Issue Position: Obamacare

Issue Position

I decided to use this website to address the issue of Obamacare because, at least at the time I am writing this, it is once again the hot topic in New Hampshire politics.

The Myth

I have read, repeatedly in a number of different places, a defense of the Affordable Care Act, that give same concern. The argument goes something like this: Voters elected a Democratic president as well as giving the majority of both houses to the Democrats. Acting on the will of that majority, Obamacare was duly passed and signed into law as well as vetted by the Supreme Court. The voters then overwhelmingly supported the law (I presume b re-electing Obama). In this story, Republicans are described sore losers who are using parliamentary tricks to thwart the will of the people.

The Reality

The problem with this story goes back to the presidential primary, when Barack Obama and Hillary Clinton squared off on the topic of expanding health care. Both campaigned on a promise to extend coverage to those who were uninsured, but differed in their approach. While Clinton proposed an "individual mandate," Obama explicitly opposed that approach.

After the election, Obama's positions began to change as the realities of actually passing the legislation began to assert themselves. Despite majorities in both houses, passage of a health care bill was by no means assured. Too timid of a plan might lose the support of those on the left who wanted nothing short of a single-payer (i.e., government) system. At the other end of the spectrum, fiscally-conservative Democrats did not want a proposal that would result in increased federal costs. If you remember the language of the time, Obamacare was supposed to "bend the cost curve" and thereby offset the additional costs of insurance by savings in the costs of medicine itself. However, even this would not balance the scales. A number of new taxes were required on top of the individual mandate, which put extra money in the pockets of the insurance companies without having to pass through the federal government as taxes.

The Legislature struggled with this balancing act to produce a proposal that "paid for itself." In the end, even with a majority, they had difficulty creating a plan that the majority could support. The House version of the bill passed by a tiny majority (220-215), with 39 Democrats opposing (and one Republican voting in support). Difficulties with passage through the Senate were overcome using parliamentary tricks. The point is that the vote to pass was so close and hinged on so many delicate compromises, any one of the issues that plague Obamacare today might have sunk it during the original vote.

Popular Opinion

As to the issue of the will of the voters, the claim of overwhelming support is unfounded. The best that can be said it is an issue that divides the public. In national polls, support for Obamacare has not been able to get a majority and has more often than not lagged behind the opposition.

Of course, like in the original debate, the opposition to this program takes a number of different forms. It ranges from those on the far left that want free health care provided by the government. It also contains people who have supported the idea in principle, but are concerned about current costs. Then there are those that are opposed completely.

Frankly, it is easy for me to understand why those on the left would be disappointed. Especially here in New Hampshire. Obamacare has created a situation where we are all required to purchase insurance through a insurance company that has essentially been guaranteed a monopoly. Factors that are cited as contributing to the high cost of health care - a lack of competition, the profits of the insurance company - these all remain. We are largely stuck with the same old options, except now we go through a government-run website, and pay more for the privilege. Nonetheless, the bulk of Democrats do seem to support Obamacare as, I suppose, "a step in the right direction."

Here in New Hampshire, the trend is similar to that at the national level, but more clearly opposed to Obamacare and it's implementation. As discussed before, peoples opinions are more varied than can be expressed in a simple support/oppose chart. It is worth reading the report from which the chart shown on page 2 was taken, to see the breakdown of the data. One thing that seems pretty clear to me; Even when New Hampshire elects a Democratic majority, it is not because they want to be forced to purchase overpriced insurance products from a monopoly advisor.

A trend, also apparent in national polls but more clear in New Hampshire, emerges when looking at the results over time. The controversy surrounding the law's passage initially resulted in strong resistance (57% opposed, more than double that in support). As time went on, opposition softened, but has picked up again substantially since last fall. Currently, those opposed are once again in the majority (53%) and once again approaching the 2:1 ratio versus supporters. The support was strongest during the lull, well after the law was passed but before most of its provisions began to take effect.

In fact, I would go so far as to say that the program was designed to create several years of quiet. Implementing the law quietly allows the new bureaucracy to build up without much opposition. Once people begin feeling the negative effects and opposition hardens, it is hoped that it will be too late to dismantle years of "progress" in creating the new system. Even the delays built into the law have not been enough. President Obama continues to use selective enforcement of the law to delay some of the worst effects until after elections (first his own re-election, and now the mid-term elections of 2014) and further bureaucratic entrenchment have taken place.

One final, interesting, statistical point. In the Kaiser study, cited on the previous page, there has been a recent surge in opposition from the people the bill is purported to have been written for. The uninsured, who are now beginning to struggle with the actual system that has been implemented, now overwhelmingly disfavor Obamacare. Opposition is polling at 56%, far more than double those with a favorable opinion (22%).

State Politics

At the level of State politics here in New Hampshire, questions such as whether to repeal, replace or try to fix the system are generally beyond our control. Instead our efforts often focus on shielding NH from the uncertain but potentially fiscally damaging impacts in the future. During my term in the House (2011-2012) we passed legislation prohibiting New Hampshire from creating a State-based exchange. While State legislators can do little to influence the Obamacare implementation, we felt it was important to limit NH's exposure. Despite the new law, which was signed by Governor Lynch, as soon as the 2012 elections were over, the Governor and NH State agencies looked for ways to circumvent this restriction. The newly-elected House also put forward a bill to repeal that protection. This bill, HB544, was ultimately re-purposed to pass the House's version of Medicaid Expansion. This remains the current hot topic, as most Republican's reject the necessity of taking on what could potentially be a vast future cost in order to accept federal money in the short term.

The Senate version adds some additional clauses to mitigate against future cost shifting from the federal government. It also tries to solve some of the issues through the use of private insurance. private insurance. However, conservative voters and leaders agree that this is a risk not worth taking on for a questionable return. Nevertheless, the Senate passed the "compromise" version of Medicaid Expansion, with all of Democrats and a majority of Republicans voting in favor.

This highlights importance of electing officials that agree with the majority of the voters.

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