And when the servant of the man of God was risen early, and gone forth, behold, an host compassed the city both with horses and chariots. And his servant said unto him, Alas, my master! how shall we do? II Kings 6:15
Elisha was in a tough spot. God, through Elisha, was helping the King of Israel elude the more powerful Syrian army. When the King of Syria discovered Israel’s secret weapon, he sent a bunch of his best chariot soldiers (the military killing machines of the day) to capture Elisha. They surrounded him at Dothan.
Republicans have adopted a similar strategy with Obamacare and so far have been just as frustrated as the King of Syria.
President Obama used the majority that he earned in his first election to get this legislation passed.
He lost that legislative majority in part because of Republican opposition and popular backlash to the law.
The law did survive legal challenges that ultimately went to the Supreme Court.
It also survived a second national election where Obama’s opponent, Mitt Romney pledged to repeal the legislation. Paul Ryan was recently quoted saying that Obamcare was a key component in their defeat.
“This was our challenge that Mitt Romney and I had in this last election,” Ryan said in a speech at the annual Faith and Freedom Coalition conference in Washington, DC. “We had to argue against the promise and the rhetoric of President Obama. The great soaring rhetoric, all of the empty promises.”
It may have also been the unseemly spectacle of Romney arguing against a program that he had promoted while Governor of Massachusetts. Or it could have been the failure of Republicans to offer a credible alternative, but we’ve already discussed the 2012 election in more than enough detail.
Now Republicans are attempting to defund any part of the bill that they can get their hands on, while beating the drum as loudly as they can that the implementation is going to be a disaster. This is right in the wheelhouse for Republicans, since Big Lie politics has been their strategy pretty much since this President first ran for office. The result is that some people are scared, though there is little proof yet that they have anything to be afraid of.
When you look at this from a historical perspective, the same things happened to every major new government social program over the last century, Social Security, Medicare, and Medicaid.
In 1966 the Johnson government had to mount a door to door campaign to sign up seniors for a free medical insurance program designed to help them with what for many was their single largest expense.
“What will happen then, on that summer day when the federally insured system of paying hospital bills becomes reality?” Nona Brown, a New York Times reporter, wondered in a story published April 23, 1966. “Will there be lines of old folks at hospital doors, with no rooms to put them in, too few doctors and nurses and technicians to care for them?”
Medicare wasn’t a slam dunk either. JFK was the first to propose it and he failed. The AMA opposed it. Two months before LBJ signed the bill the AMA ran ads across the country denouncing the program as “the beginning of socialized medicine”. Some experts said that the government would fail to enroll enough seniors to make the plan work. They worried that the $3.00 monthly premium would be too expensive, particularly for those poor seniors who needed it most. They also said that there wouldn’t be enough physicians to treat all of these newly insured people. Segregation was also a problem in the south were hospitals refused to provide service for elderly African Americans. Medicare patients had access to only 1% of the available hospital beds in Mobile Alabama because they potentially could be used by African Americans. Within weeks of the start of the program, however, all 65 hospitals were accepting patients.
There are also parallels to Medicare Part D rolled out eight years ago. In the spring of 2005, Medicare Part D was less popular that Obamacare is now in part because even fewer Americans understood how IT worked than understand how Obamacare works. Just before the start of enrollment, in October 2006, “only one in five seniors expected to enroll in Part D.” The rest either hadn’t made up their mind, or thought they already had similar coverage.
Seniors, it turned out, were not exactly great at predicting their behaviors: 53 percent of Medicare beneficiaries ended up enrolling in the new benefit. The CBO was off by a bit too, with the average drug plan costing $29 per month rather than $35.
The Medicare Part D rollout had plenty of problems and still hasn’t reached all of the seniors originally targeted. It has also been criticized as a give-away to Big Pharma. But in a recent survey, 90% of the participants in the plan said they were satisfied.
“The temporary issues were just that, temporary,” said Mark McClellan, who led Medicare during the rollout. “The memories didn’t last that long. In the end, it comes down to how good the insurance coverage is.”
So what are the clues that we’ve been seeing so far for Obamacare?
Premium bids on the health exchanges, for example, are coming in slightly lower than the Congressional Budget Office projections. Call centers are starting up right now, but it’s still hard to predict what call volume they will receive in the coming months.
Medicare Part D started marketing a year ahead of the program. Obamacare is planning a big push this fall closer to when the new plans will actually be available.
What they have determined is that they have to get 7M people signing up through the exchanges, 2.7M of whom need to be in the 18-35 set. Fortunately this is in the wheelhouse of the Obama administration because this was the same targeted group that helped elect Obama in 2012, and the administration has kept all of the microtargeting data that proved so effective in that campaign.
Here’s an example of what they have learned.
The Obama administration believes it has four ways to pull people — both young and old — into the market. There are the subsidies. There’s the individual mandate. There’s the hoped-for ease and transparency of the new marketplaces. And then there’s the fact that people want health insurance.
The rest of the good news for Obamacare is that young people are the largest uninsured group at 18M. 8M will qualify for free insurance. 9M will qualify for subsidized insurance. Now the prospect of getting 2.7M young people to sign up doesn’t seem nearly so daunting. The urban institute projects that 96% of 21 to 27 year olds will qualify for some subsidy. Combine that with the individual mandate penalties for those who can afford insurance and you get the results seen in Massachusetts, where the number of uninsured young adults dropped into the low single digits.
That’s not to say that Republican opposition won’t still impact the rollout, but that opposition is going to be increasing desperate as the facts on the ground prove Republican claims to be, yet again, lies.
A good example is the recent revelation in Indiana. Republican Governor Mike Pence has made opposition to Obamacare a major part of his platform in hopes, perhaps, of making a run at national office. Funny thing happened on the way to the primaries, however.
Pence’s administration gleefully announced that under Obamacare Indiana premiums were going to rise to an average of $572 a month. That’s a 72% increase over where they are now. That seemed to fly in the face of announcements from states like California, Oregon, Washington, and New York where Democratic governors announced projected savings.
Turns out that those same savings exist in Indiana too with the most popular plans coming in under $300, but Indiana officials masked that savings by assuming that at least 30% of the people in that state would purchase the most expensive options. The national guideline is more like 8%. In Midwestern states like Indiana that number is even lower.
The recalcitrant Michigan Senate also finally voted today to extend Medicaid to the poor and accept the Federal government subsidies. If the tea party zealots that comprise the majority in the Michigan Senate ultimately wilted under the reality that this deal is just too good to pass up, the same thing will happen in all of the other states opposing Medicaid expansion. Accepting the deal makes too much economic sense. Those states who oppose it for political reasons will discover, just as they did in Michigan, that they have put their business community at a cost disadvantage. Even fanatical conservatives understand where their support comes from, and if they persist in their opposition, the business community will make sure someone more favorable to expanded Medicaid coverage takes their place.
Obamacare will succeed because, just like the 2012 election, he has the numbers. The numbers of people who will see improvement in their healthcare coverage WILDLY outnumber the people who may either see their rates go up or their coverage change because of actions of their employer. The CBO has already said that 90% of those who currently have coverage through their employer will not see any change. And each person, whose access to healthcare improves as a result of this plan, will oppose any future effort to take that coverage away.
And he answered, Fear not: for they that be with us are more than they that be with them.
And Elisha prayed, and said, Lord, I pray thee, open his eyes, that he may see. And the Lord opened the eyes of the young man; and he saw: and, behold, the mountain was full of horses and chariots of fire round about Elisha. II Kings 6:16-17