The horizon is not so far as we can see, but as far as we can imagine

The Individual Mandate and the Government Shutdown

Let’s get specific.  The House spending bill linked continued funding to a one year delay of the individual mandate—the requirement that everyone buy insurance.  This is not the same thing as delaying Obamacare, everyone who wanted a policy could still buy one.  While there are subsidies for buying insurance, for many of the working poor they don’t cover most of the cost, and the insurance they buy is very high deductible, meaning that they are forced to either pay a fine, or buy insurance that they can’t afford to use.

Straight up the individual mandate is a transfer of  money from the working poor and the young and healthy to insurance companies and older sicker individuals. It forces people who can’t afford an extra expense every month (and if you have never lived paycheck to paycheck you should shut your mouth, you have no idea what it’s like) to buy something they can’t afford: to choose between food or rent or insurance.

On the face of it, and leaving aside motives, I cannot see that the Republican bill was a bad thing.  Absent a real, robust public option and much stronger subsidies than exist, the individual mandate was always the most odious part of the ACA.  This is not to argue that Obamacare does not do some good, it will save some people’s lives and reduce other people’s suffering. But it does so explicitly by hurting some of the most vulnerable people in America: the price of your healthcare, if it’s helping you, is hurting other, vulnerable, people.

I note, also, that employers were given a delay on their mandate, but individuals: poor people, were not given an extension on theirs.

Let us speak, next, to the details of the shutdown: if you do not like that most of the NSA, say, is still operational, but food and airline safety inspectors are furloughed, that is a decision made by the executive. It exactly reflects Obama’s priorities, it is not a decision made by Republicans.  You can blame Republicans for the shutdown, you cannot blame them for the specifics of how it is carried out, that is entirely Obama’s decision.  Spying on Americans and killing brown people with drones is vastly important to Obama and always has been.  Making sure you don’t die of e-coli, apparently not so much.

The individual mandate, from every poll I can find, is the most unpopular part of the ACA, opposed by straight majorities of Americans and definitely opposed by the Republicans who elected the Representatives who voted to delay it.  This is not a case of Democracy not working, it is a case of Democracy working.  What one House does, another can undo, that is the essence of democratic change.


Destroying the Islamic Courts Union in Somalia Caused the Nairobi Mall Attack


(CORRECTED) If the Republican Bill were to Pass…


  1. par4


  2. someofparts

    That’s actually a reassuring way to look at it. If you read Kos this morning, this move is seen as a strategic ploy executed on behalf of disaster capitalist billionaires.

  3. RJ

    If I’m not mistaken, wasn’t it only the 3rd iteration of the House bill that proposed to delay the individual mandate? I think the prior two either tried to wholesale defund the program or delay the entire program for a year. It’s hard to tell exactly what was going on from the news.

  4. The Republicans may have chosen the individual mandate as an unpopular target after a string of other sorts of targeting, but their opposition is precisely grounded against the idea of the state being used to provide expanded access to health care of any kind, whatever tool they may use to express it.

  5. selise

    @RJ, you can see the house of representatives history of votes taken at

    no need to rely on “news” which may be inaccurate even when clear.

  6. pond

    The Affordable Care Act aka Obamacare was based on the Massachusetts health insurance law enacted under Governor Mitt Romney, based on Newt Gingrich’s proposals to counter the Clinton Administration’s efforts to enact single-payer universal health care. Like the Massachusetts law, Obamacare is not health care but is rather health insurance (though the law is such a dog’s porridge of details and fine print that few can understand the whole thing or how it works).

    With this in mind it would be instructive to look at Massachusetts and how its law worked out. On the whole, polls there indicate the citizens are happy with the law and glad they have it. But one survey looked at the law’s effects, and the results were troubling. Though the law achieved its stated aim of seeing to it that almost all residents had health insurance (about 94% if I recall aright), levels of actual health CARE were unchanged. This was due to the high deductibles. Poor Mass residents had “health insurance” but could not afford “health care.”

    Obamacare has provisions in it that aim to lower costs of services, but in the end, how much more health care can we have when so much of our money goes to insurance companies, their shareholders and executives, rather than to doctors, nurses, hospitals, and medicines?

  7. On a whim I want to and typed in fake details to see what kinds of insurance might be available.

    I lied and said I was single, 32, living in Berkeley CA, making $19,000 per year. In real life that would mean that I am probably living with roommates out of necessity, don’t have a car, have to eat quite humbly, etc.

    After subsidy, to name one example, I could be paying $38 / month to get:

    $500 medical deductible
    $50 brand drug deductible
    no prevantive care copay
    low cow pays down the line
    maximum annual out of pocket $2,250

    To me this looks like a pretty good deal and like one that wouldn’t break this $19K hypothetical guy.

    I’m not saying that proves Ian wrong but it might be interesting for others to take a look at the exchanges and see what they come up with.

  8. I also did a hypothetical 4-person household. Adults 32 and 33 plus two kids. $22,000 / year.

    In California, we’d get medi-Cal. No private plan has anything for us.

    If I change the income to $40K (which is still very low for a family that size in this area) — the same decent-looking insurance again but for $89/month after subsidy.

