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The Politics of ‘Obamacare’

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Apparently, the Patient Protection and Affordable Care Act can ruin a good breakfast.
Specifically, this year’s Farm Bureau Country Ham Breakfast at the Kentucky State Fair. Democratic Gov. Steve Beshear used part of his time at the podium to defend the legislation and his decision to move forward with the creation of the Kentucky Health Exchange (video here: http://goo.gl/8dq0TM).
That included criticizing other officials who have worked against those efforts.
“It’s time for our leaders … all of our leaders on the local, state and federal levels … to put aside their time-worn political posturing and start working for the good of the people,” Beshear told the crowd.
A few of those officials, Senators Mitch McConnell and Rand Paul, were also at the breakfast. McConnell responded to Beshear’s comments (video here: http://goo.gl/IKS0uK).
“Governor, the solution to Obamacare is to pull it out root and branch,” McConnell said.
Meanwhile, McConnell’s primary opponent, Matt Bevin, doesn’t think the incumbent senator has gone far enough. Bevin has pledged to defund Obamacare, even if it means shutting down the government. McConnell favors defunding the law, but he has not endorsed a possible shutdown.
Amid the back-and-forth between politicians, the Kentucky Health Exchange (kynect.ky.gov) is scheduled to go live Oct. 1. The exchange is the next step toward full implementation of the Affordable Care Act, yet it’s difficult to find any mention of the law on the website.

Agree on problems, not the solution
Sen. Paul, a critic of the Affordable Care Act, does see areas of agreement among Republicans, Democrats and independents. Insurance costs too much and "a significant chuck of people," about 15 percent of the population, do not have insurance, according to Paul.
"The actual problems I think we kind of agree on," he said. "We just don't agree so much on the solution."
In Paul's view, the Affordable Care Act will lead to higher health care costs. By requiring insurance companies to cover specific services, premiums will rise.
He added that it remains to be seen if more people will be insured as a result of the ACA.
"If you work 34 hours per week in a fast food restaurant, your employer won't have to provide insurance if he knocks you down to 29 hours per week," Paul said. "You say that's horrible that an employer would contemplate that. Well, the employer looks at costs and they have competitors and they are trying to sell something cheaper than their competitors. So, they are always driven by expenses."
Paul is also concerned that individual insurance policies will be too expensive for many people to afford. As an alternative, he would prefer to see more competition in the health care industry.
He gave two examples of how competition has affected his own practice as an ophthalmologist. He said LASIK surgery started at more than $2,000 per eye, but now costs less than $500 per eye in many cases. He also sells contact lenses within pennies of the prices offered through Wal-mart.
"People would go there if I didn't offer a similar price," Paul said. "Competition does work for things in health care. We just have to figure out how to get competition involved to drive prices down."
He said one way to do that is through health savings accounts (HSA), private accounts where people can set aside money to pay for health care expenses.
Paul added that he doesn't think many people realize how much money they can save by purchasing insurance with a higher deductible. A 22-year-old fresh out of college could save money by having a $5,000 deductible. That person has a low risk of getting sick, but he would recommend purchasing a catastrophic policy to cover major issues (like cancer). By doing this, that person would have lower monthly premiums, and he or she could set aside money in an HSA and gradually put more and more money aside to meet those higher deductibles, if needed.
He also thinks paying cash would change how people approach their health care needs.
"Now, no one asks the price of anything unless you have a high deductible or unless you have no insurance ... when the consumer doesn't care about the price, the price rises without any kind of consistent control," Paul said.
He added that as much as people might think charity is old fashioned, he knows it can help people. He said he's been involved with a charity performing free eye surgeries for decades, and he knows many physicians who have provided care for free to people in need.
If possible, Paul would like to defund Obamacare, although he said he opposes shutting down the government to do so. He also said he thinks it’s a long shot to happen. If the House approved a budget without ACA funding and the Senate included funding in its budget bill, that might lead to a compromise to prevent or delay implementation of at least some of the health care law.
If implementation can be delayed for a year, Paul sees the next election as a way to gauge how the public feels about the Affordable Care Act.
"I think 2014's going to show that the country really is not that excited about Obamacare and really would like to go back in the other direction," Paul said.
Congressman Ed Whitfield, R-Kentucky, said he believes part of the animosity toward the Affordable Care Act came from how it was passed. At that time, the Democrats controlled the House, the Senate and the White House, and then-Speaker of the House Nancy Pelosi would not allow any amendments to the bill.
"There were very strong feelings about that kind of approach, especially from a President who talked about transparency and working with the other side," Whitfield said.
Another issue is that many people still don’t understand how the law will affect them, Whitfield said.
"This was such a gigantic change, dramatic change, that it's created confusion. There's already thousands of pages of regulations," Whitfield said.
He also argued that the Affordable Care Act will increase taxes by $1 trillion and reduce funding for Medicare by $500 billion. He said the law is also affecting the economy.
According to Whitfield, 72 percent of new jobs created nationally since January have been part-time jobs. He said that is partly because of an ACA requirement that businesses with 50 or more full-time employees must provide health insurance or pay a penalty.
"It's really created a major obstacle to economic growth," Whitfield said.

'Big plus for us'
In spite of the opposition to the Affordable Care Act among nearly all of Kentucky's Congressional delegation, Gov. Beshear has been a vocal advocate for the program within the state. He could not be reached for an interview. However, his office provided information about the issue, and Beshear has spoken about the effects of the Affordable Care Act in multiple videos posted to his official YouTube account (available here: http://goo.gl/10BGh1).
Beshear repeatedly has defended his decision to create the Kentucky Health Exchange, an online marketplace where Kentuckians can apply for Medicaid or purchase private insurance. The exchange is scheduled to open for enrollment Oct. 1, and Beshear argues that will allow more than 640,000 people to have insurance.
“In the single most important decision in our lifetime for the long-term health of Kentuckians, I recently announced Kentucky will include 308,000 more Kentuckians in the federal Medicaid health insurance program,” Beshear said in a May 10 video commentary (here: http://goo.gl/WbtijX).
In a May 9 video (available here http://goo.gl/IVKhCN), Beshear said more than $10 billion will come from the federal government to cover the cost of this expansion, while the state will need to put up around $473 million in matching funds over the next eight years.
The state will receive a net benefit of more than $800 million over that time as a result of the influx of federal funds, according to Beshear.
Beshear made many of the same points in his May 10 video commentary that he made at the Farm Bureau breakfast at the state fair. He said Medicaid expansion and the Kentucky Health Exchange will provide an opportunity for thousands of Kentucky families to acquire insurance coverage. That in turn, will improve the overall health of the state's residents, and the Medicaid expansion will create an estimated 17,000 jobs statewide, he added.
Beshear also pointed out that Kentucky ranks 44th in overall health nationally, and he said the state is "right at the bottom" in terms of heart disease and cancer. Likewise, Kentucky has some of the worst rates of colon cancer, diabetes, and obesity in the United States.
Beshear has argued that improving health care access will improve the health of the state's citizens, and that will improve the economy.
"Missing less days at work, being able to miss less days at school, you know, all of that is an intangible, obviously, and we didn't attempt to assign a number to it," Beshear said in his May 9 video. "But it's going to be a big plus for us."