brandice romancer: #ACA: Five Health Insurance Talking Points ? The Crawdad Hole

Cross-posted from P&L.

Let me get right to the point: We need to start developing some talking points on The Affordable Care Act (ACA). I say this because in the wake of the Supreme Court ruling, I have encountered a proliferation of Obama supporters talking up the good sides of the health care bill (extended child benefit and the elimination of pre-existing conditions among them). In addition, political operatives are busy making the progressive equivalent of the ?welfare queen? talking point by calling people without health insurance ?freeloaders.?

These argument will make inroads if they are not met with clear, consistent opposition. We can?t afford to let them persuade people who already have insurance (the vast majority of Americans) that this will benefit everyone. It won?t. It will hurt everyone, one way or another, whether it?s the loss of employer-provided health care, the loss of health care freedoms, or difficulty transitioning upward in terms of class. In addition to highlighting these points, we need to make arguments about what?s good about the bill, and how these features can be kept while eliminating the mandate. Don?t underestimate the power of the Rogerian argument.

I?m not talking about the kind of talking points that you can find on Twitter, or that are coming from conservatives. Bless their allied hearts, but the rhetoric tends to be a bit?shrill. This is a job particularly suited to political independents like us. Once we nail these talking points, we can deploy them to persuade anyone up for grabs, or anyone who has doubts about the effectiveness of the structure of the bill. We might even be able to help some conservatives understand the need for making such clear points, instead of relying on linguistic shorthand like ObamaTax. Our clear-headed thinking could naturally resonate in the national conversation, but only if we take the risk and start talking to people, and are willing to confront true believers when we encounter them, especially if there is a larger audience around.

With this in mind, I?ve articulated five talking points you can use to inform people about the consequences of allowing the full bill to go into effect.

Talking point #1: Keeping your kids on your health insurance plan until they are 26 is a great idea.

Start with this Rogerian argument, which is disarming, about the talking point on the most popular part of the bill.? Keeping your kids on your health insurance in this economy if you can afford it is a great idea. The talking point is simple, and one the insurers themselves made when everybody and Obama thought the Supreme Court would overturn it: insurance companies will keep this feature no matter what happens to the bill. Why? Because it vastly increases the pool of potential clients with the means to pay for it. Young people can?t normally afford insurance, and they have little incentive to buy it even if they could. That issue is partially resolved by this change. Coverage for children up to 26 years of age is not going away, even with full repeal. In fact, that age might even be increased eventually. It?s a matter of health insurance policy, not federal law.

It?s also fair to point that a lot of young people don?t have parents who can afford to keep them on their insurance plan, and plenty of parents can?t afford their own plans themselves, so ask, what happens to them?

Talking point #2: Employer-provided insurance is going away.

It?s built into the bill. According to this Kaiser flowchart, the tax penalty for businesses with 50 or more employees, but less than 200 employees, is between $2,000 and $3,000 per year, per employee, minus 30. Considering that the median cost of providing an employee health insurance? is $10,000 a year to the employer (not counting employees? obligations, which is another $4,000), the math suggests that employers will save significant money if they just drop health insurance for all employees. The penalty increase, by the way, is a percentage indexed to the rise in insurance premiums, thus will never approach, let alone exceed the cost of the premium itself. The government?s own pamphlet (PDF) on penalties for employers does not mention any penalty at all for dropping health insurance altogether for businesses that employ more than 200 full-time workers.

So, to recap, if you?re employed by a small employer with less than 50 employees, you?re on your own. If you?re employed by a small employer with 50-200 employees, your employer will always save money by canceling your insurance. If you work for a big company with more than 200 employees, there appears to be no penalty for them dropping health insurance altogether. Don?t forget to point out that employers are unlikely to make up the gap in compensation with an increase in pay. Many people already distrust their employer, and this talking point will make sense to them as a result.

Talking point #3: You might keep your plan, but you won?t keep your choice.

This might seem the most difficult talking point to make, because this part of the bill has not gone into effect. But it?s actually pretty easy. All you need to know are the relevant portions of the bill, which are?Section 1311 (h)(1) subsection (B). This is the part of the law that requires all Americans to purchase ?qualified plans.? Choice goes away automatically with this piece, because sensible plans like catastrophic plans are banned. Furthermore, subsection (B) states:

[A qualified health plan may contract with] (B) a health care provider only if such provider implements such mechanisms to improve health care quality as the Secretary may by regulation require.

Bolding mine. So it will soon be the case that a qualified health insurance plan (which is now mandated for all Americans) may only contract, thus pay, a physician that accepts the regulations that the Health & Human Services department is now drafting for the quality of care of patients. No more deciding between this and that treatment unless you are willing to pay direct medical expenses to a doctor who does not accept any kind of insurance, and you?re willing to pay the tax penalty for noncompliance.? Your health care choices are thus curbed or eliminated, or your wallet takes a bigger hit, your choice. About 10% of Americans have enough economic security to make this choice, ftr. Did I mention those regulations are already up to 13,000 pages and they?re not done yet?

