In 2010, the GOP kicked some electoral butt as a result of Obamacare, now they're about to get their butts kicked if they keep up efforts to appeal it. The Affordable Care Act (Obamacare) is here to stay, and it is and always was the signature accomplishment of the Obama administration. To quote Joe Biden, it's a "big F**KING deal."
How does it work?
The Affordable Care Act is officially known as the Patient Protection and Affordable Care Act, but has become known as the "Obamacare." Obamacare was the classic "law by committee." President Barack Obama took a hands-off approach to the crafting of the law and allowed Congressional Committees to craft differing versions of a law whose main goal was to cover as many Americans as possible. The result which is by no means perfect was light years ahead of the messed up system that was in place.
Despite attempts for a single payer system or even a system with a "public option," the overall plan is still primarily a private insurance company based system. Most Americans (excluding those over 65, disabled, or covered under the Children's Health Insurance Program {CHIP}) have some form of employer-based healthcare. Obamacare made it mandatory for employers with over 50 fulltime employees (30 hours or more a week) to offer "affordable" and "minimum essential coverage." The rest of the public (excluding the aforementioned seniors and the disabled) fell under mandated Obamacare insurance.
Without getting into the specifics of federally run exchanges and state-run exchanges, Obamacare gave monetary subsidies to individuals making between 100 and 400 percent of the federal poverty level (around $12,000 a year per individual and an additional $4000 for each dependent.) The Advanced Premium Tax Credits amounted to large "gifts" to the health insurance companies which allowed individuals to pay reduced premiums for health insurance. The subsidies allowed millions of people the chance at health coverage. This was the "carrot." The "stick" was the individual mandate (a monetary penalty if you didn't buy health insurance.)
If your income is under 133 percent of the poverty level (about $16,000 a year for an individual or $32,000 for a family of four) you are eligible for Medicaid (the Medicaid Expansion.) If you make over $48,000 as an individual or $96,000 for a family of four, you do not get any financial help buying insurance, but you still have to purchase health insurance or face a financial penalty assessed by the IRS on your next year's taxes.
All of this, by the way, is paid and did not increase the deficit.
The Supreme Court mucks it up
As soon as Obamacare became the "law of the land," Republicans (the guys and gals who abhor the courts "making" laws) filed legal challenges to strike down Obamacare. The thrust of their argument was that the mandate to buy insurance was an unconstitutional use of power by the federal government. It was argued that the Commerce Clause did not allow Congress to force people to buy health insurance, which, of course, lead to the crazy legal discussions by the late Justice Antonin Scalia about the federal government forcing individuals to buy broccoli.
In the end, Chief Justice John Roberts saved the day, by declaring Obamacare good to go constitutionally, but not under the Commerce Clause, but he reasoned that the individual mandate was a "tax" and Congress certainly has the right to tax. He also threw a bone to the conservatives by saying that states were not required to enact the Medicaid expansion, because that was a bridge too far constitutionally. A number of states (those controlled by Democratic legislatures or Governors,) took the federal money and expanded Medicaid. Those under Republican control said "we don't want your stinkin' money" and shafted its poorest residents by refusing to expand Medicaid. The number of states expanding Medicaid has steadily increased, and currently 37 states and the District of Columbia have expanded Medicaid (the most recent few by popular referendum.)
The Supreme Court may get another chance to muck things up if the case which is working its way through the federal court system makes its way to Washington. Before the GOP got its butt handed to them in the 2018 election, Republicans repealed the individual mandate as part of their tax "reform" legislation. This afforded those diehard Obamacare haters to file suit which basically says that since there is no more individual mandate, there is no tax, and thus the whole of Obamacare is unconstitutional. A federal judge in Texas agreed, but his ruling is on hold pending appeal.
Repeal and Replace
Repeal and Replace has been the mantra of Republicans for years when it comes to Obamacare. While this slogan carried some weight when the GOP first coined the phrase, it no longer excites crowds, except for true believers. This lack of favor came for two major reasons --- Republicans had no "replacement" and Obamacare now usually polls at least fifteen points on the positive side. It seems like people are happy with the law's prohibition of discriminating against people with pre-existing conditions, keeping children on their plans until age 26, the subsidies, and the elimination of junk insurance plans. The jury is also in on premium costs because even though health insurance costs continue to rise, the rate of increase has slowed dramatically.
The basic reason for passing Obamacare was to increase the number of individuals with health coverage. Health insurance would no longer be a luxury only for those who could pay the bill. Hard working individuals would now be able to go to get medical care without having to "tough it out" and pray for the best or get medical care and then seek bankruptcy protection. At least 20 million people now have health insurance who wouldn't without Obamacare, and the GOP and President Donald Trump have no plan to cover these people. Health Savings Accounts ain't gonna do it.
Where do we go from here?
Obamacare is here to stay, and thankfully so. Millions of Americans now have health insurance who could never afford it. One of the groups who benefit the most from Obamacare are those "small business people" the GOP loves to canonize. It is not uncommon for a family health insurance plan to cost as much as $3000 a month, that $36,000 a year for those of you scoring at home.
A small businessman (making $60,000 a year) with a family of four would have to pay about $2000 a month for a family health insurance plan. Under Obamacare, that small businessman would now get that same coverage for about $400 a month. Now he can make that business grow and not have about being forced into bankruptcy by health insurance premiums or bills from an unexpected illness.
President Trump has promised a "really good" health insurance plan both on the campaign trail and now since he's instructed the Justice Department to join GOP Attorneys General in support of striking down Obamacare. He recently said, the GOP will become the "party of healthcare." This ain't gonna happen if you don't have a plan. Trump's die-hard bases might take him on his word about healthcare, but a good majority of the American people won't.
Buzz and I are in agreement with a vast majority of the American people. Fix Obamacare and don't throw the baby out with the bath water. Obamacare is not perfect, but it is so, so much better than what we had before. Millions of more Americans are covered, and that's a great start. Let's start tweaking it to cover even more Americans.
