The Fix is In

Essential to making the Affordable Care Act affordable is that a significant percentage of those in need of coverage subscribe to the plans offered through the Act's insurance exchanges. By including in large numbers healthy people who will rarely if ever seek medical care beyond a routine check up with people, either because of pre-existing conditions or simply because they become ill and therefore in need of more frequent and costly care the cost will average out in such a way as to allow the exchanges to provide coverage at rates significantly below private coverage. The costs attendant to providing care should also be driven down through a variety of strategies (electronic medical record keeping and ACOs, for example) but at its core it is through this basic strategy that the true affordability of medical insurance coverage becomes possible. 

It is, however, that very simple concept that makes the strategy most vulnerable to failure and it is to that basic concept that Republicans, and in particular, the extremists in the party and their benefactors have directed their strategy. Through a multi-pronged campaign that intentionally lies about the Act...that it will kill jobs, drive up taxes, take life and death decisions away from the individual and hand it to the State, strip hard working Americans of their preferred insurance coverage...the goal has been to so frighten potential enrollees so that they won't enroll. If they are successful, the enrollment numbers will be too low for the Act to realize its potential benefits giving the Tea Party evidence that their predictions were correct and the Act an abject failure that needs to be repealed. That the Act failed  because it was intentionally sabotaged by the very people who will so gleefully take credit for their having been so correct in their predictions will, of course, be lost in the discourse that will ensue. 

To this point the strategy would seem to be working to perfection. With the exception of Kentucky no southern state has created exchanges leaving it to the Federal government to take responsibility for creating and operating the exchanges. Faced with such a well-funded campaign of lies and deceit, the government's chances of success, at least at this point, would seem remote. Compounding the problem for vast populations of people with a genuine need for help is that these same states have refused to expand Medicaid to provide assistance to those who are trapped in a government subsidy nether world because they are at the upper income levels of what constitutes poverty and, by those states' statutes therefore not entitled to Medicaid (again because the States refused to expand Mediciaid to accommodate these people). 

It is a political game to be sure in which literally millions of people, many though not all, poor and minority, are being used as pawns by the extremist wing of the Republican Party to supposedly make a philosophical point. What that point is remains as elusive as does the way out of this mess. In the meantime people in desperate need of help go without.