After six years with Obamacare, public opinion forces Republicans to think “expansion,” not “repeal.”
PENNEY KOME: OVER EASY
American attitudes towards universal healthcare insurance have long baffled the rest of the world. Only in the US is serious illness a ticket to bankruptcy and the food bank. How is this conducive to healing?
The Republican party has always insisted that Americans would rather die free than depend on socialist medical care. One result is that the American infant mortality rate is a “national disgrace,” according to the Washington Post. And Americans seemed okay with that – until lately (1).
Many presidents have attempted to introduce a universal state-run healthcare system similar to Canada’s or Europe’s. Bill Clinton won the 1992 election after campaigning heavily on health care, HRC, Hillary Rodham Clinton, introduced a national health care plan in 1993, when she was very popular First Lady. Her policy ran into trouble immediately.
US conservatives, libertarians, health insurance and pharmaceutical industries furiously rejected anything that smacked of universal health care, saying patients would be stigmatized by having public rather than private insurance. They also launched vicious personal attacks on HRC that destroyed the proposal and permanently damaged her reputation.(2)
President Barack Obama campaigned on health care reform in the 2008 campaign and managed to pass the Affordable Care Act (ACA) during the two-year window (2008-2010) when the Democrats held the White House, a majority in the House of Representatives, and a Supermajority in the Senate. The ACA expanded Medicare and expecially Medicaid, the existing public health insurance programs. (3.)
Since the president signed the ACA into law in August 2010, House Republicans have voted more than 60 times to repeal it, knowing the president would veto the Bill, even if the Senate passed it. (4.)
Part of President #45’s 2016 election triumph was the GOP’s opportunity to introduce yet another Bill to repeal the ACA (“Obamacare”), in full expectation that the majority Republican Congress would whisk the Bill through promptly. Wrong! How mortified they must feel that the Speaker of the House had to withdraw the (empty) repeal-and-replace motion for lack of supporting votes!
Remember the old bumper sticker, “My karma ran over my dogma”? Between 2010 and 2016, US public opinion on healthcare changed dramatically. As with affirmative action programs, once people actually had to live and work with an “other,” they found the situation more congenial and less threatening than they ever expected.
While the greatly expanded Medicaid included 20 million more people, the catch is that each state has to sign on to the program and design its own system. Thirty-two states joined Medicaid, each with its own version and requirements.
As the New York Times editorialized, “….Medicaid now provides medical care to four out of 10 American children. It covers the costs of nearly half of all births in the United States. It pays for the care for two-thirds of people in nursing homes. And it provides for 10 million children and adults with physical or mental disabilities…
“The program is so woven into the nation’s fabric that in 2015, almost two thirds of Americans in a poll by the Kaiser Family Foundation said they were either covered by Medicaid or had a family member or friend who was….” (5)
Those people, and their loved ones, resisted the Bill. They contacted their Republican Congressional reps to protest this was not why they voted them in. Their vocal opposition forced their representatives to back away from #45’s ill-conceived plan.
More than resistance, what the Republicans encountered is a parade marching in the other direction. Pew Research found that by February 2017, a majority of Americans (54%) supported Obamacare. In 2010, only 40% approved of the Act, and 44% disapproved of it. Ten percentage points is a lot of growth in seven years. (6.)
Medicaid has won over participating state governments, several of which moved quickly to expand their Medicaid programs just as soon as it was clear Trumpcare had failed. Kansas and Missouri moved to expand; recalcitrant Governors in Virginia, North Carolina, and Georgia have indicated interest in joining Medicaid to get health coverage for their poor people.
The NYT notes that, “The A.C.A. offered a tempting deal to states that agreed to expand Medicaid eligibility to everyone with incomes up to 138 percent of the poverty level — $16,400 for a single person — mostly low-wage workers like cooks, hairdressers and cashiers.
“The federal government would initially pay 100 percent of the costs of covering their medical care, and never less than 90 percent under the terms of the law. Over the past three years, 31 states and the District of Columbia took the deal….”
Remember, many states are facing the twin opioid and suicide epidemics now wracking the US. Disability rates are at an all-time high, although people may turn to disability when faced with lifetime limits on welfare eligibility. There’s evidence that cash-short state governments are encouraging welfare recipients to apply for federal disability funds instead.
States that sign Medicaid agreements for convenience or out of desperation, soon find they are saving money and producing goodwill among voters. Patients bring home healthy babies; they take their children to the doctor. They visit family members in long-term care. People with disabilities rely on Medicaid for adaptive equipment and physiotherapy. And oddly enough, they don’t seem to worry about any social stigma at all.
In short, just as Canadians have come to love our Charter of Rights as much as Americans love their Bill of Rights, now it seems that Americans have come to embrace health care for all the way that Canadians do (and most of the rest of the world.) As Joni Mitchell sang, “You don’t know what you’ve got” until somebody tries to take it away.
Copyright Penney Kome 2017
Contact: komeca AT yahoo.com
Read more F&O columns by Penney Kome here
Penney Kome is co-editor of Peace: A Dream Unfolding (Sierra Club Books 1986), with a foreward by the Nobel-winning presidents of International Physicians for Prevention of Nuclear War.
Read her bio on Facts and Opinions.
Contact: komeca AT yahoo.com
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