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Repeal or "Fix"

The debate over Obamacare narrows.

10:35 AM, Oct 5, 2010 • By JEFFREY H. ANDERSON
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Existing insurance coverage and quality of care:  Famously and repeatedly, President Obama told Americans: “If you like your health-care plan, you can keep your health care plan.”  But the facts suggest otherwise. Shortly after passage, the New York Times reported that AT&T would be “evaluating prospective changes to the active and retiree health care benefits offered by the company,” and that other employers might well follow suit.  Documents provided by Verizon, according to the Times, said, “‘To avoid additional costs and regulations, employers may consider exiting the employer health market and send employees’ to state-run insurance exchanges, where people can buy insurance.”

In June, figures leaked from the Obama administration estimated that, under “mid-range” projections, 51 percent of employees would not be able to stay on their current health care plans.  Under the “best case” scenario, 39 percent would lose their plans; under “worst case” projections, 69 percent would lose them.  Among small-business employees, projections were even worse:  between 49 and 80 percent would lose their plans.

Last month, the American Council on Education wrote that Obamacare “could make it impossible for colleges and universities to continue to offer student health plans,” which currently provide coverage to more than 4.5 million students nationwide.

Meanwhile, Obamacare’s rather brazen Medicare cuts threaten Medicare coverage in general and Medicare Advantage coverage in particular. According to the CBO, in its real first decade, Obamacare would cut Medicare Advantage by more than $250 billion. That represents average cuts of about $25,000 for each of the 10 million Medicare Advantage enrollees. These cuts haven’t yet kicked in, but their impact is already being felt. Last week, the Boston Globe reported that Harvard Pilgrim Health Care “will drop its Medicare Advantage health insurance program at the end of the year, forcing 22,000 senior citizens in Massachusetts, New Hampshire, and Maine to seek alternative supplemental coverage.”  As a senior executive for the company observed, “We became concerned by the long-term viability of Medicare Advantage programs in general.... We know that cuts in Medicare are being used to fund national health care reform.”

But Medicare Advantage plans aren’t the only Medicare benefits that Obamacare threatens. The Medicare chief actuary projects that, by the end of the decade, Obamacare’s cuts in Medicare hospital reimbursement rates (inaccurately called "productivity adjustments") will cause them to fall below even Medicaid reimbursement rates. The chief actuary writes, “roughly 20 percent of Part A [hospital] providers would become unprofitable within the 10-year projection period as a result of the productivity adjustments” and therefore “might end their participation in the [Medicare] program.”

The Real Choice

The general sense of American citizens echoes the official government projections that Obamacare would increase federal spending and taxes, increase health costs, and jeopardize existing health coverage.  In a recent Associated Press health care survey, conducted by Stanford University and the Robert Wood Johnson Foundation, respondents — by a tally of 67 to 10 percent — said that five years from now, Obamacare would require them to pay higher, rather than lower, taxes.  By a tally of 60 to 11 percent, they said that Obamacare would raise, rather than lower, their health costs. By a tally of 67 to 8 percent, they said they are currently receiving “good” or “excellent,” rather than “poor” or “very poor,” health care — and by a tally of 65 to 7 percent, they said they have “good” or “excellent,” not “poor” or “very poor,” health insurance.  But respondents reluctantly expect both their own health care and other people’s health care to get worse, rather than better, under Obamacare.

Such results are all the more compelling because likely voters have consistently opposed Obamacare more vehemently than Americans as a whole, yet the AP survey didn’t even screen for registered voters, let alone likely ones. Furthermore, only 25 percent of the survey’s respondents were Republicans, compared to 37 percent Democrats.  That 2-to-3 ratio won’t remotely reflect the actual turnout in November.

The real choice, however, that voters face in November is not truly between repealing and fixing Obamacare. It’s between repealing and expanding ObamaCare.  As Yuval Levin has written in these pages:

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