When he announced for the U.S. Senate in 2013, Ben Sasse prognosticated that the implementation of the Affordable Care Act (ACA) would cause America to “cease to exist.” Sasse’s apocalyptic prediction of doom was well within the Republican mainstream during Obama’s first term. Numerous prominent Republicans predicted that Obama’s policies would destroy the country. For example, in 2010, John Boehner predicted the ACA would cause “Armageddon.” Neither the Nebraska press nor the national press has ever called Sasse (or any other Republican) to account for these ludicrous predictions.
Sasse should be required to explain these remarks in light of the progress of the U.S. economy since the ACA passed in 2010. In every month since the passage of this landmark legislation, the economy has added jobs. The unemployment rate has dropped from 10% to 4.9%. Approximately 200,000 new jobs per month have been created since early 2013. The price of gasoline is hovering just above $2 per gallon and the stock market has tripled in value. For the first time since Bill Clinton’s second term, middle class wages finally began to grow again in 2015. In an alternative political universe, the mainstream press and the GOP would be lavishing praise on a President Romney.
The ACA itself has also proven to be a big success. Lest we forget, during the George W. Bush Administration, 8 million Americans lost health insurance coverage. Since the implementation of the ACA, 20 million formerly uninsured Americans have obtained coverage and the uninsured rate has fallen from 18% to an all time low of 9%.
This record increase in insurance coverage isn’t the only accomplishment of the ACA. The 2010 health care law can also claim these other impressive accomplishments:
Pre-existing condition clauses have been outlawed. The insurance industry can no longer discriminate against the sick and the injured.
Health care spending is down significantly. The U.S. health care system is projected to spend $2.6 trillion less between 2014 and 2019 than before the ACA became law.
The ACA closed the Bush-era Medicare doughnut hole saving the average senior citizen a little over $1,000.00 per year.
Millions of young adults have been allowed to stay on their parents’ insurance policies until the age of 26.
These little publicized accomplishments of the ACA have undeniably improved the quality of life for millions of Americans. Nevertheless, the ACA could use some tweaks – like all other major legislation in the past. For example, several years after the passage of Social Security in 1935, coverage was expanded to additional workers, including farm and domestic laborers. An automatic cost of living increase was passed in 1972. Medicare was most recently expanded with the passage of the prescription drug benefit in 2003.
At the present time, the biggest challenges posed to the ACA are higher insurance premiums and an overall lack of competition in the insurance industry. It was recently reported in the Omaha World Herald that insurance premiums in Nebraska could increase next year anywhere from 12% to 31%. Many of the premium increases will be largely nullified by the payment of subsidies to those who purchase coverage on the exchanges. Approximately 75% of people who purchase insurance on the ACA exchanges receive subsidies.
Contrary to the allegations of the GOP, the ACA can’t be blamed for these premium hikes. The real source of these increased prices is the lack of competition in the health insurance industry in Nebraska and many other states. In Nebraska, two insurance companies control 80% of the market. According to the American Medical Association, Nebraska has the 8th least competitive market for health insurance in the country.
The obvious solution to this problem is to create more competition. We Democrats need to bring back the “public option” or what has also been called “Medicare buy in for all.” (I called it “Medicare Plus” during my 2014 campaign for Congress.) This would allow a consumer to select Medicare to be his/her health insurance carrier in the ACA insurance exchanges. This would mean that Medicare would compete with the likes of Blue Cross Blue Shield and Coventry in the exchanges.
The Medicare Plus proposal would create a needed dose of competition in the heavily concentrated Nebraska
Another common sense way to reduce insurance premiums would be for Nebraska and the 18 other holdout states would be to adopt the Medicaid expansion. Adoption of the Medicaid expansion would bring into Nebraska over $2 billion in federal money over the next five years, insure approximately 77,000 additional Nebraskans and provide a vital lifeline for many rural hospitals.
Adoption of the Medicaid expansion would also reduce premiums for middle class consumers according to a recent report from the U.S. Department of Health and Human Services. The HHS study found that middle class people in states that had adopted the Medicaid expansion paid insurance premiums that were 7% lower than those in the hold out states.
Unfortunately, we can’t count on the Republicans to work with us to improve the ACA. The GOP has been fixated on the total repeal of the ACA since it was passed in 2010. The Republicans in Congress have promised over 20 times since 2009 to produce a replacement plan and hold an up or down vote on it. There still is no replacement plan and no up or down vote. The Republicans would prefer to hold out for their predicted “Armageddon” rather than work across party lines to help their constituents by making improvements to the ACA.
We Democrats must let people know that the ACA is working and has bettered their lives. We must also inform people about our proposed improvements. The voters also need to know that it is the Republicans who are playing politics by obstructing the reform of our health care system. The most important thing we can do to preserve and improve the ACA is to elect more Democrats across the board in 2016. I know we can do it! Let’s get it done!