An op-ed by Dr. Thomas J. Hendrix, PhD, RN
The Healthcare exchanges opened for business at the beginning of October and the roll out has been a disaster. In fact, the website has hardly functioned at all and millions of Americans have now begun to receive their cancellation notices from insurance carriers leaving them, in effect, on their own and without coverage in the very near future. When directed to the federal exchange to find replacement policies, an increasing number are finding policies that are more expensive, and have less coverage with higher co-pays and deductibles. There are many reasons to oppose the Affordable Care Act (ACA), but those opposing it need to be cautious. With an unlimited supply of taxpayer dollars to hire the best computer experts, the government will eventually fix the website. When this “fix” is coupled with a media that supports this President regardless of facts on the ground, the inevitable proper operation of the website will be heralded as evidence that the ACA itself is “fixed”. This will not be true. Though the technical aspects of the website may be taken care of, the structural flaws of the ACA will not be resolved. Those that oppose this government imposition into the most personal aspects of all our lives must push back hard. Push back and reject the underlying structure of the law.
Primarily because the structural flaws of the ACA are now becoming clear to even those Americans (and Alaskans) that do not follow policy very closely, 15 Senators that voted for the ACA and are up for re-election, recently met at the White House. They told the President that he had to do something because they were worried about their upcoming election less than one year away. Shortly after this meeting, the President had an interview with NBC news and said the following:
“I am sorry that they [the American people] are finding themselves in this situation based on assurances they got from me,” and “We’ve got to work hard to make sure that they know we hear them — and we are going to do everything we can to deal with folks who find themselves in a tough position as a consequence of this.”
Almost immediately the political pundits and the media put out the message that the President apologized and he just wants to work together to fix it. That is one of the talking points that those that voted for this law will repeat over and over for the next 12 months and it must be vigorously pushed back right now before it becomes accepted as a fact. Opponents of the ACA cannot grow weary of pushing back or stop pushing back because they assume that the citizens have heard it or understand it. They need to push back time and time and again. This is about holding elected officials accountable for their actions. There must be a consequence.
So let’s look at the President’s words. He said he is sorry that Americans are “finding themselves” in a bad situation. In other words, Americans are wandering about simply living their lives and, all of a sudden and out of the blue, they began to receive insurance cancellation notices. This is very a passive voice way to say that the cancellation of coverage somehow just happened. However, the truth is that this was very active and deliberate and that the ACA brought it about. Americans didn’t “find themselves”; they were forcibly pushed into this situation by this law. Those who support this law and those who actually voted for it cannot be allowed to get away with spinning away what this law has actively and purposely done to Americans (and Alaskans). This was not unexpected. This was not a surprise and those who voted for it cannot be allowed to say that it was unexpected without being vigorously challenged every single time they say it . . . over and over again.
The President said that Americans (and Alaskans) find themselves in this situation “based on assurances they got from me”. This is also deceptive. Nobody finds themselves in any danger based on the words of either the President or those who voted for this law. Although their words were deceptive, it is not their words that are hurting us. It is their actions that are hurting us and have hurt us in spite of their promises not to do so. It is the law they voted for that is hurting us. It is the very predictable results of the impositions mandated by this law that are hurting us. The President actually said he felt bad he was not clear when he explained it to the public. Once again, this is deceptive. The problem for those who voted for this law is that the words were very clear. In fact, they were crystal clear. He and those who voted for this law were not giving us murky words about a difficult concept to understand. In contrast, they gave us very understandable words about something that was simple to understand. They assured the American (and Alaskan) people that if we liked our doctor or health plan, we could keep it period! This was very easy to understand. My school teacher wife understood it. My firefighter nephew understood it. We all understood it and we understood it because the supporters of this law made sure they were very clear about this promise during the run up to the ACA vote. Well, they got their vote and their law was passed. The problem for the President and those that voted for this law is that their promise was perfectly explicit then and remembered now. The deception is very plain to see. Many people voted for the supporters of this law based on the crystal clear promises that were made. Next year, these supporters of the ACA must be presented with what they actually did in contrast to what they said, and their opponents should not allow the discussion to devolve into some magical fixes that will surely come if we just wait long enough into the future. The spin that has begun must be pushed back and it must begin right now and it must be done each and every time the spin resumes.
