Richard Kirsch

Roosevelt Institute Senior Fellow

Recent Posts by Richard Kirsch

  • Florida Election Shows Danger and Promise in Obamacare Debate

    Mar 17, 2014Richard Kirsch

    Democrats may have lost the special election for Florida's 13th congressional district, but the polling shows a path to success in 2014 with the Affordable Care Act.

    Democrats may have lost the special election for Florida's 13th congressional district, but the polling shows a path to success in 2014 with the Affordable Care Act.

    As pundits debate the impact of Obamacare on the special Congressional election held in Florida on March 11, a headline from a new Bloomberg national poll actually does as good as any describing what happened in the Sunshine State: “Americans Stick with Obamacare as Opposition Burns Bright.” That national finding also describes what happened in Florida, where swing voters supported the ACA, but more opponents turned out to vote.

    The Bloomberg survey found the “highest level of acceptance for the law yet” in Bloomberg’s polling, with almost two out of three (64 percent) of those surveyed saying they supported either retaining the Affordable Care Act (ACA) with “small modifications” (51 percent) or as it is (13 percent).

    The troubling result in the survey for the political prospects of the ACA is that the one-third (34 percent) who want to repeal the law are much more likely to vote. No news here. We’ve known that the ACA is a highly motivating issue for Republican voters, who turn out at a much higher rate in off-year elections than Democrats and independents.

    The real news is in the first set of findings, the growing popularity of Obamacare outside the Republican base. These findings were confirmed in the Florida election, when Alex Sink, the Democratic candidate, pushed back against attacks on the ACA from David Jolly, the Republican candidate, and independent groups supporting him.

    Jolly’s position was clear:  “I’m fighting to repeal Obamacare, right away.” So was Sink’s: “We can’t go back to insurance companies doing whatever they want. Instead of repealing the health care law, we need to keep what’s right and fix what’s wrong.”

    The key part of Sink’s message was to remind voters why people wanted health care reform in the first place. As one of Sink’s TV ads said, “Jolly would go back to letting insurance companies deny coverage.” That’s an effective reminder of the huge problems Americans have had for decades, when insurance companies could deny care because of a pre-existing condition, charge people higher rates because they were sick, even charge women higher rates than men. The ACA ended all that.

    As would be expected in Florida – and even more so in a special election – the candidates worked especially hard for the votes of seniors. In their ads for Jolly, the Republican Congressional Campaign Committee repeated their misleading charge from 2010, trying to scare seniors into opposing the ACA by saying that it cut $716 billion from Medicare. But unlike 2010, when Democrats did not respond to attacks on the ACA, Sink pushed back. She reminded seniors that the ACA actually provides important new Medicare benefits, including closing the infamous prescription drug “donut hole.” Sink’s ads accurately said, “His [Jolly’s] plan would even force seniors to pay thousands more for prescription drugs.”

    By Election Day, voters had a clear contrast between the positions of the candidates on the ACA. It was a close election, with Jolly winning by a small margin (48.4% to 46.5%) in a district with an 11-point Republican advantage, one that has been represented by the GOP for nearly 60 years. But polling found that independent voters in the district supported the “keep and fix” position over the “repeal” position by a margin of 57% to 31%. Sink actually gained ground over Jolly during the election on the question of which candidate had a better position on the ACA.

    The narrow margin is encouraging in a district with this large a Republican voter advantage, but still falls short of the turnout in 2012, when President Obama narrowly carried the district. Democrats will need to do better in November, if they are going to hold on to contested Senate races and have a chance of picking up House seats.

    Fortunately, unlike in 2010, the Democratic Senate and Congressional campaign committees at least understand that they can’t run away from Obamacare. Doing so will cede independent voters to Republicans, just when those voters are becoming very supportive of the “keep and fix” message. While Democrats would prefer to keep the focus on the economic pressures being faced by American families – highlighting issues like the minimum wage – they’ll only be heard if they also engage aggressively in the fight over the ACA.

