David Hoppe

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:: Obamacare: finally! At last!

The sky’s still up there

by David Hoppe

Has the sky fallen yet?

I’m asking because after years of threats, warnings and the gnashing of expensively capped teeth, Obamacare has finally arrived.

And the sky, I see, is still up there.

Starting this week, anybody who needs health insurance can shop for it through the markets — called “exchanges” — that have been created for this purpose in every state.

In Indiana, the federal government is responsible for running the health insurance market. That’s because our state’s governor, Mike Pence, wants nothing to do with Obamacare or, as the law is officially known, the Affordable Care Act (ACA).

You may recall that in June 2012, when the U.S. Supreme Court ruled that the ACA was constitutional, then Rep. Mike Pence stormed into a conclave of his Republican cohorts and exclaimed that said ruling was comparable to the 9/11 terrorist attacks.

It’s not clear what Pence was thinking at the time. Perhaps it was that Chief Justice John Roberts and the other justices who voted in favor of the ACA were terrorists. Or maybe the idea of going to the doctor without the fear of going broke struck Pence as being a surprise attack on privilege.

In any event, when word got out about his outburst, Pence did what American politicians do best after unguardedly expressing their true selves. He apologized.

Pence, however, is hardly alone in his demonization of a bill that has yet to fully take effect. His fellow House Republicans have voted to repeal Obamacare no less than 41 times. It’s been called “a power grab,” by Rick Santorum; a “health dictatorship,” by Newt Gingrich; and “a crime against democracy,” by Michele Bachmann.

And then there’s people like me, who are unhappy because the bill seems too complicated, dislike the way it keeps control of our healthcare in the hands of insurance and pharmaceutical companies, and would rather see a single-payer, Medicare for Everyone approach. What’s more, because of Gov. Pence’s opposition to the ACA, thousands of uninsured, working-poor Hoosiers will be left in the lurch due to Indiana’s failure to fully embrace the bill’s expansion of Medicaid. 

That said, I still think we can be glad Obamacare’s time has come. For all its potential glitches and hiccups, there are a number of ways in which the ACA stands to make the lives of people better.

As has been pointed out by other observers, the bill makes a difference insofar as it prevents denial of coverage to children with pre-existing conditions, enables adults up to the age of 26 to stay on their parents’ health plans, prohibits rescinding coverage as well as lifetime and annual limits, and requires new health plans to provide free preventive care without cost-sharing such as co-pays and deductibles.

But I suspect the bill’s biggest impact will likely be felt in how it changes the ways people think about their jobs.

For generations, Americans have linked health insurance and employment. Our jobs have not only been our source of income, they have also provided vital health insurance benefits. This approach took hold during World War II, when employers started adding insurance benefits to employment packages as a way of attracting workers during a labor shortage.

In 1945, President Truman proposed an optional, national health insurance program. The idea was popular, but shot down by, among others, the national Chamber of Commerce and the American Medical Association, who branded it socialism.

The employer-based system worked pretty well for awhile. But over the last 30 years, as medical costs have risen, the terms of insurance policies have grown stingier and stingier. This has cost both employers and workers. Now, while most people continue to be insured through their workplaces, their coverage is less expansive and more expensive.

Onerous as it is, this situation is still preferable to having no coverage at all. A serious accident or chronic illness can turn a life into a financial ruin. That’s why anyone who has a job with health insurance will do almost anything to stay where they are. And if you’re a worker with a chronic illness or condition, holding on to your job can be a matter of life and death.

This situation is bad for everybody. It makes younger workers feel stuck and keeps older workers hanging on for dear life. It doesn’t do employers any good in terms of productivity, or profits.

By cutting the knot binding work and healthcare, the ACA stands to make younger workers more mobile, able to follow opportunities without fear that an accident or troubling diagnosis will derail them. It provides older workers the security of knowing that if they are unable to work, they can still get coverage.

This is new. Whatever Obamacare’s limitations, the decoupling of work and healthcare represents a kind of liberation. No, the sky’s not falling. It’s actually looking pretty good.