Obama Wrap-up Part II: In Sickness and in Health

Bitten by the bug: Democrats will have a harder time pushing public healthcare agendas now that the ACA's erosion and collapse is close to completion.

The Obama Administration's main domestic agenda priority when entering office in 2009 was to expand health insurance coverage and access to all Americans. At the time, this seemed like a necessary issue to tackle. The Great Recession had cratered the saving of the middle class, deprived many of them of the healthcare plan through the job that didn't exist anymore, and they didn't stop getting sick. So what did he create? The Patient Protection and Affordable Care Act (ACA), or Obamacare. Why did they choose a subsidized healthcare exchange as opposed to the socialist dream of universal healthcare? Simple: Obama had conveniently ignored the fact that both his party and the despised GOP were in the pockets of insurance, pharmaceutical, and hospital lobbies. What did he do about it? According to the New York Times he and his cohorts were "sometimes negotiating deals with a degree of cold-eyed political realism potentially at odds with the president’s rhetoric". Deputy Chief of Staff Jim Messina negotiated with hospital lobbyists a deal that according to MSNBC, the Huffington Post, and other sources took the public option as well as universal healthcare by default off the table. What they were left with was subsidized private insurance, and that's what we call the ACA/Obamacare.

Well, about four years after launching in 2013 the ACA is in serious trouble. Skyrocketing premiums and deductibles have created an outcry and a backlash. As the only major legislative accomplishment of his tenure, the ACA's repeal would mean the final demolition of the Obama legacy, and it was something that both him and the mass communications media, popularly known as the main-stream media, was well aware of when his preferred candidate Hillary Clinton was campaigning for the presidency. I have written more material on this topic than on any other one since starting my pages, and part of it was in order to explore the issues that complicated Obamacare beyond the Dems vs. GOP chatter and ones that I myself had never contemplated. This will be a more brief analysis, but I will try to include some of the primary events that guided this debate from cradle to . . . well, we'll see if it reaches the grave. NOTE: The military veteran healthcare will be covered separately, but it is relevant when addressing the organizational structure of a healthcare system.

Birth of the ACA

One of the things that is frustrating about discussing Obamacare is that it is such a complicated piece of policy, there are not very many people in daily life that have a full grasp of the issues and the process, and there is too much hyperbole attached to it on both sides. On the GOP side there was the claim that it was socialized medicine; it is not that. It's actually just crippled and price-fixed limited market medicine that's built for failure. On the other side, there was the ludicrous proposition that the criticism of the ACA was motivated by racial hatred towards Obama or corporate greed. MSNBC's Melissa Harris-Perry even claimed in 2013 that just saying Obamacare was a white racist way to diminish the policy and the president. Never mind that there was a similar use of the word Romneycare for the policy of Republican Gov. Mitt Romney in Massachusetts.

The ACA was actually proposed in order to deal with a number of goals for the Obama '08 campaign:

• Eliminating the ability of insurers to deny coverage based on pre-existing conditions.
• Requiring all citizens that can pay for insurance plans to buy one in order to ensure coverage for all. This became known as the individual mandate.
• Creating a subsidized federal health insurance exchange, what would eventually be called Healthcare.gov along with state exchanges in order to offer more competition and options for low income customers.
• Lowering the cost of health insurance.

How the ACA butchered the Dems and Obama's agenda

US Rep. Joe Wilson (R-SC) made headlines by
calling Pres. Obama a liar during an address
on healthcare on Sept. 9, 2009. 

In the first year of Obama's presidency, the GOP dug in and fought the ACA on several fronts especially in the areas of the bill that required employers and insurers to cover abortions and birth control. This tactic failed to defeat the bill: In the Senate it passed with a 60-39 party line vote, while in the House it passed with a 219-212 majority with only Democrats supporting it while 34 Democrats and 178 Republicans opposing it.

Nevertheless Obama & Co. believed that this narrow legislative victory would carry him forward for the rest of the term. He was wrong: the ACA's major framework would not come into action until the beginning of 2014, well into his second term. Consequently, the GOP would win the 2010 midterm elections in the House thereby stripping Obama of his power in the legislature, while he would win re-election in 2012. This divided government virtually guaranteed that Obama's further legislative agenda would be unimplementable, and he was unable to regain control of the House in either 2012 or 2014. In fact, in 2014 the Democrats lost control of the Senate as well.

Another issue that caused Obamacare to erode the president's support was the implication that it may eventually be expanded to give coverage to illegal immigrants. In 2009, a congressman was heavily reprimanded when he claimed that Obama was lying in denying that that was his plan. By 2006, it was acknowledged even among liberals that California was going to try to do just that. So although Obama himself may have never actually granted this provision, his party's zeal to promote it notwithstanding its failures became  their undoing in 2016 as they failed to recognize that it was now a liability. 

Omens afoot

How is it that the Dems continue to sing the praises of the ACA

when its roll-out was so botched that its implementer HHS Sec.

Kathleen Sebelius resigned within four months of it going live.

(ABC News). 

