As my esteemed colleagues have written on this topic about what was passed and what lies ahead (see Ben Miller’s post and Mark Ryan’s post), there remains a need describe what to do. Below, I have indicated the likely scenario of arguments and tactics to be weighed against the Affordable Care Act and our options to reply, both reactively and proactively. I invite your additions to this list.
- It’s a Tax
Courtesy of Chief Justice Roberts, be prepared to hear the sound loop of the Supreme Court’s determination that the Affordable Care Act is a tax. OK, so be it. The proper reply is that there are “No Free Riders.” No one likes it when people cut in, and they sure don’t appreciate paying for another person’s way. So how about having a ready reply to the anti-tax clan, with a “pay as you go” plan, and “equal contribution for equal distribution” system. Start practicing.
- Medicaid Expansion Tramples States’ Rights
This is hard to even conceive of as a hassle to states. The provision that would have penalized states for not accepting the Medicaid expansion has been struck down. So, now we have a situation where states have the choice to accept additional federal funding to provide greater coverage for its most impoverished constituents or to reject them. Mind you, as the law presently stands, states which reject the Medicaid expansion provisions will end up providing greater coverage for middle-class folks while leaving its poorer residents with less help. Go figure. The argument here is to point out the ridiculous and fatuous nature of any politician (in particular, Republican Governors) of depriving its lowliest citizens of greater healthcare access. According to them, the poor don’t matter. Call it as it is.
- Repeal of the Act If the Republicans Take the White House and Congress
This is a real possibility. The momentum moving into the November election is to take every stakeholder who gained from the Affordable Care Act and to drive them to the polls. Right now, the economy is in doldrums and that does not bode well for hanging onto the Act. What is needed is for every American to affirm what they got out of the legislation (and what is to come), and to stand up and say, “I’m keeping this and I am keeping the President that delivered it.” Want to know what you have right now? Check it out:
- Automatic Federal Budget Cuts
This is the hidden horseman of the Apocalypse that can upend the whole she-bang. No matter who ends up in the White House and with which party has the majority control, there will be an accounting. Without agreement on the bipartisan committee’s recommendations, the automatic cuts imperil every state’s budget that relies on federal funding. This can very well turn out to be the hidden assassin of the Medicaid expansion plans referenced above. If a state is cash-poor, why would it want to take on the enormous burden of the program, especially if it is being hit with additional federal cuts? No dice. Under a Republican administration, these extraordinary budget cuts would only poise Democrats for an off-season election victory in 2014. Under a Democrat-ruled government, these cuts would mean clear austerity across the board, paving the way for a likely Republican win in 2014. Under either scenario, the lost privileges from the Affordable Care Act would be felt deeply by many Americans. I believe the demand for access and the need for lower health costs will drive the push for universal care once and for all. But I am getting ahead of myself. As the automatic cuts loom ahead, there will be a need for lobbying and pressuring Congress to act to avoid draconian measures. This is where all of us will have to act, demanding change. The time has come to simply admit that taxes aren’t bad; taxes are funds that pay to get the job done. If you want it, pay for it. No thieves allowed.
There you have it. Your toolkit moving forward. Practice and repeat.