How to talk about Obamacare
At a congressional town hall in Murfreesboro, Tennessee last week, 35-year-old teacher Jessi Bohon stood up to ask Republican Rep. Diane Black why she was so eager to take healthcare from the sick. In the process, Bohon gave Democrats a lesson in just how they should go about defending Obamacare from Republican efforts to repeal the law.
“As a Christian,” Bohon began, “my whole philosophy in life is pull up the unfortunate. The individual mandate: that’s what it does. The healthy people pull up the sick.”
But if we instead took “those people and put them in high-risk insurance pools,” she continued, “they are costlier and there’s less coverage for them.” That would mean “effectively punishing our sickest people.”
Separate insurance programs for the sick are a staple in most conservative healthcare plans. Speaker Paul Ryan recently touted high-risk pools to a cancer survivor at a CNN town hall. “We believe that state high-risk pools are a smart way of guaranteeing coverage for people with pre-existing conditions,” Ryan told the man, who feared losing the coverage he gained under Obamacare. “By financing state high-risk pools to guarantee people get affordable coverage when they have a pre-existing condition, . . . you’re dramatically lowering the price of insurance for everybody else.”
Bohon and Ryan espouse polar opposite moral philosophies when it comes to healthcare. Bohon believes in a system that calls on the healthy to pull up the sick — one that integrates the sick and healthy alike into a single universally shared health system. Ryan, on the other hand, would quarantine the sick into the insurance equivalent of leper colonies — segregating them off for the financial benefit of the healthy.
In conservative healthcare plans, high-risk pools are meant to provide a backstop for the sick who are “uninsurable” on the private market. Conservative plans include such a backstop because they loosen Obamacare’s guarantee that people with health conditions can buy private insurance. The plan offered by Ryan and the House Republicans, for instance, would allow insurance companies to price-gouge the sick if they let their insurance coverage lapse. So if you’re sick and cannot afford private insurance, you get coverage in a separate high-risk pool.
Ryan’s “solution” for the sick is all the more morally repugnant because it’s wholly ineffective. High-risk pools have been tried before and provided terrible, expensive coverage. Before Obamacare, thirty-five states had high-risk pools for people with illnesses. Enrollees paid premiums that were more than double those paid by healthy individuals on the private market. They also got hit with deductibles as high as $25,000 and caps on coverage as low as $75,000. Even worse, most high-risk pools excluded coverage for pre-existing conditions for as long as a year, making this “coverage” virtually useless to those that needed it most.
Even while providing such flimsy coverage, high-risk pools were chronically short on money. Conservative health policy experts James Capretta and Tom Miller estimate that halfway decent high-risk pool coverage would require federal cash infusions to the tune of at least $15 billion per year. But proposals from Ryan and health Secretary Tom Price would allocate $2.5 billion or less per year — a comically small fraction of what’s needed to sustain high-risk pools.
This makes high-risk pools little more than a shell game. Like block-granting Medicaid, high-risk pools are just another scheme to underfund services for the needy. This, of course, is par for the course from Ryan, who habitually embraces thinly veiled ways to slash government spending by leaving the poor out to dry.
That’s a stark shift from the “compassionate conservatism” of the early 2000s, when the GOP staked its claim as the “moral values” party in response to the tawdry scandals of the Clinton administration. The GOP oriented its electoral coalition around values-driven Evangelical Christians, and (at least in messaging) professed to care about the poor.
But over the ensuing years, the GOP let itself drift far from the moral high ground. Compassionate conservatism gave way to the anti-47 percent disdain of the Romney campaign and the bloodless Randianism of Ryan’s GOP Congress. Those moral detachments paved the way for the harsh dog-eat-dog, zero-sum worldview of Trumpism — a world unbound from any real principles aside from not being taken for a sucker.
Liberals thus have a huge opportunity to reclaim the moral high ground. Though today they too often eschew moralizing, past liberal champions embraced the rhetorical power of their fundamental principles. For instance, in 1963, John F. Kennedy made the case for the Civil Rights Act as “primarily [ ] a moral issue,” one “as old as the Scriptures,” asking us “whether we are going to treat our fellow Americans as we want to be treated.”
By connecting Obamacare to her Christian values, Bohon echoes JFK’s invocation of these principles a half century ago. And to galvanize a popular opposition to Trump and the GOP Congress, liberals must make comfortable technocratic arguments secondary to a full-throated moral defense of the issues they care about. Yes, high premiums and deductibles in healthcare are a problem. But promoting universal healthcare as principally a means to “bend the cost curve” is a bit like emphasizing the economic benefits of the Civil Rights Act.
After all, the details of healthcare policy speak to what kind of society we’ll be. And those details should reflect values deeper than I’ve Got Mine and You’re On Your Own. Bohon’s philosophy tells her that we’re all in this together. Elected Democrats shouldn’t be afraid to remind us of that.