By Kurt Eichenwald / February 9, 2015 9:15 AM EST
After almost six years of gloom-and-dooming, every intellectually honest Republican has to admit Obamacare is making life better not only for individual Americans but for the country. It is saving tax dollars, beefing up American’s monthly budget and setting the country on a path of ever-lowering deficits. Some experts are even claiming the law has improved the care in hospitals.
There were plenty of reasons to suspect Obamacare might have been a colossal failure—although none of them had to do with death panels, huge lines for treatment, a government takeover of health care, etc. But there were real economic issues that could have killed Obamacare, such as insurance companies refusing to participate, individuals not signing up or too many sick people seeking insurance while the generally healthy sat on the sidelines.
None of that came to be. And while there are some flaws around the edges of Obamacare, the law is doing what it was intended to do and doing it well.
Despite that, those who see no difference between governance and politics are still trying to abolish Obamacare. That’s what happens when someone lives in an information bubble of conservatives talking to one another on Fox News, Breitbart.com and The Rush Limbaugh Show.
The Republicans have one last shot at taking down Obamacare, and if they succeed (against all logic, reason and honesty), ugly, countrywide damage will be inflicted on the United States, and on the Republican Party. Like Napoleon’s rash attempt to conquer Russia in 1812, the GOP is lulling itself into believing that overrunning this enemy will lead to supreme victory, when in fact it is the path to self-destruction.
To understand why, start with one fact everyone can agree upon: Obamacare is now fully intertwined with the entire health care system. Pricing for insurance policies, costs of hospital care, utilization standards—all of these are already being strongly influenced by Obamacare. Extracting it out of the insurance and health care systems will be like trying to pull chocolate out of a marble cake: It will be messy and will pretty much destroy your dessert.
Here is how the Obamacare cake looks right now. The number of Americans without health insurance is plunging. Data from the Centers for Disease Control and Prevention, innumerable pollsters and the Urban Institute show that, between September 2013 and September 2014, the number of uninsured adults fell by 30.1 percent. That brought the uninsured rate near or at historic lows (the most recent figure, as of this month, is 12.9 percent, compared with a record high of 16.7 percent the year Obamacare became law). And the numbers could have been even better if not for Republican governors who refused to accept federal money to expand Medicaid in their states. Those states, unsurprisingly, showed a lower decline in the rates of the uninsured than those that expanded Medicaid: The expansion states saw uninsured rates drop 36.3 percent, while the non-expansion states showed declines of only 23.9 percent.
Now here is where we have to state an obvious and unavoidable fact: Uninsured people don’t just slink off into a corner and die. They seek treatment, but usually when it is an emergency, and this will be the most expensive kind of care available.
If you had no insurance, and felt a slight pain in your chest, would you go to the hospital? Probably not. Would you head to a doctor’s office? Never, since the doctor wouldn’t see you without insurance. But when you finally have that massive heart attack caused by the very treatable high blood pressure you weren’t treating, you’d go straight to the only (and most expensive) option available: the emergency room. And if your baby had a fever, you’d do the same thing. And because you’re uninsured, there would be none of the discounts negotiated with insurance companies. No, you’d be billed full charges for an emergency room visit, and there is no way—except in conservative fantasyland—that someone unable to afford insurance would ever be able to pay the $200,000 medical bill for a heart attack.
So who pays? The insured, through higher rates and hospital-price inflation, and the taxpayer, through local, state and federal taxes for something called “disproportionate share”—a federal program that spreads the cost of treating indigents in hospitals. Now before anyone demands an end to disproportionate share, know this: Without it, lots of rural and urban hospitals would die because they wouldn’t have the money to keep the lights on. And because Obamacare is available to provide insurance to the uninsured, disproportionate share is supposed to be cut way, way back.
But that hasn’t happened yet. Why? Because too many red state governors won’t expand Medicaid. And by refusing to have their residents pay federal taxes that go toward picking up the cost of care for the uninsured, Republican governors are forcing their residents to pay taxes that go toward paying the more-expensive cost for uncompensated care. When rural hospitals in red states started shutting down in anticipation of disproportionate share ending without an expansion of Medicaid, GOPers fought to delay that so their constituents didn’t suddenly find themselves without a hospital. Obama caved and extended disproportionate share, helping the Republicans avoid forcing their constituents to face a scary reality. But that won’t last forever.