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ACA is worth debating

trahant MARK


Newsflash: Republicans hate the Affordable Care Act. Of course they can’t even call it that; it’s only “Obamacare.” A word that’s pronounced with a sneer, derision and contempt.

Ok. That’s not news. The message about how evil the Affordable Care Act was branded around the fiftieth time that House Republicans voted for repeal.

But how does it stand as an election issue? Should candidates run on the merits of the Affordable Care Act?

If the question is asked and answered as a political one, then probably not. The law is still not all that popular.

A poll released this week by the Kaiser Family Foundation reflects that unpopularity. “Registered voters are more likely to have an unfavorable view of the ACA than a favorable one (49 percent versus 35 percent),” Kaiser reports. “Opinion tilts even more negative among likely voters1 (51 percent versus 35 percent).”

But the health care law is also not as a big deal with voters as it was a few months ago. “Asked to name in their own words the two most important issues in deciding their vote for Congress, the most frequently-mentioned issue is the economy and jobs (21 percent),” according to Kaiser. “Thirteen percent of voters name health care as a top issue, including just 3 percent who specifically mention the Affordable Care Act. Those who view the law favorably are about equally likely to mention health care as a top issue in their vote as are those with an unfavorable view (12 percent versus 15 percent).

I would suspect that Indian Country is no exception to this polling. Most of the people I have talked to are not keen on the paperwork associated with the Affordable Care Act and don’t like the idea that insurance will be a major funding source for the Indian health system.

That’s an notion that makes sense — unless you consider the alternative. The alternative is nothing. There is no plan from those advocating repeal to improve funding for the Indian health system. (One funding test for Indian health will come from the House Continuing Resolution budget, a short-term spending bill, and those details are expected shortly.)

There are important questions that should be asked of every candidate: If you support repeal, then what happens to the funding mechanisms for Indian health? How will that money be replaced in this austere climate? I have asked many Republicans running for office across the country and I have yet to hear one single satisfactory answer.

Earlier this week House Republicans started talking about another way to address the Affordable Care Act. NBC News reported that one option is to repeal a portion the the law, such as the provision for insurance subsidies when companies pay more medical claims than expected. “Republicans have dubbed that part of the law – called “risk corridors” – a “taxpayer bailout” of the insurance companies if Obamacare fails,” NBC News said.

But the problem with that idea is that it costs money. The Congressional Budget Office estimates that risk corridors save the government some $8 billion through 2017.

When you look at the big picture that’s the biggest problem with repealing the Affordable Care Act: Every action has a consequence. And most of those consequences cost money.

Ah, details, details. But Kaiser had an interesting finding about that, too. Roughly half of all voters say “they are tired of hearing candidates talk about the law and would rather they focus on other issues, while a similar share (47 percent) feel it’s important for candidates to continue the debate.”

That make sense given that the Affordable Care Act is the law of the land.

I still think the Affordable Care Act is worth debating in an election. We now know that nearly 7 million people are uninsured that should have qualified for Medicaid. The cost to the states that ejected the Medicaid expansion $423.6 billion, according to a study by the Urban Institute. In addition to that, “hospitals are also losing $167.8 billion in Medicaid revenue. Every comprehensive state-level fiscal analysis that we could find concluded that expansion helps state budgets, generating savings and revenues that exceed increased Medicaid costs.”

Indian Country reflects that same divide. Native Americans living in states without Medicaid expansion are short-changed. This is money that should be funding the Indian health system.

That’s a topic worthy of an election debate.

Mark Trahant holds the Atwood Chair at the University of Alaska Anchorage. He is an independent journalist and a member of The Shoshone-Bannock Tribes. For up-to-the-minute posts, download the free Trahant Reports app for your smart phone or tablet.

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