    In fact, the ACA is an economic issue; just ask anyone who has lost her job and her health coverage. Or the millions of low-wage workers who can’t afford to go to the doctor, or are trying to pay back medical bills from the visit they could not put off. As millions more Americans get coverage – 11 million as of the end of February between the new exchanges, the expansion of Medicaid and young people under 26 – Democrats should incorporate the ACA into their overall economic message.

    Supporters of the ACA have consistently believed that once the ACA began to be implemented, it would become more popular. We’re starting to see that shift. The challenge now will be turning that popularity into votes in November. 

    Richard Kirsch is a Senior Fellow at the Roosevelt Institute, a Senior Adviser to USAction, and the author of Fighting for Our Health. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.

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  • The Simple Solution to Obamacare's Employer Mandate Problems

    Mar 3, 2014Richard Kirsch

    Requiring employers to offer insurance to all employees or pay an additional payroll tax would eliminate the problems with the employer mandate, and start a shift toward broad tax-based coverage.

    Requiring employers to offer insurance to all employees or pay an additional payroll tax would eliminate the problems with the employer mandate, and start a shift toward broad tax-based coverage.

    In the last month, two more misleading headlines – one on lost jobs and the other on premiums for small businesses – have further roiled the overheated debate about the impact of the Affordable Care Act (ACA) on business and jobs. The question of how to deal with our employer-based health system continues to provide fodder for attacks on Obamacare. And it has proven to be  – and promises to continue to be – the basis for the most potent attacks against Republican proposals to replace the ACA. But in terms of policy, there is a simple solution, which would rationalize the contradictions in the Affordable Care Act and ease the way for the long-term goal shared on the left and right of separating health coverage from employment.

    The general approach taken in the Affordable Care Act was to require most employers to provide coverage. The specific proposal in the final legislation, shaped by compromises with and pressure from both small and big business lobbying groups, required employers with more than the equivalent of 50 full-time workers to pay a portion of health coverage for employees who work 30 hours a week, or pay a fine. This is the employer mandate, which was delayed a year by the Obama administration and will be phased in starting in 2015.

    The employer mandate does accomplish much of the prime goal of reform. Most employers have incentives to continue to provide coverage, or expand coverage. New coverage options are available for most people who do not get coverage at work, which was virtually all of the 50 million people who were uninsured when the ACA became law in 2010. People are not locked into jobs just because of health coverage, which was the real finding of the Congressional Budget Office report projecting 2.3 million people would retire or reduce their hours of work. Ending job lock opens up those hours to people who want to work and is a huge boon to entrepreneurship.

    But the problems with the structure of the employer mandate are obvious. The law creates incentives for employers to keep workers’ hours under 30. It also establishes the potential for a business with a growing number of employees, when it exceeds the 50-employee threshold, to suddenly have to pay for health coverage.

    The existence of incentives to cut hours or limit employees does not at all mean that employers will adjust for them. The accusations that the ACA is creating a part-time economy are belied by the facts: part-time employment is going down as the economy accelerates. In addition, employers that are adding workers rapidly as their businesses grow are not going to stop expanding  – or establish dozens of very small corporations – to avoid paying for health coverage. Still, we are seeing examples of some employers, including public employers and universities, limiting workers’ hours to less than 30. Others, like Trader Joe’s, are establishing different employment tracks for part and full time employees, with health care as a key factor. As this is all new – with the mandate not yet in effect – it is impossible to measure the future impact, but the incentives are certain to shape some business decisions.

    There is a simple solution, one that was included in the version of the ACA enacted by the House in 2009. Employers that decide not to provide health coverage for their employees would be required to pay a percentage of payroll as a tax to cover health care, just like employers do now for FICA (Social Security and Medicare). Instantly, the cliff impact is gone, both in terms of hours and number of employees. Employers could either provide coverage to all employees, or pay for health coverage in the same manner as FICA, a regular cost of adding an employee, with a marginal increase in cost for each hour someone works. There is no advantage to hiring someone for less than 30 hours or keeping under 50 employees.