If your targets have additional questions about this argument, point them to this link and this one.

Talking #4: This bill makes upward mobility harder, especially for the working poor and working class.

Start by asking your target(s) if the idea of economic inequality resonates with them. Occupy Wall Street may be a whole lot of failure, but this idea did resonate in the national conversation, because the imbalance is more pronounced than at any point in living memory. If it does, proceed with this argument.

The working poor and working class already have far too many demands made on them by society as a whole, especially now with the economy as it is. Food and gas prices have risen dramatically, placing a greater burden on their meager wages. Even if they don?t have a tax burden when they file returns, they pay sales tax on everything they buy except for food. If they work, they need transportation. If they have kids, they have additional burdens. A telephone is not a luxury with crime rates what they are, especially in low income neighborhoods. They simply can?t afford a greater burden in the form of a thousands of dollars increase in what they?re paying out per year.

But even if they qualify for the tax credit, or are forced onto Medicaid (currently estimated at 18,000,000 people), which is unfair in and of itself, they will face the welfare paradox. For starters, the tax credit for health insurance will likely eliminate or replace their Earned Income Tax Credit, which the working poor and working class rely on to supplement their annual budgets. The poor themselves, working or not, will no longer be able to transition gradually up the class scale. They will need to jump from no pay or maintaining a low level of pay that allows them access to benefits (currently 133% of the appallingly low poverty line for Medicaid once the bill goes into full effect), or they must leap into the middle class in order to afford all the demands placed on their budgets while maintaining their current standard of living. The welfare paradox is already the largest contributing factor to inter-generational poverty, and the ACA exacerbates this problem. This hardly seems fair, and seems destined to increase economic inequality, not resolve it.

Talking point #5: What do you mean by freeloader?

We?ll end with the ?freeloader? talking points. It?s offensive on its face. The people who don?t have insurance today are largely without due to the fact that they can?t afford the overpriced product called health insurance. The people who can afford it, but won?t buy it are a tiny fraction, but they are the one?s this ?freeloader? talking point is designed to identify, then muddy the waters so that even people who can?t afford it are all lumped together with them. Even among those who can afford it, but don?t choose it, a coherent argument about cost effectiveness is in order. It makes no sense to pay thousands of dollars per year for coverage when out of pocket direct medical expenses per year may only average a few hundred dollars.

You can also flip the argument, though beware that the flip is equally offensive on its face, which is why I?ve saved it for last. You do risk alienating certain audiences with this talking point, so use it carefully. But if you think about it, the real freeloaders are those with pre-existing or expensive medical conditions as a result of their lifestyle choices. Divide that group of insurance clients with pre-existing conditions between those who ended where they are by what they did, and those born with conditions they had no hand in making. It?s shrewd, it?s calculating, but it?s also very real and potentially effective. Why should the young and healthy have to pay for the fact that someone else chose to smoke for 50 years, or ate fried foods and Twinkies until they wound up with diabetes, or contracted cervical cancer after a diagnosis of? HPV, a sexually transmitted disease. If you?ve taken good care of yourself, why is this your responsibility? Why are we all forced to pay for the healthcare of smokers, drinkers, drug addicts, food junkies, and the sexually promiscuous? Dare to ask these questions.

Audience

You may be wondering, who can be persuaded by these talking points? Who should I target? You?ll have to pick and choose among these diverse talking points based on your audience, but here are some suggestions. Your first audience should be the employed with access to health insurance. These are the people most likely to accept the bill without giving it much thought. People often assume the world they live in is reality, when in reality, there are about 8 different realities in America, depending on where you fall on the class scale. Also, target the young. They are the ones who will pay the highest price for this bill ultimately. Join the conversation wherever you see an Obama supporter disseminating information on the ACA. You aren?t targeting the Obama supporter, just the supporter?s audience. It?s okay to piss off the supporter, and the more you do, they more they are likely to mess up their talking points. Avoid getting angry yourself, however, as you are at the same risk.

Finally, talk to your working class friends or those you encounter, because the structure of this bill suggests their class is being targeted for elimination. If it goes into effect, we might not have much of a working class anymore as people are forced onto the welfare rolls. Working class people dread being forced into welfare; I can testify to this first hand. Some of them on the lower end of the spectrum only work because they know how awful welfare is, and how it changes how you are treated by the people you encounter in your daily life. These folks would likely have an easier time if they didn?t work, but they?d feel bad about themselves all the time and be treated with less respect than they are now, and they are already disrespected a lot by people of means who make unwarranted assumptions. Just ask Barbara Ehrenreich, who wrote Nickled and Dimed: On (Not) Getting by in America.

Note: Apologies for the length. It was necessary, and thank you if you?ve read this far.