The President said that “we are doing everything we can to deal with the folks who find themselves in a tough situation”. There we are again “finding ourselves” and where do we “find ourselves”? We find ourselves in a “tough” position. To repeat, we are in tough position because of what the President and those who voted for the ACA have made law. They systematically and, I would argue, deliberately, put us in a tough position. It is their fault. Then we need to ask, what is the “tough position” we are in? The answer is that millions of Americans (and many thousands of Alaskans) are losing their health insurance because of this law. Then the President says he will “deal” with the problem. How will we get “dealt” with anyway or are these just more words? Will the supporters of this law rescind the mandatory aspects that make the current pain inevitable? I suspect not.
If history is a teacher, this President and the law’s supporters believe that these mandates are essential. They believe in them and therefore we must experience the current pain because they are so much smarter than we are and they know what is best for us. In fact, they know it better than we know for ourselves. I feel like I am being told to take my medicine while the medicine is killing me and nobody seems to be listening. They ACA supporters must necessarily believe in these mandates because they deliberately put them into the law. So how will we be “dealt” with? Will we be spun? I think so. Will we be deceived some more? I know so. Will the law be changed? It will not. Maybe the “dealing” strategy is to try and trick us by making the “pain” less obvious going into the election so that the law’s supporters are not harmed by the voters. The pain is guaranteed to come (and they know it) but maybe they can get through the election. How will they do that and will those candidates that oppose the ACA allow it to occur? When the supporters feign ignorance, be prepared with many studies that predicted this. When they plead unintended consequences, ask them if they read the law before voting for it. If yes, they are either deceptive or not very bright. If no, were they really representing us or were they representing past-Speaker Pelosi (D-CA) who proclaimed that we had to pass the law in order to find out what’s in it? Well, now we know what’s in it and whoever voted for it should have known as well.
The President has already delayed the employer mandate with a wave of his hand because he (and his supporters) did not want the effects of this mandate to become apparent prior to the 2014 election. They did not want us to see that once the mandate hits the workplace, the cancellations and changes will begin to impact others who are outside the individual insurance market. As a direct result of the ACA, a majority of small businesses will drop their plans as will many large firms. In fact, the Heritage Foundation estimates that the number of people who will receive cancellation notices will easily eclipse the 100 million mark and this does not include their families. Avik Roy, a well-known health policy expert at the Manhattan Institute, estimates that 129 million will eventually lose their insurance coverage as a direct result of the ACA. If these 100+ million voters began receiving notices, could the President and those who voted for this law continue to repeat the 5% deceptive number? After all, another part of the President’s non-apology was:
“What we’re talking about here is the 5% of the country who currently purchase insurance on the individual market”
You can certainly expect the supporters of the ACA to parrot that line. Is it true? Once again, it is not. Once again, we are being deceived. Is this a pattern of saying things that are known to be untrue? The President told us that he granted the delay in the employer mandate so that employers would have more time to plan for the transition. Does anyone believe that? I think we now know that this President and those that voted for the ACA will say anything in order to have their way. Isn’t it more likely that this delay was granted so that a hundred million+ voters would not receive cancellation notices in the months leading up to the election? Does the delay of this disruptive mandate mean that these same workers will not receive these notices? The simple answer is no. However, those who voted for this law will be able to avoid that conversation until after the election is over and then the senators will have six more years for the voters to forget about it. Will the opponents of these politicians let them get away with it? Expect the ACA supporters to tell potential voters in 2014 that these are exaggerations not to be believed. But, as Chris Conover, PhD, an economist at Duke University tells us, the rules governing whether current plans can remain in place were anticipated by the Obama Administration three years ago when they stated that only 20 to 51% of small group plans would be retained leaving 49 to 80% that would be disrupted. Similarly, only 36 to 66% of large group plans would remain the same. This tells us that 34 to 64% would not. These are their words. These are their projections. They know this huge disruption is coming and they also know that the 5% number is completely false but they continue to say it. We are only seeing the tip of this disruptive iceberg but that will not stop the spin as those who voted for this law attempt to fool the voters. Does anybody believe that debate moderators will put these deceptions front and center? Those candidates who oppose the ACA and are running against ACA supporters certainly can and they must.
