June 29, 2012

Obamacare likely won't help the poorer that much

Why not? Slate has the details, and here's my thumbnail.

Much of Obamacare, like Romneycare, is/was predicated on expansion of Medicaid.

Well, with Obamacare, the biggest "loss" for Dear Leader in the Supreme Court ruling is that the federal government can't force expansion of Medicaid the way the legislation planned. Slate estimates that Obamacare will likely cover, at most, just half of the currently uninsured.

Sure, that is a half-loaf that's better than none. But, if Obamacare's OK actually makes it harder, not easier, to pass a single-payer system, then a short-term win could actually be a long-term loss.

Add in the fact that the feds may not necessarily do the best in cost controls on an expanded Medicaid, for states that opt in on that, and the issue looks like it's kind of serious. 

I'll admit that it's often my nature to be a bit of a pessimist. However, since Obama junked the public option, and included (in my opinion) inadequate cost controls in what he did propose, I've not seen a lot to make me highly optimistic.

Overall, I fear this will likely wind up being a case where the good is the enemy of the best. And, while Slate confirms that, I didn't need that confirmation.

That said, let's point out one other thing.

One of the most popular portions of the bill was and is the one letting parents keep their kids on the parental insurance until they're 26. Well, that's squarely targeted at the middle class; working poor can't afford that, and likely will in many cases still not qualify for Medicaid, even in states that expand it, and won't be coerced into buying insurance for themselves, let alone 22-year-old kids, by a fine/tax.

And, as election season continues, Obama will tout those portions of the bill most. 

As for the tax portion, or penalty, that forces the mandate? First, most working poor who don't qualify for Medicaid might not readily be able to afford the tax, either. What's Obama going to do then? Still dun them? Push Congress to expand the Earned Income Credit to offset this?

And, since it is now a tax, not a penalty,  does this  put enforcement in the hands of the IRS, not Department of Health and Human Services? Do you think the IRS has time and manpower to chase down "health insurance deadbeats"? Do you think it wants that PR nightmare, either?

Beyond the Byzantine administrative issues (not as bad as "Hillarycare" but bad enough), these are major issues.

And, the relatively modest amount of the tax hit, even if it is still unaffordable for some, is apparently part of why Chief Justice Roberts was OK with Obamacare as long as the "ding" is a tax, and not regulation of commerce, as noted here. Indeed, it's arguable that conservatives shouldn't be moaning as much as they are. Yet more on that line of thought here.

Next question — in light of "Hillarycare" and the issue of who would enforce the "ding," especially if it had to be considered as a tax (assuming Dear Leader at least assumed there would be a constitutional battle over this), did Obama think through the issues I just lined out? Especially if he did, doesn't think underscore just how much this is a neoliberal bill,  not a truly liberal one?

The middle class votes. The poor, not so much.

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