Obamacare IS The Conservative Alternative: No "More Conservative" Plan Works

The Affordable Care Act (“ACA” or “Obamacare”) was the conservative health care plan, fulfilling all major conservative principles.
02/26/2017 12:20 am ET Updated Feb 27, 2017
Stephanie Keith / Reuters

Here’s a sobering thought to consider for millions and millions of Americans about to be denied coverage: The Affordable Care Act (“ACA” or “Obamacare”) was the conservative health care plan, fulfilling all major conservative principles.

That is why they have never been able to craft an alternative—at least one that works. Former President Obama often said that, if they have a better plan, that achieves the same goals, he would sign it. No plan that is ‘more conservative’ works. Hence, no bill.

The only reason you will lose your coverage is because it was passed by President Obama.

The Affordable Care Act was created in the extreme conservative group called the Heritage Foundation (Jim DeMint now runs it). The notion that the Heritage Foundation would propose a “government takeover” of anything is absurd on its face.

It was first introduced into Congress by very conservative Senator Charles Grassley (R-IA) and several other Republican senators in the 1990s.

It was enacted first by Republican Governor, and 2012 Republican standard bearer, Mitt Romney (R-MA). He considered it the signature achievement of his term because it was a conservative program. Conservatives claim to favor testing policies in the “laboratories” of the states. Romney did.

The ACA includes as its lynchpin the “individual mandate”. That is, personal responsibility. It prevents “free-riders” on the system. Personal responsibility is touted as a core conservative principal. It was in the original Heritage Foundation plan and considered one of its key conservative elements.

Without the money the mandate provides, without everybody participating, those currently healthy as well as the ill, coverage cannot be provided at reasonable premium costs to those with prior illnesses. It evens out over time as we all are likely to be ill at some point and need care. Coverage facilitates earlier recognition of disease allowing more effective, less expensive, treatments. Not to mention the personal responsibility, non-freeloading, conservatives claim to champion.

The alternatives to “enforce” a mandate without calling it a mandate is smoke and mirrors, and totally unnecessary even for a conservative Congress because the mandate was the Heritage Foundation’s. Senator Ron Paul (R-KY) proposes denial of coverage for those who do not maintain continuous coverage. But, that approach penalizes someone when they are older and wiser for either unknowing or stupid decisions made when they were younger. Moreover, young people have a feeling of invincibility that is difficult to overcome by rational argument. If you doubt it, just ask the cigarette companies who preyed on this for half a century.

Medicare was due to become insolvent in 2016. Thanks to ACA Medicare will be solvent at least to 2028. One way it gets there is using market forces (i.e., incentives) to improve care and reduce costs. Conservatives repeatedly argue that market forces are the way to improve outcomes and reduce costs. The ACA has achieved that by providing accountable care organizations (“ACOs”) $0.50 of every $1.00 saved year-over-year on patient care, and, at the same time, making hospitals eat the cost of care of any patient re-admitted within 30 days. Hence, there are financial incentives to improve patients’ health before discharge, and to save money. It works. Tens of millions of dollars are already being saved with these incentives operative. Conservatives should be high-fiving.

The ACA closed the “doughnut hole” in Part D of Medicare. Part D was passed by a Republican Congress and signed by a Republican president. The “doughnut hole” was one of its drawbacks. Without a dime of government spending, ACA reduces and eventually eliminates the doughnut hole, reducing out-of-pocket drug costs for senior citizens, so that their savings and their social security go further. Again, a plus for conservatives who want as little government support as possible.

The ACA provides free contraception. The safest and most effective contraceptives are the most expensive, but still much less expensive than pregnancy. Studies in Missouri and Colorado have shown a drastic reduction in abortion when women are given voluntary access to free contraception. Last I heard, conservatives don’t like abortions.

It also results in fewer unwanted children, fewer “children-having-children”, and enables young women to finish their educations, leading to healthier families and better incomes. That would lead to less crime arising from unstable family situations, and fewer people on welfare. Conservatives at least pay lip-service to the importance of strong families.

The ACA forbids annual and life caps on coverage. Hence, if a person experiences a serious illness, it does not force the family into personal bankruptcy. Prior to ACA, unpaid medical bills were one of the leading causes of personal bankruptcy. Rumor has it that conservatives do not like mortgage forfeitures or unpaid obligations, nor like having to support social support programs like food stamps and welfare that often are the consequence of personal bankruptcy. The ACA dramatically reduces the bankruptcies due to medical costs of illness, thus reducing food stamps and welfare needs. It also enables families to remain together under one roof.

The ACA was designed to create minimal additional federal bureaucracy—if, that is, states take the money provided to establish their own insurance marketplaces. Kentucky did that. Oddly, most Republican governors did not. The ACA established federal marketplaces only as a fall-back if states did not. Conservatives like minimal federal bureaucracy, but cannot blame the ACA for Republican governors not taking the costless opportunity to run it all at the state level.

The ACA expanded Medicaid. Now, granted, this may not be conservative, but, if so, it is the only provision thusfar that fails that test. Consider, nonetheless, the effects conservatives claim to love. If all governors had accepted the expansion, its citizens would have been covered, thus preventing costly long-term chronic diseases. For example, high blood pressure. One can have high blood pressure for years without realizing you have it. An annual check-up can discover it, and it is highly treatable. Without treatment, it causes stroke, heart disease, kidney damage, eye damage. In addition to pain and suffering from the illness and its effects, consider the costs of treating stroke, heart attack, kidney failure and visual problems, not to mention lost wages. Coverage and treatment prevents pain, suffering, death and saves money. Conservatives like to save money.

The ACA provides free mammograms. Conservatives claim they believe that children do better with two parents. Saving children’s mothers’ lives by catching breast cancer early would help achieve that goal.

Conservatives claim they try to create “more freedom”. What could be more enslaving than bad health? It saps strength, energy, and money. Obamacare is the most freedom-expanding law passed in decades. In addition to maintaining health, the existence of Obamacare enables greater job mobility (do not have to stay at a job to keep one’s health insurance), and frees resources to invest in one’s self or some venture or children’s education, and protects families against bankruptcies due to illness or accidents.

Then, of course, is the impact on the budget. The Congressional Budget Office predicted the ACA would save about $1 Trillion (yes, that is with a “T”) over the course of its second decade. One might wonder what problems conservatives have with saving taxpayers’ money.

There is a simple reason Republicans have been unable to craft a workable alternative—they had one in the 1990s, and Democrats enacted it as the ACA (“Obamacare”).

Republicans ought to embrace the ACA for what it is: their own program. They should claim credit for it, and work to improve it by, e.g., deepening the subsidies, restoring the risk corridors that were lifted from President George Bush’s Part D of Medicare, and vigorously sending out the message for more people to sign up for coverage.

Indeed, conservatives desperately need the ACA to work.

For conservatives to say that the ACA, their own plan, hatched in their Heritage Foundation, does not work is to state that market mechanisms do not work.

A very odd position indeed.

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