Wednesday, November 20, 2013

ALEC on the Affordable Care Act. Or The Guy Behind The Curtain.

The UK Guardian reports on how Republican "model bills" are created, this time applied to the Affordable Care Act (ACA):

With Obamacare still in crisis from its botched technical rollout, the signature reform of the Obama presidency faces threats from state-based politicians who have devised a strategy to scupper the federal health insurance exchanges.
The move is the latest in a sustained effort by conservative states, mainly in the south and midwest, to resist key elements of the changes that are designed to extend healthcare to millions of uninsured Americans.
The idea for the new attack is the brainchild of the American Legislative Exchange Council (Alec), a group that acts as a dating agency for Republican state legislators and big corporations, bringing them together to frame rightwing legislative agendas in the form of “model bills”.
A new Alec proposal, approved by its annual meeting in Chicago in August and published as a model bill for adoption by state assemblies across the nation, would scupper the federal health insurance exchanges set up under Obamacare. The Health Care Freedom Act, as Alec calls its model bill, threatens to strip health insurers of their licenses to do new business on the federal exchanges should they accept any subsidies under the system.
Alec justifies the measure as a way to protect local employers from the “employer mandate” – the provision in Obama's act that penalises employers with more than 50 workers who do not offer any or sufficient healthcare cover for their employees. However, health insurance experts say that were the model bill to be taken up widely by Republican-held states, it would seriously disrupt the federal exchanges, and in turn put the whole health reforms in peril.

I love those euphemisms.  "The Health Care Freedom Act" indeed.  Perhaps it should be titled the Freedom From Health Care Act?

Let's go back to the reasons for the ACA:  Over forty million Americans without health insurance (with consequences ranging from preventable deaths to the fact that someone must pay for the care the uninsured receive, i.e., subsidies for care), the great difficulty of finding affordable insurance for anyone with pre-existing conditions (which with age is a large percentage of us all), the patchwork nature of the whole system and rapidly rising health care costs.

These are the problems.  And many of these problems will sneak right back in with the kinds of proposals that ALEC drafts.

I was for a single-payer system and still am, and my reason has to do with the inherent problems in markets for most health care services (lack of informed customers, great levels of  uncertainty, lots of supply-side collusion, very price-inelastic demand combined by the need for third-party payment systems, considerable external benefits not captured by markets etc etc).  A single-payer system is not without flaws but it's better than the market-based alternatives, especially the kind of imaginary free market alternatives the conservatives desire.  Those will not work because of the characteristics of health insurance and most types of health care.

Instead of fixing that patchwork quilt of American health insurance, ACA just covered the whole frayed mess by another layer of muslin.  But it is better than nothing, especially in fixing the problem of the uninsured.  And yes, even with the really deplorable launch problems the ACA sites have experienced, because the proper view to how things are going to work is a long-run view.

ALEC would like the old system back, thankyouverymuch.  I would like something more logical and reasonable.  I won't get it, but I hope ALEC won't get what it wants, either.