Sunday, July 13, 2014
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Some Obamacare opponents are starting to sound incoherent

Congress passed Obamacare almost three years ago. More than 30 attempts at repeal have failed. The Supreme Court has upheld its central provisions. And the presidential candidate who promised to rescind it on day one lost the election. Yet, Obamacare's opponents won't give up. And some of their statements are starting to verge on incoherence.

Some Obamacare opponents are starting to sound incoherent

Will they ever get over it? Congress passed Obamacare almost three years ago. More than 30 attempts at repeal have failed. The Supreme Court has upheld its central provisions. And the presidential candidate who promised to rescind it on day one lost the election.

Yet, Obamacare’s opponents won’t give up. And some of their statements are starting to verge on incoherence.

Two Republican senators introduced yet another bill to repeal part of the law this week. It would rescind the individual mandate, which requires that everyone maintain health insurance. That provision is central to the effective functioning of private markets for individual policies. Without it, people could game the system by waiting until they become ill before purchasing coverage, which would force companies to charge unaffordable rates.

In a statement introducing their proposal, Senators Orrin Hatch (R-Utah) and Lamar Alexander (R-Tenn.) called the mandate “an assault on constitutionally protected freedoms.”

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Have they heard about the separation of powers in American government? The arbiter of the constitutionality of legislation is the Supreme Court, and Court upheld the mandate last June.

There are many reasons for disliking the mandate. Even many Obamacare supporters think there are better ways to accomplish its goal. But it’s difficult to argue that it is unconstitutional after the Supreme Court has clearly spoken.

Even more bizarre is a recent statement by Mississippi Governor Phil Bryant, a Republican and staunch Obamacare opponent. In an interview with Kaiser Health News, he declared, “There is no one who doesn’t have health care in America. No one.”

His basis for this assertion? “Now, they may end up going to the emergency room.” Other Obamacare opponents have echoed his claim. Mitt Romney offered a similar opinion during the last presidential campaign.

Gov. Bryant and the others are referring to the Emergency Medical Treatment and Active Labor Act (EMTALA), a law passed by Congress in 1986 that offers limited protection to indigent patients. It requires hospitals to stabilize those who come to their emergency rooms before asking about payment. This guarantees all patients access to emergency stabilization but nothing more. Once a patient is stabilized, hospitals can, and often do, require proof of insurance coverage before they will do anything else.

Contrary to Gov. Bryant’s assertion, EMTALA does not provide the 48.6 million uninsured Americans with general access to health care. A few of them receive care in public clinics, but most end up going without it. Numerous studies have shown that they are more likely to become sick and to die than those who have coverage.

My guess is that Senators Hatch and Alexander and Governor Bryant know much of this. Their statements mostly amount to political posturing to fan the remaining flames of Obamacare opposition. However, they could do so with arguments that have more coherence.

The structure of Obamacare leaves much room for reasoned debate over the best way to extend health insurance coverage to all Americans. In avoiding serious discourse, these opponents imply that they have nothing meaningful to say. The posturing against Obamacare that they and others have engaged in has achieved little in actually blocking the law. Perhaps it is time for them to offer constructive ideas on ways to improve health reform rather than a flow of statements that make little sense.

About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on and in the Inquirer's Sunday Health Section.

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Robert Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
Krystyna Dereszowska A third-year law student concentrating in health at Drexel
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