  9. Julien

    It’s a delicious irony that the text of the bill about preventing the shutdown(🙂 is no longer available, because the government is shutdown.

    But look, it doesn’t matter. Dysfunction breeds dysfunction. Or more precisely: Hyper-partisanship -> Shitty laws -> Hyper-partisanship -> Shitty laws. Lather, rinse, repeat, ad infinitum.

    Is ObamaCare a shit sandwich? You betcha! Does everyone know it? Yes, sir! Could it have been a million times better? Hell yeah! How many elected officials care about those facts? Not a goddamn soul.

    Each side sees itself as the Spartans at Thermopylae. Why are they at Thermopylae? It doesn’t matter anymore, what matters is the battle. Why are Republicans obsessed about taking down ObamaCare? Because Democrats pushed for it. Why are Democrats so intent on defending that shit sandwich? Because Republicans want to slice it to pieces.

    But it’s a mistake to think this has anything to do with ObamaCare. Any other item would have done, in a pinch. What matters is the blood and the fight. And being able to go back to your financial backers and tell them that victory is in sight, if only they give you a little bit more.

  10. Ian Welsh

    As long as the subsidies kick in you’re generally ok. It’s the people on the margin who get fucked. Working poor may not have been the best phrasing: upper lower class/lower middle class.

    40K – one 25 year old adult (aka. healthy), one dependent.

    Cost after aid: $185/month

    5K deductible for medical and drugs

    at least one free preventative care visit a year.

    $60 for other primary care visits – up to 3 a year

    $70 specialty care copay

    $120 “urgent care copay” (aka- when you’re actually sick)

    lab testing/x-rays – 30% (the next cheapest plan is $45 per, might be worth it for that alone)

    Emergency care co-pay (aka. hospital/outpatient surgery) 30%

    $19 drug copay (the best part of the plan, imo)

    $6,350 maximum out of pocket for one – $12,700 a year for family.

    I’m tired and I’ve been up since midnight, I’m not going to bother doing the math on this right now, though if someone gets stupid, I may bother. But I’m betting if you add up average food, housing, clothing, transportations and taxation costs for this little 2 person household, that $185 a month, aka: $2,232/year is actually a burden, and will make a big difference. In exchange you get insurance which always charges you to do anything except one free visit to the doctor a year. Are you getting 2K of value most years?

    It does provide some catastrophic health care protection, to be sure, and if you have regular high drug needs you’ll come out ahead. Few 25 year old single mothers (the most likely scenario) or fathers do, however.

    For amusement I put in the exact same details, 48K a year – the premium goes to $289 a month after a $9 subsidy. $3,486 a year for insurance that has those copays and deductibles? That’s catastrophic insurance, unless you get really sick, or use a lot of drugs, you are not going to get your money’s worth.

    What’s rent in 92110 Zip code for a mother and child? Add food and everything else, and I’ll lay long odds they’re tight, right up against the border.

    This is a subsidy, this household is subsidizing not just other people’s health care, but insurance company profits. Maybe you think that’s acceptable, me, not so sure, especially when there are so many better ways to do this (and don’t tell me Obama fought for those better ways, he never even tried.)

    I worked in insurance for years, it’s one of the few places I have formal accreditation (though in life, not medical, but the principles are the same.) The costs are too high on people who won’t have much in the way of events, and I’ll lay long odds they’re too low on people who will have events.

    Now that could be fine, if it was done properly through the taxation system without insurers skimming off money, in a context where young people weren’t completely screwed by housing, student loan costs and a shitty economy, but in this world it’s going to hurt a lot of people. It’s the wrong way to do this, profoundly the wrong way.

  11. selise

    @Julien, the text of the bill is still online. you just need to add the colon to the end of the url.

  12. c. takes my husband and I from a 6,000 plus dollar deductible to a 3,000 deductible and a tax benefit monthly cost from 480 per month to 140 per month. This is the same insurance provider we are currently using. We pay and through the nose to keep my husband cared for. We own a small business and the cost of health insurance has put us on edge for putting food on the table and keeping the business afloat. There have been ups and downs in business not planned for in the last 5 years but we’re still in business.

    I don’t disagree with the main argument above about why the shutdown is happening nor do I disagree with the overall statement that it’s not always to everyone’s benefit but here in Minnesota we’re sending in our paperwork to move to purchase our insurance through the exchange this week. It’s a very simple decision for us and will give us the ease needed in our budget to keep going.


  13. Chaz

    Kindly explain to a humble foreigner how this all differs from RomneyCare…

  14. John Puma

    The ACA (aka “Obamacare”) IS corporate welfare as the article suggests.

    In 2009, it should have been the spineless Dems who shut down the government until HR 676 was passed
    — Medicare for all.

  15. Chaz PERMALINK
    October 1, 2013
    Kindly explain to a humble foreigner how this all differs from RomneyCare…

    It doesn’t. It’s Obomneycare.

