The debate over Obamacare rages from Providence to Pasadena. As the state moves closer to launching its health insurance exchange, RIPR political analyst Scott MacKay parses the arguments and traces the law’s Rhode Island roots.
Ask Rhode Island Republican State Chairman Mark Smiley what he thinks of the Affordable Care Act, also known as Obamacare and you’ll get a blunt answer: He says, ``I hate it.’’
Smiley’s position is simple and wedded to his party’s national stance: Repeal the entire law and start over. ``Socialism,’’ he says, ``doesn’t work.’’
Whatever Republicans think, the new health care program and the Internet medical insurance purchasing exchanges are underway. Our state’s plan, called HealthSource-Rhode Island, will be rolling out insurance coverage options and prices in the coming weeks, with a start date of October 1.
While U.S. House Republicans have voted 40 times to repeal the whole law, they haven’t put together any alternative ideas on providing access to the 30 million Americans who have no insurance. Or for addressing the huge problem of shifting costs from those who don't contribute to the health care system to those who do.
History is replete with irony. Health care is at the top of the current list. Local and national Republicans say any government requirement in health care smacks of government control and dreaded socialism.
Yet Obamacare has undeniably Republican, and even Rhode Island, roots. In 1993, Rhode Island GOP Sen. John Chafee was the first to proposed an alternative to a health insurance regime pushed by then-President Bill Clinton and his spouse, First Lady Hilary Clinton. The architect of the Clinton’s plan was a Rhode Islander, policy guru Ira Magaziner of Bristol.
The centerpiece of Chafee’s idea – the so-called individual mandate – was once seen as a conservative idea. It combined the virtue of individual responsibility with an end to the cost-shifting that has helped make health are more expensive for average Americans.
Chafee’s plan was embraced by icons of the conservative movement, including Newt Gingrich, the Heritage Foundation, the conservative think tank, and Sen. Bob Dole, the Senate GOP leader.
The requirement that everyone have health insurance was once seen as personal responsibility, a bedrock pre-Tea Party Republican principle. Everyone is going to sick at some point in their life; nobody leaves this earth alive. If you get sick you have the responsibility to have insurance. Under federal law, hospitals must treat the sick. So if you show up sick at an emergency room, you get care. If you don’t have insurance or enough money to pay for the treatment, the costs get shifted to the taxpayer in the form of uncompensated care costs. Or it ends up inflating the insurance rates of other hospital patients who pay for their coverage or get it at the workplace.
In next-door Massachusetts, the Chafee template was adopted by Republican Mitt Romney when he was the Bay State’s governor. The Romney plan so resembled Obama’s program that one of Romney’s 2012 opponents for his party’s presidential nomination, Minnesota Gov. Tim Pawlenty, famously labeled it Obamney care.
What has happened since has been an all-our Republican onslaught against the president. Many Tea Party Republicans in Washington have even said they would be willing to shut down the federal government to defund the Affordable Care Act.
The paradox is that just about all the public opinion polling shows that while a majority of Americans may be against the hazy concept of Obamacare, they support many of its parts. Is there really a majority against banning insurers from dumping patients who have pre-existing medical conditions? Or allowing college students to remain on their parents plans until they are 26? Or eliminating the limits on how much insurers will pay for those who have such serious conditions as cancer or heart disease?
In Rhode Island, about 11 percent of citizens do not have health coverage. Many of these are people who work for small businesses, the backbone of our economy. Christine Ferguson, director of HealthSourceRI, vows to work closely with small business owners to help them get affordable health care for their workers. Healthy workers are obviously more productive. (Ferguson, of Jamestown, was also a prime mover in the Massachusetts program when she worked as the Bay State's healtgh commissioner under Romney).
This is not to downplay the challenges to Obamacare. There are many hurdles. Among them: That not enough healthy people will sign up. Or that insurance companies will behave as, well, insurance companies and continue to hike premiums. That the computer online exchanges will face glitches that are inevitable given the complexity of merging a new health care program into an existing one that is one-sixth of the national economy.
And there is a fear that some companies in such industries as fast-food and big-box retail may accelerate the hiring of part-time workers so they won’t be liable for health care coverage. Yet, in Massachusetts, this hasn’t happened; employers have actually increased health coverage for workers. And these burger and-fries-joints and big box suburban sprawl-marts started shifting to part-time workers many years ago, well before Obamacare.
Rhode Island is much like Massachusetts in political attitudes and population demographics. But the economy in the Ocean State is not as robust as our neighbor. Getting employers to offer workers health insurance is always easier when jobs are chasing people than when people are chasing jobs.
The Obamacare debate would be helped if Democrats would push back more strenuously against Republican attempts to demonize a program that is not yet in place. Respected Democrats such as Sen. Jack Reed should vigorously call out opponents. And things would be far easier if Republicans would offer reasonable alternatives rather than being the party of NO and relentless resentment.
One wonders what Republicans most fear: That the plan will crash under its own weight or that it will be successful in giving the uninsured coverage and injecting some common sense into a health care system that has long been a drag on the American economy.
Scott MacKay's commentary can be heard every Monday at 6:35 and 8:35 on Morning Edition and at 5:50 on All Things Considered. You can also follow his political reporting and analysis at our `On Politics' blog at RIPR.org