    Paying a percentage of payroll also has another huge advantage over both the ACA and the current system of employer-provided coverage. Right now, the cost of health insurance premiums does not vary with an employee’s income. This creates a much bigger disincentive to hiring lower-wage workers. For example, a $6,000-a-year policy is 20% of the wages of a $30,000 a year employee but only 5% of the pay of a $120,000 a year employee. Paying a percentage of payroll instead would make it much more affordable to hire low-and-middle income wage earners than it is now. And while it would make it more expensive to employ higher-wage workers, most employers with high-wage workforces already provide health coverage and would be likely to continue to do so, rather than pay the payroll tax. If they did choose to pay, the cost is more easily absorbed for high-wage employees. Besides, that is not where we have an employment problem in the U.S.

    This solution mimics the structure of union-employer benefit funds, which are typically found in industries where workers have fluctuating hours. Under these “Taft-Hartley” funds, employers and workers pay into the fund based on the number of hours an employee works. The loudest opponents from the left of the employer mandate in the ACA have been unions whose members get health coverage through such funds now. The unions have said that the ACA encourages employers to stop paying into the funds, now that government will provide subsidies for many workers. But if the current employer mandate were replaced by a payroll tax, the status quo that has worked well for these funds would be maintained.

    Historically, the biggest opponent of a payroll tax for coverage has been the small business lobby, which is why the ACA does not require small employers to provide coverage. That is why the House version of the ACA phased in the payroll contribution based on payroll size, with no contributions required for payrolls under $500,000, increasing gradually to an 8% contribution for payrolls over $750,000.  This eases the burden on small employers.

    Slowly, the employer-based health coverage system in the United States is dissolving. Over the past 30 years, the share of workers with ESI has shrunk from 70% to 57%. Recently we have seen employers who traditionally have wanted to take responsibility for structuring employee coverage begin to use private exchanges, in which their workers get a fixed amount of money to choose from a choice of health plans. These trends hasten the broadly shared goal of separating employment from health coverage.

    As the debate over the ACA turns from repeal to fixing the law, progressives should make the payroll contribution proposal a central focus, our response to problems with the employer mandate. If enacted, as more employers choose to pay into the fund rather than provide their own coverage, we would move closer to ideal of a broad-based tax for coverage, not tied to an individual employer. And while a payroll tax is not progressive – it is proportional – it is much more progressive than the very regressive system we have now of fixed premiums regardless of income. The result would be evolution toward a relatively broadly based tax for health coverage, a key to making health coverage a right. 

    Richard Kirsch is a Senior Fellow at the Roosevelt Institute, a Senior Adviser to USAction, and the author of Fighting for Our Health. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.

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  • In VW Vote, Republicans Fight the Really Radical Idea that Workers Should Have a Voice in Business

    Feb 18, 2014Richard Kirsch

    When a company is not fighting against a union, why do that union's efforts fail - and what does that say about the U.S. model for labor?

    When a company is not fighting against a union, why do that union's efforts fail - and what does that say about the U.S. model for labor?

    Current management theory recognizes that businesses do better when employees are involved in decision-making. But that trend ran smack into the paternalistic view that workers are replaceable parts in the narrow vote by workers at Volkswagen (VW) in Chattanooga, Tennessee to reject the United Auto Workers (UAW). Here was a case where right-wing politicians, who usually worship at the alter of business, decided that a business that actually valued its employees’ ideas was un-American.

    In many ways what is remarkable about the vote of workers at a VW plant in Tennessee to reject the UAW was how close it was. Despite an aggressive campaign against the union by the state’s Republican leadership, if just 43 workers out of 1,338 had switched their votes, the union would have been voted in. The 626 workers who voted yes stood up to a campaign of intimidation by elected officials and right wing organizations that threaten not just their jobs, but harm to communities in the rest of the State. When it is so much safer to say no, we should recognize the guts of the hundreds of workers who by voting yes, declared that they deserved respect at their workplace.

