24 million people who now have the chance of getting it.

There is a great deal more in the law. For instance, there are provisions to slow the growth of Medicare costs, provisions that Republicans are calling a “tax on Medicare,” even though candidate Paul Ryan books the savings in his budget plan.

The plan does require a mandate, because otherwise people would be able to wait until they get sick, then buy insurance. How burdensome is that mandate?

First, the mandate does not apply if your income is too low. Second, If your income is low enough, you will qualify for expanded Medicaid, if you are lucky enough to live in a state that expands Medicaid, receiving a 90 percent federal match for it. Third, the government will give you subsidies if your income is below about $88,000 for a family of four. Fourth, if you still don’t get health insurance (and why wouldn’t you?), the penalty starts at only $95 per year, rising to $695 in 2016.

The Affordable Care Act represents a real health care improvement, not just according to Democrats, but according to wiser Republicans of the past.

Rufus Wanning is an arborist living in Orland.

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