Come for the politics, stay for the snark.
Today the Affordable Care Act (ACA) turns nine.
It is still a BFD.
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Open thread
Prioritization will be a key differntiatior of Democratic Presidential and Senate primary candidates. I believe that most Democrats will share significant elements of what is on their top-10 list of areas that need federal government attention in a government that could theoretically have a narrow Democratic trifecta. But the key will be prioritization.
In 2009-2010, the US Senate was able to do the following big things:
In 2017-2018, the US Senate was able to do the following big things:
Senate floor time is a key constraint. A very productive Senate might have slots for two big bills, three or four medium actions (such as SCOTUS nominees) and a lot of housekeeping. A productive Senate is most likely positively correlated with the size of the effective majority.
Right now, there are numerous agenda items that could qualify as a “big” thing from the Democratic/liberal perspective. The following will be an incomplete list:
Any of these things could easily eat up three months or more of floor time in the Senate. I’ve listed well over twenty four months of potential floor time activities from an incomplete list if all of these items were considered to be “big” items for the Senate. That is infeasible as it neglects the basic day to day functioning of the Senate as well. The Senate still has to approve nominees, it still has to pass appropriations, it still has to make tweaks and changes to the law as circumstances dictate.
So the question will be prioritization.
Candidates are likely to share the same items on a top-10 list but the rank ordering and asset allocation will matter a lot. One candidate might want to spend six months on healthcare again at the cost of doing not much if anything on immigration and naturalization. Another candidate could want to spend a little time on a minimal “fix-it” healthcare bill while spending more time on global warming policy. Those are all defensible choices. But the prioritization is very valuable information.
The floor time constraint of any 2021 agendaPost + Comments (37)
In comments to the post on pragmatic evolution of US health policy on Monday, The Question raised a point that I want to respond to:
on health care why do we always have to pre-negotiate with ourselves and have ourselves primed to accept half a loaf? I am so tired of being sensible when there is no gorram reward. If loudly shouting the most extreme thing we want gets us even half what the republicans have gotten out of it why the hell not??
I want to raise an empirical point and then a broader political/policy point that explains my thought process.
First, empirically, what has “shouting the most extreme thing” gotten Republicans?
It has gotten them power.
What have they done with it so far? In 2009, Democrats at this point had a smaller functional majority in the Senate and a slightly larger majority in the House than the Republicans have today. Democrats had passed and signed into law the stimulus, CHIP re-authorization, Lily Ledbetter, and the Dodd-Frank CARD ACT by now. They were grinding their way through what would become the ACA.
What have the Republicans accomplished as of today?
Ultimately, the reason I can’t get with the whole Democrats are neoliberal shills thing is shit like this:
As legislators and the executive branch renew their efforts to repeal and replace the Affordable Care Act this week, they might want to keep in mind a little-known financial consequence of the ACA: Since its adoption, far fewer Americans have taken the extreme step of filing for personal bankruptcy.
Filings have dropped about 50 percent, from 1,536,799 in 2010 to 770,846 in 2016 (see chart, below). Those years also represent the time frame when the ACA took effect. Although courts never ask people to declare why they’re filing, many bankruptcy and legal experts agree that medical bills had been a leading cause of personal bankruptcy before public healthcare coverage expanded under the ACA. Unlike other causes of debt, medical bills are often unexpected, involuntary, and large.
The whole fucking point of the Democratic party is to help with situations like this. Would single payer be better? Of course. But 750K fewer bankruptcies is a big fucking deal, and we all owe Obama and Democrats a big thanks for passing ACA. People got voted out of office for supporting it, and Obama’s favorability took a hit for passing it. But they did it anyway because it was the right thing to do.
Update. The best thing we can do to preserve ACA is win a couple special elections. You can give to Rob Quist who’s running for the House seat in Montana, here.
National healthcare spending is significantly (~10%) below 2010 projections:
Just out: @urbaninstitute/@RWJF, MT: “US on track to spend $2.6 trillion less 2014-2019 vs. projections from ACA.” pic.twitter.com/zFAvPpr6oY
— Andy Slavitt (@ASlavitt) June 20, 2016
And people are less stressed about being able to pay for a medical bill:
Fewer Americans having trouble paying for care. The ACA not the only factor, but a big one.https://t.co/VPqKkPGmdT pic.twitter.com/AQTi2VgU81
— Larry Levitt (@larry_levitt) June 20, 2016
Why I was told that was Unpossible
Open thread
We’ve looked through four decades of data, and the share of people who are uninsured has never been this low. pic.twitter.com/UPvLtA8NtR
— Larry Levitt (@larry_levitt) May 17, 2016
The interesting thing to me in this chart besides the final outcome is that the introduction and proliferation of government sponsored insurance after 1980 to 2010 basically was sufficient to replace 1:1 declining employer sponsored coverage and not expand coverage. Legacy Medicaid picked up more responsibility, Medicare picked up more members, CHIP was a brand new program that has covered a lot of kids. But all of those programs were effectively either status quo keepers on a population basis or slowed the rate of uninsurance growth.
There are three major challenges left.
2015 is the first year on record where over 90% of Americans had health insurance. https://t.co/0cWQJ0AQxe
— Sarah Kliff (@sarahkliff) May 17, 2016
Now talk amongst yourselves… open thread!