    The main motivation for even having the union vote in Tennessee was not what most people assume, which would be to increase wages and benefits. While wages at the VW plant are far from enough to put workers comfortably in the middle-class, they are in line with wages paid to newly hired employees at plants represented by the UAW. In today’s era of diminished expectations by workers (and heightened ones by shareholders), VW workers in Tennessee were not organizing for a raise. Instead, they were calling for the establishment of European style works councils, which give workers a role in key decision-making at the factory.

    Works councils are common throughout Western Europe, and are often legally required at businesses with as few as five employees. Typically elected by all the workers at a business, including union and non-union members, the works councils join management in a range of decisions, including: monitoring and enforcement of employment and occupational safety and health laws, setting work and production schedules, introducing new technology, and downsizing the plant. To facilitate their role, the members of the works council have the right to information about financial and business matters, employment levels and structural changes to the work environment.

    Clearly, works councils would be a lot more revolutionary in U.S. businesses than voting in a union, because works councils establish a right to what was called in the early days of union organizing “industrial democracy.” They give workers a real voice at work. Companies like VW have found, in line with modern management theory, that giving workers a voice is good for business.

    Organizing the southern auto plants established by foreign auto companies over the past two decades is a top priority of the United Auto Workers. The auto companies were attracted to the South by a combination of low wages, workers with manufacturing experience, both laws and a political climate that discourage unionization, access to growing markets, and huge state-government tax incentives.  In 2008, Tennessee awarded VW a package worth $577 million to build the plant in Chattanooga, the richest package ever awarded to a foreign auto manufacturer at the time.

    The UAW decided to try a new strategy in its organizing effort at VW in Chattanooga, based on establishing a works council. The councils operate at every VW plant in the world, except those in China and the U.S. However, under American labor law, VW cannot establish a works council on its own. When the National Labor Relations Act was enacted in 1935, it was common for employers to set up unions they controlled, as a way to block unions that would really represent the workers. To prevent company-controlled unions, the NLRA prohibited the kind of joint management-worker decision-making bodies envisioned by a works council. For the UAW, VW’s openness to a works council presented a new avenue for organizing.

    While much has been made in the press about VW signing a neutrality agreement with the UAW, that act does not mean that VW’s American managers welcomed the union. Under the neutrality accord, VW rejected common anti-union practices among U.S. employers, like refusing to allow the union to speak with workers on site, requiring workers to attend anti-union meetings and harassing union supporters. However, the UAW too made concessions, including agreeing not to meet with workers in their homes, which is one of the most powerful ways of building support and leadership for unions.

    The main visible opposition at the factory came from salaried workers and low-level supervisors, who are not part of management but also were not eligible to vote in the union election, another barrier in American labor law. Mike Elk, who covered the vote for In These Times, reports many of these employees adopted the traditional view of American managers, that the union has no interest in producing quality cars and would interfere with corporate decisions. In the hierarchical American work culture, it is not surprising that workers who have been given some authority might be resentful of ceding some of their new power to a council that included hourly workers.

    Still, the close vote made it absolutely clear that deciding factor was the strident opposition of Republican U.S. Senator Bob Corker, Republican Governor Bill Haslam and Republican legislative leaders, who said that a vote for the UAW would scare other auto manufacturers away from Tennessee and dry up any more state support for expanding production at the factory. They made these threats even though GM announced this summer that it will add 1,800 jobs to a UAW organized factory in Spring Hills, Tennessee.

    The vote in Chattanooga should be seen as another skirmish in the growing debate about the role of workers in driving the 21st century economy. Southern politicians’ strong anti-union stance has roots in racist opposition to unions, which gave African-Americans a voice at work and better wages. Their virulent anti-union stance today continues the suppression of wages that has impeded the southern economy from the days of slavery. But today, the southern low-wage strategy has become a national model, led by the behemoth of southern companies, today’s largest employer, Walmart.

    The vote at VW highlights how the U.S.’s antiquated labor laws block economic progress. If the law allowed the establishment of works councils without the requirement that a union win a majority vote, it would provide a new vehicle to improve the performance and competitiveness of U.S. firms. The continued strength of many European manufacturers, even facing global competition from firms in lower-wage countries, demonstrates that giving workers a voice strengthens business. That lesson, a foundational assumption in the high-tech sector, makes sense for American manufacturers too. If our goal is to build an economy of broadly shared prosperity, giving workers a real voice in business decisions is a far better way to compete than slashing wages.

