Rx for Change
The Supreme Court has ruled. Now it's time to get down to
the business of insuring New Mexicans' health.
In the wake of this summer's Supreme Court decision upholding the Affordable Care Act (ACA), Merri Rudd, a former Bernalillo County probate judge, wrote an eye-opening editorial in the Albuquerque Journal. At least it would be eye-opening for anyone in the comfortable bosom of employer-sponsored health care or who's reached the promised land of Medicare. Rudd's experience sounds all too familiar for those of us scrounging for coverage in what "Obamacare" opponents call the "marketplace." As she discovered, "marketplace" describes private health insurance in the real world much the way a Little League game resembles Roman gladiatorial arenas.
Rudd recounts her shock at being unable to purchase health insurance from two of the state's largest insurers, Presbyterian and Lovelace, when her coverage from the term-limited judgeship ran out. She describes herself as "a non-smoking 57-year-old woman who is 5 feet, 6 inches tall, weighs 128 pounds, has never used illegal drugs, eats a low-fat diet, takes no daily prescription medicines, walks three to five miles daily, attends yoga classes weekly, hikes and dances." Her only medical issue is a genetic predisposition to high cholesterol. She also was rear-ended in a car accident in 2009, causing a back injury that fully resolved without surgery or prescription drugs.
Both insurers nonetheless cited "history of back injury" as grounds for rejecting her. Presbyterian also dinged her for cholesterol and "height/weight guidelines" — despite the fact that Rudd's BMI of 20.7 puts her smack in the middle of "normal." Neither insurer asked about exercise or diet.
We've ranted before (Editor's Notebook, October 2009) about the plight of the uninsured and uninsurable in America. If you lost your job, would you be able to get health insurance? Rudd's experience should make you think twice. If you got hurt in an accident through no fault of your own, might that injury make you uninsurable — even if you're OK now?
The upholding of the ACA puts these questions into sharper focus, because the post-ruling ranting on the "repeal" side specifically threatens to take away the one hope for millions of Americans like Rudd: As of Jan. 1, 2014, insurance companies won't be able to deny coverage to people with pre-existing conditions or others whom their underwriting peculiarities deem too risky. Buying individual health insurance — currently a byzantine process you have to puzzle out yourself — will also become more straightforward with the establishment of state insurance exchanges. (Think about it: You can hardly turn on the TV without seeing a gecko or a basso-voiced spokesman hawking car insurance. When's the last time you saw an ad for health insurance?)
So when somebody starts an ill-informed diatribe about the urgent need to overturn Obamacare, you'll pardon those of us who must buy our own health insurance for having to suppress an urge to punch that somebody in the nose.
We wish "Obamacare" opponents would be specific about what parts of the ACA they don't like. Of course, they loathe the mandate (which the Court has now realized is really a tax) that everybody buy health insurance or pay a penalty. To be fair to insurance companies, though, you simply can't force them to take everybody regardless of health without forcing healthy uninsured people into the pool as well. The "mandate" was originally proposed as a free-market alternative by the conservative Heritage Foundation, embraced by Republicans including presidential nominee Sen. Bob Dole, and enacted in Massachusetts by then-Gov. Mitt Romney.
Still, we get it, conservatives have changed their minds on this much like they have on protecting the environment and other principles once held dear by the GOP. But what else, specifically, makes them so mad that the ACA must be repealed entirely (and, ideally, deleted from the history books by a Koch Industries-funded time machine)? Here's what else the ACA does:
- Allows young adults under age 26 to get covered on their parents' policies.
- Expands Medicaid to give health coverage to people up to 133% of the federal poverty level ($30,657 for a family of four in 2012). According to the Kaiser Family Foundation, New Mexico has about 200,000 people who lack health insurance and fall below that 133% guideline.
- Gives tax credits to families between 100% and 400% of the poverty level ($92,200 for a family of four) to purchase insurance through state exchanges.
- Increases Medicare taxes by 0.9% on earnings over $200,000 for individuals and $250,000 for joint filers, along with a 3.8% increase on unearned (i.e. investment) income for high-income households.
