January 18, 2011 Liz Borkowski, MPH 5Comment

This week, House Republicans are voting on whether to repeal the Patient Protection and Affordable Care Act. Their bill, misleadingly titled “The Repealing the Job-Killing Health Care Law Act,” has a good chance of passing the House but virtually none of passing the Senate or being signed by the President. It’s a chance for House Republicans to show the public where they stand on healthcare – but they seem reluctant to engage with the actual projected impacts of the law.

First, the jobs claim. The ACA does not kill jobs. Ezra Klein explains that what House Republicans are referring to is a Congressional Budget Office projection that the law will slightly reduce the labor supply. Basically, people who’d like to quit their jobs but can’t because they need the health insurance will soon be able to do so. Even those with pre-existing conditions (half the under-65 population, by one recent estimate) will soon be able to purchase insurance policies through insurance exchanges – so, they can retire early, spend a few years being full-time parents, or devote themselves to hatching startup ideas without worrying so much about where their coverage will come from. When some of the currently employed quit the jobs they’d been sticking with just for health insurance, I’m sure employers can find workers willing to fill those slots.

Then there are the deficit numbers.

The nonpartisan Congressional Budget Office has calculated that repealing the ACA would cost an additional $230 billion over the next ten years – hardly small change at a time when everyone’s bemoaning the deficit. Speaker of the House John Boehner claims the CBO score is wrong and the repeal wouldn’t actually increase the deficit.

While members of Congress can certainly argue over specific CBO assumptions, simply dismissing an entire score is akin to a football team that’s just lost a game saying they disagree with all the referees’ calls and declaring themselves the winner. (If you’re interested in Boehner’s specific criticisms of the score, Ezra Klein and Paul Krugman have good explanations of why they don’t actually change the $230 billion figure.)

While one aim of the law was to slow the rate of healthcare-spending growth (which plays a major role in the deficit), many reform advocates saw reducing our appalling uninsurance rate as the effort’s most important goal. The CBO estimates that repealing the ACA would leave 32 million more Americans without health insurance.

Lucky for us, House Republicans aren’t dismissing the uninsurance issue the same way they’re dismissing the deficit issue. In addition to the repeal bill, they’ve crafted a resolution instructing several House committees to propose changes that would “increase the number of insured Americans,” “provide people with pre-existing conditions access to affordable health coverage,” and do several other things that the ACA already does. (It does include a couple of things the ACA doesn’t; for instance, it requires that the changes not increase the tax burden, which the ACA does for people who choose not to purchase health insurance and aren’t exempt from the law’s individual mandate.)

If Republicans had sat down with this list of requirements three years ago, what kind of proposal for health insurance reform might they have created? I expect it would’ve had a lot of similarities with the ACA. The combination of an individual mandate and a health-insurance exchange was something Republicans championed until Democrats used it as the centerpiece of their legislation; in fact, it’s what then-Governor Mitt Romney signed into law for Massachusetts, where it’s successfully brought down uninsurance rates. Ezra Klein enumerates several ways in which the bill the Senate healthcare bill includes Republican ideas – which isn’t surprising, since Senate Finance Committee Chair Max Baucus devoted a lot of (ultimately fruitless) effort to getting Republicans on board.

Fixing a mixed-up healthcare system is much harder than obstructing and criticizing someone else’s attempts to do so.

5 thoughts on “Jobs, Spending, and the Healthcare Law

  1. I did think of starting a charity to bring universal health care to the U.S., but then I realised that organisations such as Medecins Sans Frontieres already existed to bring aid to Third World countries.

  2. And just how did the CBO calculate a $230 billion figure?

    Taxes are going up $700 billion, that’s how. Starting this year.

    Geez, how about a little balance in your reporting, Liz?

  3. Yes, there are some tax increases – for details, see pages 3-4 of this Kaiser Family Foundation summary of the law. New tax provisions include:

    ** Those of us who reduce our taxes by putting money into flexible spending accounts will face a lower limit on contributions (the max will drop to $2,500 annually for 2013) and can no longer use that money for over-the-counter drugs not prescribed by a doctor.

    ** Earnings over $200,000 for individuals ($250,000 for married couples filing jointly) will be subject to an extra 0.9% Medicare tax, increasing the rate on that income from 1.45% to 2.35%; also, high-income tax payers will see an additional 3.8% Medicare tax on unearned income (e.g., investments).

    ** Issuers of employer-sponsored health insurance with aggregate values of more than $10,200 for individual coverage and $27,500 for family coverage will pay taxes equal to 40% of the value of the plan that exceeds the threshold amount. (The value is essentially the total premium cost, and in 2010 average total premiums for employer-sponsored plans were $5,049 for individuals and $13,770 for families.) The issuers of these high-value plans may pass that cost along to employers, or employers may choose to offer less-generous plans. Implementation will start in 2018; the threshhold value will be indexed to the Consumer Price Index and will be higher for firms whose healthcare costs are higher due to the composition of their workforce.

    Personally, I’m happy to trade a lower FSA limit (and the prospect of slightly-higher taxes should my income exceed $200,000) and the possibility of less-generous employer-sponsored health plans in the future for the many benefits of the new law. Leaving aside my feelings that everyone in this country ought to be able to get good, affordable coverage, I know that the ACA means I personally will have a much better shot at insurance should I lose my employer-sponsored coverage and Medicare is much more likely to be in good shape once I’m eligible for it.

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