The central tenet of the Affordable Care Act—health insurance for almost all—kicked in at midnight Tuesday, at the same instant that the government shutdown began. It was one of those conjunctions of American history that bleed with irony, like the time in the waning days of the Civil War when Jefferson Davis inclined to drafting slaves to fight the Confederacy’s lost cause. Opponents of Obamacare think that by doubling down on hurting Americans, they might stun them into submission. They must be stupider than they let on.
Obamacare has its problems, and the federal government hasn’t done a good job selling it. Its implementation is another story. Obamacare has been falsely portrayed as too complicated, though mostly by people who calibrate their powers of comprehension to the grunts and growls of talk radio. Obamacare is no more complicated than shopping for your average private insurance policy, because death-panel mythologies aside, that’s mostly what it is. The so-called “insurance marketplaces,” in states lucky enough to have them (Florida is not among them) facilitate the process.
In the dark days pre-dating reform, insurers were entirely to blame for the western world’s most discriminatory, at times sadistic and always extortionary health care system. They picked what clients they wanted, denied coverage to those who needed it most, dumped those who filed costly claims, and for those on the rolls judged what care to mete out and what care to withhold, as if nameless actuarial pinheads knew better than your doctor what ailed you. That’s what’s ending, somewhat.
If there is a fundamental failing to Obamacare, it’s that insurers are still almost entirely in control. They still get to pick who gets what and at what price, infuriating clients and using the government as their perfect foil. The government merely sets a few standards, only slightly diminishing insurers’ rapacity for providing the fewest benefits at the most exorbitant cost. The government’s more honest baseline is that insurers may no longer cap lifetime benefits, boot out the sick or exclude those with pre-existing conditions. But clients must still navigate the private insurance market to get a policy. The complications were themselves pre-existing. Now more people get to suffer them. Except that the insurance industry gets to reap the profits while deflecting all bureaucratic frustrations on Obamacare.
Many of the problems are compounded by various states’ continuing war against reform, purposefully complicating what should have been the single greatest improvement in Americans’ peace of mind since the establishment of Medicare for the elderly in 1965.
Medicare should have been the model for reform. It’s the nation’s best and least expensive insurance program, a socialistic single-payer system that leaves individuals with all the free-market liberties to choose the kind of care they want. The government gets the bill (padded though it often is by private providers’ fraud). Medicare for all is what President Obama wanted when he started his road toward reform. But wouldn’t you know it: tea party geezers made up mostly of people on Medicare made sure that what they had would not be what the rest of the country would get. The Selfish Generation’s hypocrisy won the day, making anthems of falsehoods.
That’s not the worst surprise. Universal coverage for America’s 47 million uninsured was to be achieved in two ways. Those with incomes above a certain level were to go through the marketplace. Poorer people were to be made eligible for Medicaid. But when the United States Supreme Court ratified the Affordable Care Act, it excluded the Medicaid provision. States, the court ruled, could not be forced to expand the program. That gave opponents of the measure a fresh way to undermine it.
A quarter of Florida’s population is uninsured. That’s the second-highest proportion in the country after Texas. The federal government was ready to send $54 billion to Florida over the next 10 years to finance the Medicaid expansion. It would have picked up 100 percent of the bill for the first three years. It would then have picked up 90 percent of the bill for every year after that. Only mad men blinded by ideology and hatred for Obama would reject terms like that. So they did.
Florida became one of 25 states, including almost every state in the South, that rejected the Medicaid expansion. Almost every one of those states is controlled by Republicans.
It’s not too late. Just last month, two states that formerly opposed the expansion, Pennsylvania and Michigan, finally saw more dollar signs than tea leaves and switched sides. Even Gov. Rick Scott wanted to flip in February, but was stopped by the Legislature. Maybe he’ll try again.
Meanwhile, because of the Medicaid rejection, 1 million Floridians will remain ineligible for health insurance of any kind. They’re not poor enough for Medicaid, and too poor for the insurance marketplace. They’re not unemployed. They’re not loafers. They’re cooks, cashiers, nurses, retail store clerks, janitors, housekeepers and construction laborers. They’re the grunts who make life easier for the Selfish Generation. They’re disproportionately black and Hispanic. And they’re victims of a form of ideological bigotry that can thank Florida’s Republican legislature for holding their health hostage.
We need more than a shut-down. We need a purge.