  16. S Brennan

    This article gives the sordid history of “Obamacare”. Izvestia of the empire state notes with glee that it’s a Republican idea meant to stop Hillary [circa 1993] from implementing reform of the US healthcare service. That’ right, it’s designed to prevent reform of the poorest performing* healthcare system on the face of the earth. “Obamacare” is meant to ossify the current system, anybody who says it will lead to further reform is a clueless tool.

    Any Republican that opposes “Obamacare”, or any Democrat that supports “Obamacare” is a filthy, lying, hypocrite….period.end.stop.

    In my country, the “left” preaches austerity and is afraid of progress, while “conservatives” support despoiling of national resources and promote welfare to those who want for nothing.

    *Cost/Benefit…47th in the world performance-wise and yet over 2 times more expensive [per capita] than the next most expensive system.

  17. Sandman

    If the Republican opposition to the ACA, to the point of shutting down the government and threatening the “full faith and credit” of the United States, such as it is, is inspired by genuine concern for how the individual mandate part of the Act impacts on those “at the margins,” they’ve yet to make that plain. Even with the assistance of a supine, courtier press.

  18. Z

    Ah, it’s all ka-bullshit anyway, part of the two party dance to fuck over poor, old people and decrease their ss. That’s where this is all headed. At first, I thought that the obamacare fight was just a sidelight to getting to cutting ss, but the more I think of it, it creates the perfect pinion point in our two-party seesaw system so that neither of the two corrupt parties will pay any price for fucking over the people with very unpopular ss cuts.

    obamacare is hated by republicans and much more favored by the democrats. If obama “has” to cut ss to save obamacare, the demozombies will blame the ss cuts on the republicans. And the republicans will turn around and sell it to their base as obama foisting obamacare on them and cutting ss to save it – and the republizombies will buy it. So, therefore there will be little change in the political landscape – the seesaw will stay intact – and our rulers will still have almost total control of our political system.

    This shutdown gives obama a chance to play his reasonable role too – the reasonable drone killer, the reasonable mass spyer, the reasonable civil liberties abuser, and now the reasonable ss benefit cutter. All while he purposely makes the shutdown as painful as possible on the american people. The lowlife has dragged this country from fiscal drama to fiscal drama to set the stage just right so that he can portray himself as being hero as he cuts poor, old people’s ss after he fellated wall street for 5 fucking years and made damn sure they grew their wealth and power after practically destroying our economy.

    It’s going to be hard to stomach watching this shit play out and the hyper-partisan fools falling for it. I hope it doesn’t play out the way I believe it will.


  19. Daniel De Groot

    Ian, I don’t think the polling really supports what you’re saying about the mandate. The polling on this has been all over the place.

    In 2009, I found a poll that put support for a mandate at 56%. That piece is also worth re-reading because during most of the pre-passage debate, the Republicans and Movement Conservativism made very little noise about the mandate. It was conspicuous in its absence from their ads and talking points.

    In 2012, in the run up to the Supreme Court decision, NBC/WSJ polled people whether they thought SCOTUS striking down just the mandate would help or hurt their families. Only 18% said striking down the mandate would help them, 25% said it would hurt them and 55% said not much difference.

    Finally there’s a variety of polling showing majorities in favour of just letting the law take effect and asking the Republicans to stop trying to block it. E.g. (NBC/WSJ):

    Really I don’t find the idea that because Republicans have the power to do this it becomes legitimate very convincing. Extreme measures should be reserved for extreme circumstances and it’s really hard to find a compelling policy argument about extreme harms Obamacare will cause. Some people will be hurt, I don’t question your math, but that isn’t why Republicans are doing this.

  20. Thomas Lord

    This anecdote doesn’t resolve any issues but is interesting and the coincidence is kind of funny.

    One of Ian’s scenarios was a younger single parent type, $40K. He figured the $185 he found for a Bronze plan was (a) not worth the money; (b) could hurt such a person’s budge badly.

    NPR this morning interviewed a youngish single parent w/ projected income (she’s a consultant) of around $40K!

    Before looking it up she said (paraphrase — numbers are roughly what I recall) “If there’s something around $90/$100 per month it’d be a good deal and I’d take it. If it’s $400/month I’d have to pick the penalty, instead.” NPR found her a bronze plan roughly in the middle at $225 or so. Frustratingly, they did not get the woman’s reaction to the actual quoted price!

    (When I looked in CA, at least, that $225 would get that household one of the Silver plans with relatively low deductibles, etc. And, of course, that $225 is pre-tax money so the take-home ding would be notably less.)

    Overall I agree w/Ian that the program likely has donut holes and it’s a bit rough that people who fall into them will be subject to the penalty.

  21. Sarah

    When doing the math and factoring in costs, remember this:
    You cannot get care if you cannot find a doctor.
    ACA will result in extremely “thin” networks. Simply put , doctors and hospitals will not accept patients on exchanges, much as fewer and fewer accept Medicare patients now. The ACA reimbursements are too low. So even if you can afford it, you may not be able to find an in network provider. And if you go out of network, in many places the out of pocket max no longer applies.
    So when you’re researching, look up your own drs or your nearby hospitals and see if they participate in exchange networks.
    Bet you’ll be surprised how few actually do.

Powered by WordPress & Theme by Anders Norén