    Richard Kirsch is a Senior Fellow at the Roosevelt Institute, a Senior Adviser to USAction, and the author of Fighting for Our Health. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.

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  • Obama and the GOP Present Two Very Different Paths to Opportunity for All

    Feb 3, 2014Richard Kirsch

    Both the 2014 State of the Union and the Republican response emphasized the need for an opportunity society, but only the president called for collective action.

    Both the 2014 State of the Union and the Republican response emphasized the need for an opportunity society, but only the president called for collective action.

    Midway through listening to Rep. Cathy McMorris Rodgers’ Republican response to the State of the Union address last week, a colleague of mine e-mailed, “they got & used the economic narrative talking points to write this.” My friend was referring to the progressive economic narrative (PEN), developed to provide progressives with a powerful, clear story about the economy and the role of people, government, and business.

    In fact, there are powerful similarities in the story of the American Dream that both Obama and Republicans express, particularly as Republicans increasingly see that they must speak to Americans who are being pushed out of the middle class and struggling to stay out of poverty. That convergence is not by itself bad. It is an opportunity to draw attention to the huge chasm that exists between the two narratives, a Republican story based solely on the individual and a Democratic one that sees the individual in relation to collective action.

    Perhaps this is the line by McMorris Rodgers that triggered my colleague’s ire: “Last month, more Americans stopped looking for a job than found one. Too many people are falling further and further behind.” After all, one line from PEN is “Too many Americans can’t find a job and too many jobs pay wages that don’t support a family.”

    It is not a surprise that Republicans have been embracing part of the progressive story – that the middle class is getting crushed – because that is how most Americans are feeling, and pollsters for both parties are emphasizing that politicians must speak to where people are now to have any credibility.

    The similarities go beyond just relating to economic insecurity. Both Obama and McMorris Rodgers have the same vision of the American Dream, an opportunity society in which people are, as McMorris Rodgers said, “not defined by our limits, but by our potential.” Or, as the president put it, “our success should depend on… the strength of our work ethic and the scope of our dreams.”

    The heroes in both stories are hardworking Americans. Obama: “the notion that if you work hard and take responsibility you get ahead.” McMorris Rodgers: “They taught me to work hard, help others, and always, always, dream for more.”

    A job is how our hero achieves his or her dream. McMorris Rodgers says, “a job is so much more than a paycheck – it gives us purpose, dignity…” The president asks that “we do more to make sure our economy honors the dignity of work…”

    The underlying value in both stories is opportunity. McMorris Rodgers anticipates that Obama will focus his speech on inequality and tries to cut him off at the rhetorical pass: “The president talks a lot about income inequality. But the real gap we face today is one of opportunity inequality.”

    But Obama was not, in fact, giving a speech about inequality. He too was focused on opportunity, as Benjamin Landy bemoaned. “Instead of inequality, the President talked about ‘opportunity,’ a poll-tested alternative Obama deployed 14 times during the 65 minute speech. ‘Inequality’ was mentioned three times.”

    Saying that “opportunity for all” is “what unites the people of this nation,” Obama declared, “Opportunity is who we are. And the defining project of our generation is to restore that promise.”

    It is on the question of how we achieve the quest for opportunity for all that the president and McMorris Rodgers profoundly differ, where opposite visions of how we achieve the American Dream are projected. And remember that McMorris Rodgers’s speech is entirely a representation of Republican messaging

    According to McMorris Rodgers, you get there by yourself, with the help of your family. Her talk, as those of you who had the patience to listen through it will remember, was all about herself and her family: the work and savings ethics taught by her parents in a rural small town in Eastern Washington, her raising of her son born with Down syndrome.

    And that, in her political narrative, is how we address the challenge facing the country, “one manufacturing job, nursing degree, and small business at a time.” Her talk barely bothers with policy directives, but those few that appear are based on the individual.

