On KQED Public Radio’s The California Report Magazine on Friday, Scott Shafer talked with Marian Mulkey, the director of the Health Reform and Public Programs Initiative at the California HealthCare Foundation, a health-policy think tank (and a funder of the show).
SCOTT SHAFER: First of all, the Affordable Care Act has gradually been getting phased in nationwide. Give us a sense of what’s been happening up to now, right here in California.
MARIAN MULKEY, CALIFORNIA HEALTHCARE FOUNDATION: California has implemented many of the early provisions of the Affordable Care Act, making some new extensions of coverage available, for example, to young adults, assuring that pre-existing conditions are covered for children, and implementing many of the early programs — one for people with pre-existing conditions is in place and covering people already.
California has taken steps in terms of planning and establishing a state-based exchange, which is the marketplace by which people will be able to view their choices, identify what’s available for them and access federal subsidy support for buying coverage.
SHAFER: And it’s fair to say California has been further out in front on that than pretty much any other state?
MULKEY: Yes, California was early in determining it wanted to have a state-based exchange and moved quickly, immediately after the passage of the law in 2010 to start one up and to make some initial decisions. Continue reading →
Rep. Dan Lungren and Dr. Ari Bera are campaigning to represent the newly drawn 7th Congressional district in northern California. (Photos: Republican Conference and Randy Bayne via Flickr)
When Republican Rep. Dan Lungren faced a crowd of Tea Party supporters and Democratic detractors at a recent town hall meeting in the town of Carmichael, outside Sacramento, the arguments showed how explosive the Medicare debate can get in the hottest races in the country.
At La Sierra Community Center, the long line of seemingly irritated constituents made clear just what is on the minds of voters here: the Republican proposal to give future beneficiaries, those currently 55 and younger, a fixed amount of money to buy Medicare coverage from the government or private insurance companies.
Standing at a podium in the auditorium, Margie Metzler, a 67-year-old woman with the group Seniors Against Lungren, told Lungren that she had been laid off at age 61 and went four years without health insurance until she qualified for Medicare. “I don’t want to kick the people under 55 under the bus,” Metzler said of Rep. Paul Ryan’s Medicare plan.
“Lungren and Bera are very effective stand-ins for the two sides of the national (Medicare) debate.”
A few moments later, another woman took to the microphone with this reprimand: “All you protesters can think about is where your next government entitlement is going to come from. Rome is burning and you’re all acting like children.”
And those were the polite exchanges.
Eastern Sacramento is where the two Californias come together — where the liberal, urban coast meets the conservative exurbs and rural farmland. Lungren has had a safe seat in Congress in large part due to the district’s Republican majority. Continue reading →
Pew Research Center President Andrew Kohut, a veteran pollster, shared some insight, based on his public opinion surveys, in a wide-ranging conversation this week with PBS NewsHour’s Jim Lehrer:
“Instrumental to the dislike of this program is the mandate,” said Kohut, referring to polling last month that showed that Americans are divided on the Obama-backed health reform law but that a majority disapprove of the “individual mandate,” that requires individuals to purchase health insurance coverage or face a penalty. “What has been overwhelming is the reaction to the mandate in particular and the concern about the role of government.”
The role of government… in health care and so many other aspects of American life… has become a central point of debate this election year.
Take a look at this graph from the Gallup poll: A decade ago, roughly 6 in 10 people believed the federal government had a responsibility to make sure all Americans have health care coverage. Now just 5 in 10 think so.
Gallup health care survey 2000-2012
Yet, the government’s role in ensuring health care coverage under the Affordable Care Act is a much smaller one than in other proposals Americans have debated in recent years.
Remember the “public option”…? That was the proposal for a government-run insurance plan to compete with private insurers as part of the health care overhaul. It was widely popular, according to a New York Times poll in 2009.
The national telephone survey, which was conducted from June 12 to 16, found that 72 percent of those questioned supported a government-administered insurance plan — something like Medicare for those under 65 — that would compete for customers with private insurers. Twenty percent said they were opposed.
But it didn’t pass muster in Congress and didn’t end up in the final version of the law.
Looking back a little further, Ezra Klein, writing in the New Yorker, reminds us that the “individual mandate” that conservatives now consider a government intrusion, actually began its life as a conservative idea.
The mandate made its political début in a 1989 Heritage Foundation brief titled “Assuring Affordable Health Care for All Americans,” as a counterpoint to the single-payer system and the employer mandate, which were favored in Democratic circles.
Here’s a link to that brief, by Stuart M. Butler with the conservative Heritage Foundation, which formed the basis for a Republican alternative to President Clinton’s plan for health care reform in the early 1990s.
A spokesman for Representative Rick Berg, Republican of North Dakota who is seeking a Senate seat, told a reporter in his state that Mr. Berg wants to replace Mr. Obama’s health care law with one that does not deny insurance coverage to people with pre-existing conditions and closes the “doughnut hole” — a gap in pharmaceutical coverage — for people on Medicare. Those are two of the most popular provisions of the law Mr. Berg would repeal, which would be difficult to replicate without the regulatory mandates and tax increases he has vowed to reverse.
So what IS in the law? For an easy overview, check out this animated video from the Kaiser Family Foundation. It was produced before the Supreme Court’s ruling (and has been viewed more than 400,000 times) but most of it still holds true:
And then let us know what you think: What IS the role of government in terms of health care?