ACA eight years later

I don’t usually post my blog to Facebook, but looks like I did 8 years ago today in honor of ACA passing.  Was pretty interested to see how my thoughts then held up:

1) Hooray!!!  This is a very big deal. This is hugely important legislation and it is damn good legislation.  Sure, it’s not perfect– what is– but it sets down a structure that can be improved upon.  Want a public option to compete with private insurers in the exchange– it can be done.  Want to open up the exchanges to all employers to start moving us away from an employer-based system– it can be done.  Want to implement more Medicare-based priced controls to drive the market– it will be done.  And, there’s a good chance these things will happen in the medium-term.  [emphasis now] This bill extends health coverage to millions of Americans who otherwise would not have it– that saves lives and makes many, many lives a hell of a lot better.  It also makes a very important start on cost controls.  This part needs some work, but the CBO estimates on cost control are pessimistic, if anything, and very importantly, we’ve got basic structures in place that make getting costs down further much more technically and politically feasible.

Well, I pretty much stand by that.  What I obviously completely failed to anticipate was ability of the Republican Party to completely hinder any improvements and even just needed technical adjustments.  Still, I’d say we’re way better off than if this bill had failed in 2010.

2) The Republican party has absolutely embarrassed themselves on this issue.  They’ve completed foregone any shred of intellectual dignity they have had.  From “death panels” to arguing about a “socialist government takeover” of medicine, their rhetoric has been absolutely absurd and intellectually incoherent.  We could have actually had a better plan, e.g., a more effective excise tax, more movement away from an employer-based system, if the Republicans did not demagogue the issue so.  Of course, in many ways, given the stunning ignorance of so many Republicans in Congress, I’m not sure it could’ve been any other way.  In his recent visit to NCSU, David Frum suggested that their might be only a dozen or so Republicans in the House who truly understand policy.  I won’t even waste but a sentence on the tea-baggers.  Talk about embarrassing– what complete and total ignorant buffoons they are (oh, and racist, too).

Uhhh, yeah, that holds up.  And they’ve only gotten worse.

4) It was an interesting development the way in which abortion, which really has nothing to do with this bill, almost brought it crashing down.  In the end, Obama’s executive order was nothing but a face-saving move for Stupak and friends to walk back from their intellectually untenable position. What I’ll take away from this aspect…the US Conference of Catholic Bishops behaved in a shockingly ignorant and immoral (yes, immoral, damnit) manner.  They were willing to sacrifice the lives of tens of thousands already-born Americans for legislation, which, in all likelihood would diminish, rather than increase abortions.  Also, the institutional right-to-life movement showed themselves to be nothing more than an arm of the Republican party.  A recent NRLC committee claimed this to be the “most pro-abortion legislation” in history.  Talk about a lack of intellectual credibility.  I actually used to be somewhat sympathetic to the pro-life movement, but they have shown repeatedly that their interests in life end at birth and that they have decided whatever is good for the Republican party is good for them.

Kind of amazing to realize that abortion politics almost sunk this bill when it is such a tiny, tiny thing of what that ACA is all about.

5) The Democrats are going to lose a lot of seats in 2010.  But not because of the health care vote.  The economy is still very weak and the Democrats are overextended after two very strong Congressional elections.  It’s inevitable to lose a lot of seats.  They would be so much worse off if health care reform had failed.  That would’ve have allowed Republicans to completely define the issue and why it failed; and showed the Democrats to be completely ineffectual.  I think I heard EJ Dionne on the radio say today something to the effect of, the only thing worse than a socialist is an ineffectual socialist.  The press and the country for the longest time has been totally focused on the process.  We’re done with the sausage metaphors!  Except this: sausage is awfully tasty.  Of course, a lot of the taste doesn’t kick in till 2014, but we’ve got some good nibbles to take effect soon (e.g., closing the Medicare donut hole; allowing young adults to stay on parents’ insurance until 26).  The Democrats can now actually defend a good solid bill, not just mythical abstractions and lies (not that the Republicans won’t keep lying, but at this point the media can be much more straightforward in rebutting lies).

Well, the Democrats did lose a lot of seats and certain political scientists to remain nameless ended up arguing that the health care vote did directly cost seats:

We investigate the relationship between controversial roll call votes and support for Democratic incumbents in the 2010 midterm elections. Consistent with previous analyses, we find that supporters of health care reform paid a significant price at the polls. We go beyond these analyses by identifying a mechanism for this apparent effect: constituents perceived incumbents who supported health care reform as more ideologically distant (in this case, more liberal), which in turn was associated with lower support for those incumbents. Our analyses show that this perceived ideological difference mediates most of the apparent impact of support for health care reform on both individual-level vote choice and aggregate-level vote share. We conclude by simulating counterfactuals that suggest health care reform may have cost Democrats their House majority.

Of course, most of those seats would have been lost for the reasons stated above, but health care does seem to have made the problem worse and perhaps worse enough to be the difference in majority control.

Anyway, obviously I’ve missed some stuff, I’d say most of what I wrote held up.  I should probably check back on myself more often.

About Steve Greene
Professor of Political Science at NC State

One Response to ACA eight years later

  1. Nicole K. says:

    Believe it or not I was the first person in North Carolina to enroll in an Obamacare plan. I even had the government contact me to come forward as a success story when it was revealed that only one person that lived in Raleigh had successfully enrolled in a plan in the state.. Since I was a Republican at the time, I declined to cooperate. Here is a link to the Facebook post I created after I successfully enrolled.

    It’s hard to believe that I was ambivalent at best about ACA when it was first enacted because without it I would not be able to get the medicine I need for my narcolepsy. The insurance plan I carried before Obamacare carried a $2,000 limit for name brand drugs before the copay became 50%. The plan also had a lifetime benefit cap of $1 million. That would have left me in serious trouble as my annual prescription drug expenses are in excess of $100,000 a year.

    There’s a ton of reasons I’m not a Republican anymore but the two biggest reasons I’m probably never voting for another Republican candidate are because they want to ruin my health insurance and they want to make life harder for transgender people. But healthcare was the first thing that got me on the path to breaking ties with the GOP.

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