    The most robust policy paragraph in her talk is, “We have plans to improve our education and training systems so you have the choice to determine where your kids go to college is affordable...and skills training is modernized.” When it comes to health care, “Republicans believe health care choices should be yours, not government. [emphasis added]”

    As far as how to get Americans those jobs, Republicans have “plans that focus on jobs first, without more spending, government bailouts, and red tape.… We have solutions to help you take home more of your pay – through lower taxes, cheaper energy costs, and affordable health care.”

    The villain is unmistakable in her story: “Government that decides for you.”

    But while the president’s heroes are individual hard-working Americans, he makes it clear that we build the pathway to opportunity for all through collective action. The word “community” appears 13 times in Obama’s speech; not once in McMorris Rodgers. The president uses “us” referring to the nation, 17 times; McMorris Rodgers, four times.

    The substance of Obama’s policy solutions are replete with concerted actions, and the entire premise that we do something together, through our government, is the exact opposite of the Republican story of getting the government out of the way.

    The stories he tells unite the individual and the community. For example, a student who, “thanks to the support of great teachers and an innovative tutoring program, he led a march of his classmates – through a crowd of cheering parents and neighbors – from their high school to the post office, where they mailed off their college applications.”

    Summing it all up – the heroes, the quest, the role of individual and the community, Obama says, “It’s the spirit of citizenship, the recognition that through hard work and responsibility, we can pursue our individual dreams, but still come together as one American family to make sure the next generation can pursue its dreams as well.”

    The narratives in President Obama and McMorris Rodgers’ responses are more than just a minor part of the evening’s political theater. They speak to the fundamental ideological divide in the nation and frame the political choices before the country now and over the coming decade. In the starkest terms, it is a contrast between “you are on your own” and “we are all in this together.” We want to tell our story in those terms, for when we do, progressives absolutely win that debate.  

    Richard Kirsch is a Senior Fellow at the Roosevelt Institute, a Senior Adviser to USAction, and the author of Fighting for Our Health. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.


    Images via Thinkstock

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  • Republican Alternative to Obamacare: Pay More, Get Less, Put the Insurance Companies Back in Charge

    Jan 28, 2014Richard Kirsch

    Now that Republicans have put out an alternative to the Affordable Care Act, Democrats should emphasize what a repeal would really mean for Americans' health.

    Now that Republicans have put out an alternative to the Affordable Care Act, Democrats should emphasize what a repeal would really mean for Americans' health.

    Boy, can Democrats have fun with the new Republican alternative to Obamacare. It puts the health insurance companies back in charge and raises costs for almost all Americans. In particular, it substantially raises costs and threatens to cut coverage for the half of all Americans who get health insurance at work. Seniors, the group that Republicans have scared witless about Obamacare, would lose the real benefits they receive under Obamacare. The proposal from three Republican senators is a golden opportunity for Democrats to contrast the specific benefits of the Affordable Care Act (ACA) with what a repeal and replace agenda would really mean for Americans’ lives and health.

    When it comes to the politics of health care reform, my first adage is “the solution is the problem.” That is because once you get past vague generalities, like lowering cost and making coverage available, to proposing specifics, people will look to see how the proposals impact them personally. This is why health reform is such a political nightmare. Unlike most public policy issues, the impact is very understandable and real.

    With the ACA as the law of the land, in analyzing the Republican proposal we must compare its impact to the law it would repeal. The pre-ACA model of health insurance is irrelevant. Here is how the Republican plan would impact people, compared with the ACA:

    People who get health insurance at workbottom line: pay more for worse coverage.

    Almost half of all Americans (48 percent), or 148 million people, obtain health insurance at work. The Republican plan would tax 35 percent of the average cost of health insurance benefits at work. This is a big tax increase on working people and is extraordinarily unpopular, as the Obama campaign used to devastating impact on John McCain. And while people would pay more, they would get less coverage, as the GOP plan would allow insurance companies to once again limit the amount of benefits they will pay out in one year and return to the day when employers could offer bare-bones plans.

