November 13th, 2018
A version of this article first appeared on Forbes.com HERE
Nancy Pelosi says there are three reasons the Democrats took back the House: “Health care, health care and health care.” She may not be exaggerating. Half the Democratic TV ads were on health care. By one estimate, Democratic candidates spent a reported $90 million on health care ads alone.
If that doesn’t surprise you, it should.
Barack Obama’s attempt to reform the private insurance system has been a disaster. The last year he was president, the percent of the population with private health insurance was actually lower than the year he was first elected. That’s despite spending more than $100 billion a year on subsidies.
Remember, Obama was elected in the middle of the Great Recession. If there had never been Obamacare, the percent of the population with private insurance would almost certainly have steadily grown as the economy recovered. With Obamacare, it contracted. The only increase has been in Medicaid.
What about the people who are newly insured through the (Obamacare) exchanges? Much of that increase was offset by a reduction in employer-provided coverage. Ironically, billions of dollars in subsidies have been encouraging the substitution of inferior insurance for what would have been much better coverage.
Insurance premiums in the individual market have doubled and tripled under Obamacare. Deductibles are two to three times what they are in a typical employer plan. Networks have become so narrow that enrollees are often denied access to the best doctors and the best hospitals. The most successful insurers under Obamacare are Medicaid contractors and the types of plans they offer resemble Medicaid with a sky-high deductible.
Things are getting worse. In half the counties in the country, there is only one (monopoly) insurer. Middle class families who must buy their own insurance are getting priced out of the market, in what threatens to become a death spiral. Within the last two years, off-exchange enrollment (where there are no subsidies) has declined by a whopping 47 percent!
Overall, 28 million people are uninsured under a reform that promised universal coverage. One-fourth of them chose to pay a fine last April because the insurance being offered was so unattractive.
So why are Republicans, who had no role in any of this, being successfully attacked by Democrats? Why do polls show the public trusts Democrats more than Republicans on health policy?
Democratic candidates got help from three big Republican mistakes.
No hearings. Had the tables been reversed – had a Republican plan fared so poorly and Democrats been in control of Congress – there would have been hearings every week. The public would have been reminded of everything that wasn’t working and the harm it caused.
In the early days of Obamacare, it appeared this would be the Republican approach as well. My organization and others were asked to identify victims of Obamacare to appear as witnesses.
There were many. A woman with a brain tumor had to skip her MRI scan because she couldn’t afford it. Due to a several thousand dollar deductible, the entire cost had to be paid out of pocket. A woman in Manhattan had to travel all the way to Connecticut to see the nearest specialist in her plan’s network. AIDS patients were paying $4,000 and $5,000 for life-saving drugs before their insurance kicked in.
But none of these witnesses ever appeared. Strange as it may seem, there has never been a hearing in the House or the Senate featuring the victims of Obamacare.
No alternative. If Obamacare were abolished tomorrow, what would happen to all the people getting subsidized insurance? Would they have to fend for themselves financially. Would insurers be free to drop their coverage if they happened to be sick?
House Republicans voted to repeal or significantly alter Obamacare more than 70 times. They never bothered proposing a replacement, because they knew the votes were merely symbolic. Their bills had no chance of passing the Senate or surviving a presidential veto.
But each of those votes must have created some anxiety in people who wondered what repeal would mean for them.
Finally, the House did pass a replacement plan that almost passed the Senate as well. While the measure left many questions unanswered, the Congressional Budget Office concluded that 24 million people would lose their insurance and that the savings would be used to lower taxes on the rich, on insurance companies, on drug companies and on big business in general.
Had that bill passed, House Republican election results would have been much worse.
No vision. The left wing has a health care vision that is shared by many Democrats: if you get sick you should be able to get medical care and someone else should pay for it.
What’s the Republican vision? You don’t know? Most Republicans don’t know either.
Lack of a vision is especially harmful when Republicans make piecemeal changes to Obamacare – changes Democrats can spin as destabilizing and threatening to people who have health problems and desperately need health insurance.
In the waning days of the recent election period, Congressman Pete Sessions (R-TX) introduced a House resolution that did have a vision. States would have broad authority to reform their individual health insurance markets, provided insurance gets better for people who are sick. Better means lower premiums, lower deductibles and wider networks of doctors and hospitals.
Plus, the state would have to have a long-term goal: people who have been paying into a group plan for many years should be able to find insurance that is comparable (in price, quality and access to care) if they have to leave their employer and enter the individual market. One way to ensure that goal would be to allow employers to purchase insurance for their employees that is personal and portable and that travels with the employees from job to job and in and out of the labor market.
The vision was commendable. But it was too little too late.