Now the stage is being set to delay the individual mandate. Those 15 vulnerable Senators would probably like that a lot although they demonized Senator Ted Cruz (R-TX) when he took to the Senate floor and demanded it. The Republican establishment told us that we should not be confrontational like Senator Cruz. They told it is a much better idea to let this law fall of its own weight. That’s what they told us. Well, here we are and it is falling. I guess we’ll soon find out if only one political party is deceiving us on this issue or if they both are. The people should see with eyes wide open what this President and the ACA supporters have done. If the individual mandate is delayed, does this mean that the damage will not be done? No, the damage is coming but these vulnerable senators who voted for this law would be able to spin a fictional picture of a never-to-be-seen future. I would rather have the voters presented with a picture of reality.
The election of 2014 is not about women’s rights. It is not about gay rights. It is not about Native rights. It is not about jobs. It is not about Bush. It is not about Syria. It is not about Iran. It is not about Benghazi. It is not about fairness. It is not about feeling. It is not about taxes. It is not about energy or oil. It is only about the icy cold, hard truth of what this President and those that voted for this law have done to us. Nothing else matters. Every candidate for higher office should have a very short answer for every question posed to them in any forum on any issue and then immediately pivot to some aspect of the ACA and what it has done and will do. If a candidate has 90 seconds to respond to a question posed to them, they should answer the question precisely in 10 or 15 seconds and then pivot quickly to the ACA and they should do this time after time. They should be prepared to do this. They should practice doing this. They should anticipate the questions about other issues and plan their pivot to the ACA for each one and they should do it each time. If you allow the debate to move to any other issue for any length of time, you do not deserve to win.
I will close with this. I teach Health Policy at the graduate level to very bright, young people and hardly any of them were aware of what has happened and what is happening still. They listen to NPR and CNN and sometimes read the Anchorage Daily News if they find it laying around. These are students that are in the health field and they are bright and they were unaware of this broken health care policy. They (and everyone else) need to be told about this again and again and again. If a question comes out about a “women’s’” issue, pivot to the reduced quality of life and lower standard of living for their children in 20 years. If something comes up about education or students, remind those students that their personal private information is not secure on the Healthcare.gov server and that there is no restriction on the hiring of felons as “navigators”. Tell them that their premiums will increase by around 62% (female) or 100% (male). Turn everything into some aspect of the ACA. A famous singer when asked how he could get “up” for each concert when singing the same songs time after time responded that the people in the audience paid good money for the ticket and there is someone out there that has never heard me sing it. Similarly, if you hang the ACA around the neck of the ACA supporter again and again, there will be someone who hears it that has never heard it before. Do not get tired of saying the same things time after time. Make them pay for what they have done . . . . . . . and start right now before the spin begins . . . . . . . or you will not win. Do not let the lie get halfway around the world please. Mr. Truth, please put your pants on and fight. You need to fight!
Dr. Thomas J. Hendrix, PhD RN, is a professor at the University of Alaska Anchorage where he teaches Health Policy. He has Masters degrees in Health Service Administration and in Adult Health Nursing. Additionally, he also has a PhD in Health Policy/Health Economics. He has worked in the health care field since 1981 when, as a registered nurse, he cared for patients in the acute care setting,emergency room,and medical-surgical unit. After a 24 year career in the US Air Force, he earned his PhD at The Pennsylvania State University in 1999; taught at the University of Utah and the University of Alaska Anchorage. He is currently the Research Fellow in Health Policy and Economics for the Alaska Policy Forum. The views presented here do not necessarily represent the views of the University of Anchorage Alaska.