Both Republican Paul Gosar and Democrat Ann Kirkpatrick voted for a largely symbolic effort to delay federal penalties for people who don’t obtain health insurance under the terms of the federal Affordable Care Act.
The 264-161 vote would delay for another year the individual mandate scheduled to take effect next year. The administration has already delayed a requirement that businesses with more than 50 employees provide health insurance or pay a penalty, which is also a provision of the Affordable Care Act.
The vote represents the 39th time Republicans in Congress have voted overwhelmingly to repeal some crucial portion of the Affordable Care Act, often referred to as Obamacare. But this time, dozens of Democrats joined with all but one Republican in the House, including the Flagstaff-based Kirkpatrick, who represents Southern Gila County.
Nonetheless, observers predict that the measure will likely either be ignored by the Senate or vetoed by the president.
Gosar, who represents Northern Gila County, decried the federal reforms that will provide often-subsidized private health care for an estimated 32 million Americans as the worst law passed since Prohibition, the effort to ban alcohol that spawned the runaway growth of organized crime before its eventual repeal.
“I voted to delay implementation of Obamacare with the intention that in the next year we will scrap the worst law Congress has passed since Prohibition. This law represents the single largest peacetime tax increase on an already over-taxed American public. Obamacare destroys the relationship patients have with their doctors and puts bureaucrats in
the middle. The impact of this law has cost workers their jobs, raised policy premiums and limited health options. President Obama already admitted that his law was unworkable. Democrats have admitted it is a ‘train wreck’ — a phrase that insults train wrecks. Employers and labor unions agreed this law is misguided. As this train wreck plows full steam ahead toward the American people, I will make every effort to save my constituents from this disaster. Today’s vote is a part of that effort.”
The vote centered on a requirement that people pay a penalty amounting to about 2 or 3 percent of their income if they don’t obtain health insurance, either on their own, through an employer or through health exchanges set up by the state and federal governments. The insurance exchanges will allow people to shop for private health plans with regulated benefits and qualify for premium subsidies based on income. The exchanges would offer three or four levels of a plan with different bundles of benefits, monthly premiums and co-pays.
Private companies would run the health plans, but the rules would specify benefits at each level and require the plans to spend at least 80 percent of the money received on actually providing health care.
The program also would provide federal money to expand state-run Medicaid programs, which in Arizona would add about 300,000 to the AHCCCS rolls. Backers of the individual mandate argued that many people now gamble on not getting health insurance, knowing that they could rely on taxpayer-supported programs like AHCCCS to cover the bills after they’re medically bankrupted by a major health care crisis. The reforms would make everyone responsible for providing their own health care.
Backers estimate the reforms will provide coverage for about 80 percent of the uninsured, which estimates put at about 50 million nationwide — with Gila County suffering one of the highest rates of the uninsured in the nation.
Studies suggest that at least 45,000 Americans die prematurely each year for lack of medical insurance. Medical bills also cause an estimated 62 percent of bankruptcies in this country, a phenomenon virtually unheard of in places with universal health care like Canada.
The U.S. remains the only advanced industrialized country without universal health care, although we spend almost three times as much per person on health care as the other advanced industrialized countries, according to numerous studies.
Despite the far higher costs, the U.S. has fewer doctors per capita, a lower life expectancy, fewer hospital beds per capita and lower rates of child immunization and other measures of public health.
States like New York and California have already set up the required insurance exchange, which will allow people to shop for the different levels of allowed benefits from dozens of private insurance companies. People can also automatically apply for premium subsidies based on income.
In both those states, preliminary bids suggests the plans offered through the exchanges will actually cost less than equivalent private plans, despite the new requirements that the federally approved plans cover pre-existing conditions, have no lifetime cap on benefits and cover things like birth control and free annual checkups.
In New York, the plans on the exchange will be 50 percent cheaper than private plans not on the exchange, according to recently published estimates.
In California, plans listed on the exchange will range from 2 percent more expensive to 29 percent cheaper than comparable plans not on the exchange, recently released figures show.
The latest effort by the Republican majority in the House to scuttle the reforms stems from the Obama administration’s decision to delay the controversial employer mandate. The reform measure adopted in 2010 requires businesses with more than 50 workers to offer health insurance for any employee working more than 32 hours a week. The Obama administration recently decided to delay that requirement for a year, amid concerns that in a still-sluggish recovery, businesses would either lay off people to get below the 50-employee threshold or slash hours to force as many workers as possible below 32 hours a week.
Some estimates suggest that more than 90 percent of businesses with more than 50 workers currently provide some sort of insurance. Critics have insisted that many businesses will drop their plans or cut hours when the reforms take effect, although that means they would have to pay a penalty for not having a plan.
Moreover, several major unions that previously supported the reforms have now raised questions. The Teamsters and the United Food and Commercial workers and UNITE-HERE have harshly criticized the reforms just 90 days before the states have to set up their health exchanges. In part, the unions have cited concerns about layoffs and a big increase in part-time jobs to avoid the health care mandate. They’re also concerned that people with employer-provided health care won’t get the same subsidies as people who buy insurance through the exchanges, which effectively reduces the value of the union-negotiated health care benefits.
People with work-based insurance can still get subsidies if they’re paying more than 9.5 percent of their income in premiums or if the job-based plan covers less than 60 percent of the cost of the covered benefits.
The administration estimates that 26 million Americans can qualify for that tax-credit subsidy through the exchanges, which includes everyone with an income of up to 400 percent of the federal poverty level. The poverty level is about $11,000 for a single person and about $24,000 for a four-person household.
At the low end, the subsidy would cover almost the entire premium, dwindling until it goes away for a family of four with an income above $94,000. The subsidy system essential ensures people at the low end will spend no more than 2 percent of their income on premiums, rising to no more than 9.5 percent for families with incomes 350 percent of the poverty line.
The White House defended the reforms in the face of the latest House vote to delay the mandates, which drew 35 Democratic votes. President Obama pointed out that 8.5 million Americans received insurance rebate checks averaging $500 from insurance plans spending too much on administrative overhead, a savings to consumers of $3.4 billion under the terms of the law. Nonetheless, polls show voters remain skeptical about the value of the reform to them — and largely opposed to the individual mandates.