    While taxing health benefits would apply to all employer-provided coverage, the Republicans would give the 30 percent of people who work for businesses who employ fewer than 100 workers a tax credit. That might balance out the increased taxes for some people. However, doing so would create a huge set of economic distortions, as employers might seek to keep firm size under the 100-employee threshold.

    Individuals who buy coverage on their own or who are uninsured – bottom line: insurance companies could again deny coverage for pre-existing conditions and offer bare-bones coverage, while the cost of decent coverage would go up for most people.

    This is the group that the ACA is most aimed at helping, including the 5 percent of Americans who buy private health insurance and the 15 percent who are uninsured, totaling 64 million people. The ACA offers income-based subsidies to these people when they earn between 100 percent and 400 percent of the federal poverty level (FPL) and enrolls people under 133 percent of FPL in Medicaid, when states agree.

    The Republican plan is toughest, in comparison with the ACA, on the lowest income people and on the higher-income middle-class, compared with Obamacare. But many families in between will do worse too.

    The Republican plan would wipe out the expansion of Medicaid to people earning less than 133 percent of FPL, a provision the Supreme Court has made optional. It would cut back on Medicaid, ending the federal government’s offer to pay 90 percent of the cost of expanded coverage and replacing that with the federal government paying what it has paid historically, which is between half and three-quarters of the cost of Medicaid, with poorer states getting a bigger share. Crucially, the funding would only be for pregnant women, children and parents with dependent children who earn under the poverty level, as opposed to the ACAs funding of all adults up to 133% of FPL. That means many fewer people covered and states getting less Medicaid money. Republican governors may not complain, but you can bet hospitals will. Adults without dependent children would not be covered by federal Medicaid, which means millions will stay uninsured or lose coverage they now have, unless states pay for coverage without federal support.

    For individuals not covered by Medicaid or employees of firms with fewer than 100 workers, the Republican plan would replace the ACA’s sliding-scale subsidies, which now go to 400 percent of FPL, with a subsidy that is the same for everyone of the same age who is under 200 percent of FPL and lowersubsidies for people from 200 percent to 300 percent. In addition, the subsidies would be higher for older people than younger. The Republican plan also would take away the requirements that insurance plans offer decent benefits and free preventive care and charge women the same prices as men for coverage, along with every other consumer protection, with the exception of keeping in place no lifetime caps for covered benefits.

    Comparing the value of the Republican plan subsidies vs. the ACA subsidies for the people who would still qualify depends on income, age, and family size. Generally, it appears that the Republican subsidies are much less than the ACA for people under 150 percent of the FPL ($35,000 for a family of four) and much less than the ACA for younger people, but more for older people. However, insurance rates for younger people would go down some at the expense of older people, who insurance companies could charge a lot more than under ACA. And families with incomes above $70,000 for a family of four would lose subsidies entirely.

    Seniors and the disabled on Medicare – bottom line: seniors would pay more for prescription drugs and preventive care.

    By repealing the ACA, the Republican plan would take away its two concrete benefits for seniors. One is that preventive care services are now free under Medicare (as they are under all insurance). The other is that the ACA is lowering drug prices for seniors by slowly closing the “donut hole,” under which seniors must pay the full cost of prescription drugs even though they are paying premiums for drug coverage. In other words, the Republican plan is simply bad news for seniors, the constituency that they have scared the most about Obamacare groundlessly.


    It is not surprising that Republicans have been reluctant to come up with a replacement for Obamacare. It’s much easier to throw darts – or bombs – at the ACA than to come up with a replacement that meets Republican ideological tenants of less regulation and less government. Any plan that meets the ideological test will be much worse for people in ways they can understand. It is our job to explain it to the public clearly: pay more, get less, put the insurance companies back in charge. This debate is not simply the political game Republicans want to make it. It is about our health and our lives. 

    Richard Kirsch is a Senior Fellow at the Roosevelt Institute, a Senior Adviser to USAction, and the author of Fighting for Our Health. He was National Campaign Manager of Health Care for America Now during the legislative battle to pass reform.

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