In 2014 it was time to actually get the ACA into gear and the programme was actually hit with one of the most embarrassing sequences of failures that could be imagined as its website and associated online infrastructure proved to be very difficult to use and sometimes entirely dysfunctional. The disastrous roll-out would lead to the resignation of Health and Human Services Secretary Kathleen Sebelius, the former Democratic governor of Kansas. The botched introduction of the policy was followed by an information war between its advocates and those that claimed it was already ruining the insurance market.

Another issue that began to drag the ACA down was the unraveling of its state exchanges. From Oregon to Illinois to Tennessee, these costly state-run entities began to fall apart due to poor administration and infrastructure that caused mis-estimations of subsidy rates for customers. Few of them remain operable, one of them being the unpopular Vermont Health Connect which is now being reported to be on the verge of collapse. When Illinois' Land of Lincoln Healthcare (LoLH) collapsed this past July, the Chicago Tribune showed how it left many policy holders scrambling to get coverage while undergoing treatments for chronic illnesses such as autoimmune disease. LoLH suffered $50 million in losses heading into 2016 and never recovered. This same failure has been replicated across the country as only six exchanges are currently in operation out of an original 23.

Perhaps the most high profile issue that plagued the policy in the public eye was the revelation that two additional promises made by Obama and his spokespeople were false: "If you like your doctor/plan you can keep him/it". This was already shown to be a falsehood in 2014. 

The industry end-around nail in the coffin

Map of Obamacare premium price changes from

2015-16 for the Silver Plans.Notice

that in several key swing states (NC, CO) it was

already mushrooming going into the election year.

It was a sign of things to come as they continued to 

spike going into 2017 (ZeroHedge)

During the course of 2015-16, another trend began to rock the headlines regarding Obamacare, this one perhaps worse than the exchange collapses: Insurance giants were ditching their ACA subsidized plans because they were garnering losses. By August 2016 both Aetna and United Healthcare had pulled out of most of theexchanges. Apparently many clients with pre-existing conditions would instantly hit up their policy for a new claim. It was a recipe for failure. The criticism for the left was that the ACA would be another money grab for the private insurance giants, which is both wrong and right; they incurred major losses in the end, but like all corporate monoliths they know how to use the tax code to make it work for them.

In practical terms, this added stress to the confidence in the exchange:

• The companies' pull-outs meant automatically that the Administration's promise that the ACA would increase competition in the market was dashed. 
• The lack of competition and difficulty of covering all of the ACA's "refugees" both from the failed exchanges and the withdrawn insurance firms drove both premiums and deductibles higher.

The ACA premium price increases varied; in three states Indiana, Rhode Island, and Massachusetts they actually decreased on average, though not by more than 3%. However in several states they exploded: Tennessee (+63%), Minnesota (+59%), Oklahoma (+69%), and Arizona (+116%). For more information on the changing ACA price landscape please visit the fascinating Charles Gaba blog acasignups.net. Mr. Gaba live tracks all of the developing issues with the ACA in a way that makes even seasoned pros look like amateurs and shows who does benefit from the ACA, and who does not. If you don't trust me, please consider the fact that Gaba is a universal single payer healthcare advocate.

Waterloo 2015?

Obamacare's failure to accomplish any of

its goals was accompanied by plenty

of finger pointing towards people that

had tried to stop it to begin with. 

By Eric Allie, Illinois Policy

What is remarkable was that this was not more of an issue than it became. The news media did cover the collapse of the exchanges, but seemed to neglect the importance of it. If NBC, the New York Times, and Newsweek had been fully forthcoming in its coverage they would have decried the waste of taxpayer money on failed state enterprises that amounted to corporate welfare. But like many other policy failures, the ACA's state exchanges were never deemed sufficiently close to Obama himself to be considered his personal failure. How is it that they can ignore the fact that in his home state, backed by an all-too supportive House and Senate, Obama's pet project was a colossal failure in every respect, and by September 2016, as the President was trying to hand off the keys to the White House to his preferred successor, his hometown Chicago Tribune even acknowledged that. 

During the election season I was documenting the alarming premium increases on my Facebook page, but to be sure the actual trends that began the unraveling of Obamacare began in 2015. In February of that year it was estimated that 200 thousand ACA policy holders would be booted due to their lack of legal residency in the USA, meaning that it is possible that massive quantities of illegal immigrants had succeeded in attaining coverage from 2014 until then. The premium hikes, the denied coverage, the bungled roll-out, the collapsed exchanges, all turned it into one of the worst domestic policy quagmires of our lifetimes. Worse than that, for many lower income and unemployed Americans, Obama's signature policy had no bearing on their lives as it was intended for middle-income but chronically ill citizens. So for the poorest Americans it was literally irrelevant and garnered for them no benefits. 

Final Grade: F, and seriously he did himself in with this more than anything else he did. Obamacare was truly a policy that the President should have been sure would work before he attached his name to it. He believed firmly that its successful passage in Congress would make it a success; he though wrong, and its failure is the symbol that should be the mark of his legacy forever, and not his various late night TV appearances where he charmed the plebs.