The nation’s governors gathered in Washington, DC over the weekend to share ideas about how best to address some of the nation’s most vexing problems. States are often thought of as policy laboratories wherein each state implements varying policies to determine their efficacy. Obviously policy differences are often shaped by the political ideology of the governor. Se we can expect so-called “red” states to have market-driven, anti-union policies while “blue” states lean toward more progressive, egalitarian policies. Nowhere is this more discernible than the implementation of the Affordable Care Act. Republicans would be satisfied with giving people vouchers and letting them fend for themselves in the marketplace. Democrats seek to expand Medicaid and would have liked to offer a public option. Those farther to the left would have preferred a government-run single-payer system. The Affordable Care Act is somewhere in the middle.
We all have heard about how the rollout of this comprehensive effort to provide health insurance to millions of uninsured Americans got off to a rocky start with many state and federal health exchange websites unable to process the volume of applications they received. However, nearly two months beyond the original January 1 startup date, most exchanges are up and running and millions of Americans have been able to purchase affordable health care insurance notwithstanding pre-existing conditions. Millions more have been covered through expansion of Medicaid eligibility. There are still glitches as is expected in the implementation of such a comprehensive and complex set of policies, but for those who are finally able to insure their health, it will be virtually unthinkable to expect them to relinquish their coverage. That’s a problem for Republicans like Louisiana Governor Bobby Jindal who is still clinging to the hope of repealing the ACA.
Most Republican governors have all but conceded that the Affordable Care Act is a done deal. No doubt we will continue to see efforts to make changes to the law. With a law as complex as the ACA, there is always room for improvement. What remains to be seen is what will happen to the millions of poor Americans who are being denied healthcare insurance in those red states whose governors have refused to accept federal funds to expand Medicaid. In Florida alone, an estimated 760,000 low-income citizens are not eligible for Medicaid or federal subsidies because Florida House Republicans refuse to accept the federal government’s offer of Medicaid funding. To date, 20 states have declined Medicaid expansion, leaving millions of poor individuals and families without an option for health care insurance. It would seem some of these people would want to invoke the 14th Amendment which guarantees equal protection under the law. Not likely since Chief Justice John Roberts and the Supremes neutralized that option by declaring Medicaid expansion optional.
Overall, there have been discrepancies regarding how many people have actually signed up for health insurance under the Affordable Care Act. According Health and Human Services (HHS) Secretary Kathleen Sebelius, about 3.3 million have signed up for health insurance with 1.1 million signing up in January. However, the Washington Post’s Fact Checker disputes recent claims by President Barack Obama that 7 million poor Americans have received coverage as a result of expanded Medicaid. What is clear to the nation’s governors is that no one will be taking insurance away from the millions who have signed up.
One closely watched dimension of the ACA is the number of young people signing up for coverage. Proponents of the law fear that without significant numbers of healthy young people entering the health insurance pool, too many older and sicker Americans in the pool would drive up the cost of premiums. According to Kaiser Health News—about 879,000 young people ages 19-34 have signed up on the private eHealth (72,000) and government websites (807,000) combined through February 1st. Of course, the ACA allows young people to remain covered by their parents until 26 years old. A report by the Commonwealth Fund suggests enrolling young people may not be the most important factor determining premium pricing.
Nevertheless Republican legislators at both the federal and state levels will be seeking any means at their disposal to derail the Affordable Care Act. There are more than a dozen bills in Congress attacking the ACA and Republicans plan to use the law as a key issue in the midterm elections. As more Americans avail themselves of the security of health insurance, Republicans are going look more and more like Chicken Little yelling, “the sky is falling.”
Written By Charles E. Lewis Jr., Ph.D
Governors Agree Affordable Care Act is Here to Stay was originally published @ Congressional Research Institute for Social Work and Policy » Charles Lewis and has been syndicated with permission.
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