Obamacare Is the Picture of Health

Jesus Dominguez, 63, who does not have health insurance, reads a pamphlet at a health insurance enrollment event in Cudahy, Calif., March 27, 2014. Days before the 2014 deadline, more than 6 million people had signed up for private insurance plans under President Barack Obama's signature healthcare law. Lucy Nicholson/Reuters

There's taking a stand. Then there's taking a stand in quicksand. And that's where the Republican Party finds itself.

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.

President Obama leaves after speaking at a rally celebrating the passage and signing into law of the Patient Protection and Affordable Care Act on March 23, 2010. Jewel Samad/AFP/Getty

This brings us to the second major accomplishment of Obamacare: Health care costs, which for decades were subject to near-crippling inflation, are growing at the slowest rate since 1960. Between March 2011 and April 2014, the Congressional budget Office's projections for health care spending by the federal government through 2021 dropped by $900 billion. The decline is larger than any deficit reduction package advanced by Republicans in Congress.

When it came to dire warnings about Obamacare, the Republicans were the kings of "swing and a miss." People would flee the health care industry to avoid Obamacare? Nope—according to the Bureau of Labor Statistics, health care gained about 1 million new jobs in preparation for increased demand. Obamacare is socialism? Nope—as insurance companies vie to sell new policies, competition within private industry is growing rapidly, with the number of participating insurers growing by 26 percent between 2014 and 2015, and the number of products they offer growing by 66 percent.

Premiums would skyrocket? Nope—as any smart conservative knows, increased competition means more competitive pricing, which is why the McKinsey Center for U.S. Health System Reform found that the median increase is just 4 percent, a rate of growth so small it's almost unheard-of. Quality of care will decline? Nope—hospital readmissions, a standard measure of the quality of care (low is good, high is bad), have dropped in Medicare by nearly 10 percent, according to the Commonwealth Fund.

All this means that Republicans are left with deception and bumper sticker slogans to keep opposition to Obamacare going. That's why Senator Mitch McConnell had to lie to his constituents when running for reelection in Kentucky last fall by telling them he loved Kynect—the state's wildly popular health insurance exchange—but hated Obamacare. Apparently, McConnell deceived plenty of Kentucky constituents who didn't realize that Kynect is Obamacare.

And therein lies the problem for the Republicans: If they kill Obamacare, tens of millions of people will either lose their private insurance, lose Medicaid coverage, get tossed off of their parents' policies or be refused insurance because of preexisting conditions, and we will all see health care inflation zoom up and watch the insurance industry, which has built Obamacare into every element of its business, fall into chaos.

The threat to Obamacare is coming from one of the dumbest legal assaults ever filed. At its essence, in a series of related cases known commonly by the name of one, King v. Burwell, Obamacare opponents argue that what everyone knows to be true really isn't. The intent of Obamacare is clear: The program allows for insurance subsidies on state-run insurance exchanges as well as the federal exchange.

But wha-ho! Conservatives found the legislative equivalent of a typo in Obamacare. The law, as written, says that premium subsidies could be provided to those people who enrolled in an exchange established under Section 1311, when it should have said Section 1321. Yah, that's it—a 1 should have been a 2. The difference, though, is that 1311 refers to state exchanges and 1321 refers to both state exchanges and the federal exchanges. Without premium subsidies on the federal exchanges, plenty of people wouldn't be able to afford their insurance. (And for those who can't tell the players without a scorecard, yes, that means that Republicans are fighting to make sure that the residents in red states that didn't set up exchanges don't get subsidies. They are fighting to take away insurance from their own constituents.)

Without the subsidies, insurance becomes unaffordable for those people, the analysis used by the insurance companies no longer works, premiums can fly up, more people can't afford it, more people lose their insurance, and the Republicans have more graves to dance on. Obamacare would no longer work.

Most legislation has some sloppy errors in its language, something that in normal times leads to the two parties getting together to fix it up. But because the GOP refused to cooperatein any way on Obamacare, that typical cleanup never took place. As a result, there was some language that, even though congressional intent was clear, could be interpreted to mean the opposite of what everyone accepted as its meaning. The Internal Revenue Service, relying on the obvious intent, applied the subsidies to both federal and state exchanges. For complicated economic reasons, without those subsidies in both exchanges, Obamacare will be hobbled (and it's kind of obvious that the congressional intent of legislators who approved a law was for it to work). But the Obamacare opponents are saying the IRS can't do that because, these conservatives lie, Congress didn't intend for that to happen.

Then, the political clown car filled with those Senators for Life—the Supreme Court—came rolling in. Let's not even bother debating who will side up where: Associate Justices Antonin Scalia, Samuel Alito (the worst justice in decades) and Clarence Thomas will vote to strike down the federal subsidies, regardless of the arguments. Ruth Bader Ginsburg, Stephen G. Breyer, Sonia Sotomayor and Elena Kagan will line up in support. That means Chief Justice John Roberts and Associate Justice Anthony Kennedy will be deciding if the American health care system is plunged into bedlam and the Republican Party is destroyed for decades to come.

Wait—it's worse. If the opponents win, it will show that government can be subverted by a party that controls only the House or the Senate. All that chamber has to do is refuse to fix language problems that become evident in legislation—as they invariably do—and then use the precedent in this case to twist laws into meaningless drivel that bear no resemblance to congressional intent.

Millions uninsured, health care costs climbing, the insurance industry in shambles, wrecking the GOP, destroying democracy...seriously, you conservatives out there, is it really worth all of that devastation just to avoid admitting you were wrong about Obamacare?