Wednesday, July 18, 2012

gop fictions about the Affordable Care Act


            Shortly after I posted my last blog, focusing on a couple of the larger “untruths” coming from the GOP these days, I received an e-mail dismissing my argument by noting that, “Politicians lie.  That’s what they do.”  He (or she) was right of course.  Politicians do lie; probably always will. 

            My concern is not that individual pols will bend the truth when they think it is to their advantage to do so; my concern is that completely ignoring the truth or deliberately misrepresenting it seems to have become an integral strategy for an entire political party.  It isn’t that Mitt Romney or one of his surrogates is occasionally disingenuous; it’s that the official talking points of the GOP as a whole are so often clear and deliberate fabrications.

            Nowhere is this more in-your-face than in the broadside of attacks launched against the Affordable Care Act, or, as Republicans like to phrase it, “Obamacare.”  (as an aside, have you noticed how they always encase the word in quotation marks—you can almost see the air quote gesture and the accompanying snide look)  Some of these attacks are more egregiously lies than others, but all of them fly directly in the face of easily checked facts.

            Let’s start with perhaps the most egregious lie, the one that most often is the lead attack—that the Affordable Care Act is socialist and represents a federal government takeover of health insurance.  There are, to be sure, a lot of things in the Affordable Care Act that are complex, expressed in very dense legalese, hard to wrap a layman’s head around.  That the law requires everyone who doesn’t have health insurance to purchase it from a private insurance company isn’t one of them.  That is the central tenet of the law, and it is expressed in very clear, very direct terms.  If you don’t have health insurance but can afford to purchase it—either on your own entirely or with some assistance from the government—you must do so and the beneficiary of that transaction must be a private insurance company.

            When you point that out to a Republican, the response is usually a shuffling of the feet, a quick glance at the floor and a mumble that includes something about all the regulations insurance companies have to follow in order to sell those new policies.  Well, yes.  They have to agree not to cancel your policy the first time you need to use it; they have to agree not to raise your premium because you filed a claim; they have to agree to accept you regardless of pre-existing conditions; they have to agree not to impose a cap on the total amount you can receive in benefit payments.  When you ask a Republican which of those regulations they would prefer go away, they generally excuse themselves from the conversation and look for a more hospitable corner of the room.

            The deliciously ironic aspect of this lie is that the GOP gets no support from the insurance industry when they express it.  The insurance industry is not stupid, nor, in this case at least, interested in participating in deliberate prevarication.  The industry recognizes that, beginning in 2014, the Affordable Care Act has delivered about 30 million potential new customers.  Far from a government takeover of the private health insurance industry, the ACA is perhaps its biggest booster.
            The second most common false assertion from Republicans is that the ACA is a potentially lethal “job-killer.”  FactCheck.Org, a completely non-partisan project from the Annenberg Public Policy Center, placed this one very high on its list of “Whoppers of 2011.”  Nonetheless, there have been thus far in 2012 no fewer than 5 national ad campaigns from the Chamber of Commerce dedicated to labeling ACA as a job-killer. And John Boehner, not surprisingly, used the phrase 7 times during a 14 minute press conference.

            Republicans base this claim on a Congressional Budget Office (non-partisan) study that said ACA would likely reduce “the amount of labor being used in the economy by a small amount—roughly half a percent.”  Republicans didn’t actually base their attack on the CBO report directly, but instead on the report analyzing it issued by their propaganda machine, The Heritage Foundation.  According to Heritage, that “half a percent” “equates to about 700,000 additional Americans being unemployed.”

            As usual, the Heritage Foundation cherry-picked the CBO paper in order to draw the conclusion it wanted.  What the CBO said—in the paragraphs immediately following the one Heritage quoted—is as follows: “The expansion of Medicaid and the availability of subsidies through the exchanges will effectively increase beneficiaries’ financial resources.  Those addition resources will encourage some people to work fewer hours . . .” 

In the next paragraph, the CBO said, “Changes to the insurance market, including provisions that prohibit insurers from denying coverage to people because of preexisting conditions and that restrict how much prices can vary with an individual’s age or health status, will increase the appeal of health insurance plans offered outside the workplace for older workers.  As a result, some older workers will choose to retire earlier than they otherwise would.”

What the CBO actually was saying then is that many young and middle-aged people currently working multiple jobs or 60 hour weeks in order to afford health care, will, under ACA, be able to afford to work fewer hours and/or fewer jobs.  They will be voluntarily, in other words, “reducing the amount of labor in the economy.”  The CBO did not say this, but it follows that when people quit a second job they no longer need, that job then becomes available for someone who currently has none.  The CBO didn’t go there because, while it’s reasonable to assume that employers will still need someone to fill the vacated job, there’s no way at this point to put a hard number on how often that will occur.

The same factor is involved with the CBO’s second point, that, with affordable health care available outside the workplace, many older Americans will retire earlier.  Again, the job vacated will still need doing, and so represents another opportunity for an unemployed person to become employed.