- Shrinks the Medicare "doughnut hole."
- Requires businesses with 50 or more employees to offer health insurance or pay a penalty.
We'd love to hear Heather Wilson or Rep. Steve Pearce (who recently voted a 33rd time for repeal of the ACA) spell out which of these provisions they find so odious, rather than the generic fulminating about "Obamacare" we'll surely hear until November: "Your 24-year-old kid should go without health insurance like everybody else!" "The Medicare doughnut hole is a good thing — seniors have too dang much disposable income as it is." "The rich guys who are footing the bill for my campaign don't want to pay a penny more in taxes." Such straight talk would be refreshing, but unlikely to win them re-election.
Instead, Pearce continues to parrot claims about the ACA that have already been exposed as lies and distortions. In a recent op-ed defending his latest pointless repeal vote, he repeated the notion that the health-care law will impose $4,700 in new taxes per family, mostly on those making less than $120,000 a year. You may also hear that the ACA raises taxes by $500 billion or $800 billion, depending on who's doing the distorting.
An independent analysis by USA Today last month concluded, "only a small percentage of Americans will pay more" because of the ACA. "Fewer than 10% of the nation's 40 million tax filers are likely to pay more." The nonpartisan Tax Policy Center agrees: "The bulk of the taxes are aimed at corporations at high-income folks." GOP claims that average Americans will pay more have been debunked by independent fact-checking websites including Politifact.com and Factcheck.org ("dishonest nonsense").
The same goes for GOP charges that the ACA is a "job-killer," which FactCheck.org characterizes as "bogus" and "hooey."
The truth is, as Sen. Jeff Bingaman has pointed out, New Mexico stands to gain more from the ACA than almost any other state. With an uninsured rate of about 24%, New Mexico has recently ranked second or third in the nation in percentage of population lacking health coverage. "We've had chronically high uninsured rates for years," Bingaman notes, "and because of the health-care law we are finally going to be able to tackle that intractable problem."
The state will also receive billions of dollars to expand Medicaid — an estimated $6 billion between 2014 and 2020, while the state will have to pony up an extra $500 million during that span. New Mexico Voices for Children estimates that the economic spinoff of that extra $6 billion (new jobs in healthcare, for example) will likely generate enough extra taxes to cover the state's $500 million contribution. It's hard to see how this is a bad thing.
In an interview on Fox News, GOP Senate Majority Leader Mitch McConnell insisted that covering 30 million uninsured Americans is "not the issue." Senator, tell that to New Mexicans like Merri Rudd, who can't get health insurance.
McConnell went on: "The question is how can you go step by step to improve the American health care system. It is already the finest health care system in the world."
No, Senator, it's not — not even close, even for those who can afford healthcare. In measures ranging from life expectancy to infant mortality, the US ranks behind those countries with "socialized medicine." Perhaps the nearly $800,000 McConnell received in donations from the healthcare industry last year is the only number he cares about.
The ACA is far from perfect, and could certainly benefit from bipartisan tweaking if that weren't an impossible fantasy in this hyperpartisan era. But if you already have health insurance — whether it's the cushy plan US senators like McConnell enjoy, or coverage through your employer riddled with co-pays, or even care through the VA — you simply can't understand the importance of this legislation.
Now that the Supreme Court has ruled, it's time to put the partisan bickering behind us and move forward. New Mexico Gov. Susana Martinez needs to act promptly to meet the deadlines for expanding Medicaid coverage and establishing a health-insurance exchange. She should eschew the lawless foot-dragging of GOP colleagues such as Texas' Gov. Rick Perry and Louisiana Gov. Bobby Jindal. (Imagine their outrage if Democratic governors similarly said they intended to ignore the settled law of the land.)
You're entitled to disagree, of course. But if you've never tried to buy your own health insurance, those of us who have are entitled to say you don't know what the hell you're talking about.
David A. Fryxell is editor of Desert Exposure.