What I’m not claiming here is that ACA will lower unemployment. The act hasn’t taken full effect yet, so it would be just as preposterous to make that claim as it is for Republicans to declare with certainty that it will kill jobs.  The most reasonable conclusion that can be drawn with the facts available now is that there’s no way to say whether the net effect of the bill on jobs will be positive or negative, but the most likely effect of it will be neither.

The closest we can come to a meaningful conclusion about the job-killing power of ACA comes from Massachusetts, where for all intents and purposes the law has been in effect since 2006.  In an article entitled “Timely Analysis of Immediate Health Policy Issues” prepared in June of 2012, the authors (Lisa Dubay, Sharon K. Long and Emily Lawton) compared employment trends in Massachusetts to those in four economically similar states (Delaware, Wisconsin, Nebraska and Minnesota), and with trends nationally. 

They broke the firms being studied into several categories, the one of most interest here being firms with between 10 and 499 employees.  The Chamber of Commerce defines small businesses as those with fewer than 500 employees (in my view a rather high number for a small business).  The ACA excludes businesses with fewer than 10 employees, so this would seem the most appropriate category to look at.  The figures are revealing.

Between 2006 and 2008—the last good economic years before the Great Recession—employment in this category of small businesses was up slightly in Massachusetts and the four comparable states by 0.5%.  Employment in the nation as a whole for the category was flat.  So in the first years of the Massachusetts health care law, employment gains actually outstripped the rest of the country.

In the years 2008-2010—the worst part of the Great Recession—in the 50-499 category employment fell 1.9% in Massachusetts, 1.6% in the four comparable states, and 2.2% in the nation as a whole.  In other words, the only state with mandatory health insurance, during the worst years of the recession, suffered less small business employment drop off than did the nation as a whole.

One other point worth noting on the job-killer front.  Republicans screaming about the deleterious effect of ACA on small businesses always skip the part about businesses employing 25 or fewer people.  Such businesses that already offer health care for their employees will, starting in 2014, be eligible for new tax credits based on the premiums they pay.  And businesses with fewer than 25 employees who opt to start providing insurance will also get tax credits.

And yet, you cannot listen to a Republican talk about ACA without hearing the term job-killer in at least every other sentence.

The last lie we’ll cover here (there are several more) originated, big surprise here, with Karl Rove’s Crossroads GPS PAC.  In 201l, Crossroads ran a series of television ads charging that the Obama administration was granting ACA waivers to unions as a payoff for union support in 2008.  The charge was of course picked up immediately by Fox News, Rush Limbaugh and all the usual right-wing bloviation groups.

What they claimed was that unions that offered health insurance plans to their members were being allowed to opt out of the law’s requirement that plans could not cap benefits, either annually or over the life of the policy, while company’s who offered insurance plans were not allowed that option.

This one is so patently false that one has to assume Rove et al knew it was bunk when they made the charge but decided it would play so well for their base that it was a lie worth telling.

The truth is that ACA calls for a phasing in of the cap: $750,000 was the minimum in the first year, with the cap escalating to no cap after full implementation of the plan in 2014.  Some companies, mostly those with a preponderance of low-wage employees, immediately started complaining that the increase in premium being demanded by insurance companies would force them either to increase what their employees had to pay or end coverage altogether.  The law of unintended consequences rearing its ugly head.

Since that was clearly not the goal of the new law, the Department of Health and Human Services (which administers this portion of it), began granting waivers—actually partial waivers—to the new rule.  The waivers were granted until 2014 when ACA fully kicks in—at which point employees would have the option of buying private insurance themselves (with no cap), and low-wage workers would be eligible for tax credits to help them with said purchases.  The waivers were granted, in other words, so that low-wage workers who already had some degree of health insurance wouldn’t lose it prior to ACA’s full implementation.

Union plans were caught in the same box as employer plans.  As of this writing, HHS has received 1,372 applications for waivers, 1,280 of which have been approved.  Of those, 27 were union plans, 315 were plans managed jointly by unions and employers, and 938 were company plans.  If you count both union only and joint managed plans as being union plans, they total less than 25% of the waivers granted.  If, as would seem more appropriate, you look at only the fully union plans, the figure is less than 2%.

Kind of hard to see favoritism or some kind of payback in those numbers.

What is disturbing to me is that on this, as with many other issues, the GOP predilection for dispensing with any concern for the truth seems integral to their campaign strategy.  Lying is essentially a basic component of their playbook.

Equally concerning is that it can be a basic component of their playbook because they know they have major media outlets—Fox, Drudge, Limbaugh, Malkin the most obvious—that will give their lies extensive air time with no questioning much less editing.

But perhaps most concerning is the number of people in this country whose only source of information (voluntarily in most cases) are those right wing media outlets, and for whom the lies are self-evident truths.

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