In a last-ditch effort to stop Obamacare, Tea Party groups are trying to sabotage the healthcare law in a way that could leave young people without coverage and increase insurance premiums for everyone else. It assumes that the end of "repealing Obamacare" justifies the means of potentially years of worse health.
The gambit, as explained by Sarah Kliff of the Washington Post, is to convince young people to eschew the Affordable Care Act's health insurance exchanges and the subsidies they offer in order to destabilize the insurance risk pools. And now the leader of the effort is talking to Salon about the idea.
First, some background. The "plan," such as it is, works like this: Young people tend to be healthier and thus cheaper to insure, so they essentially subsidize the cost of older and sick people. If enough young people don't sign up, and the pool is mostly older and sick people, costs will skyrocket. A price "death spiral" is health policy experts' biggest fear with the law, but it's exactly what the conservative groups want to artificially induce, thus dooming the law.
To that end, conservatives are trying to rally young people to skip the healthcare exchange and pay the fine for violating the individual mandate to have health insurance. They're making their case with GIFs, Op-Eds and a campaign to burn Obamacare draft cards (which don't actually exist, but can be downloaded from FreedomWorks' website for later incineration). Americans for Prosperity is even considering setting up kiosks at Universal Fighting Championship matches and college football games to tell people not to enroll.
But, if this gambit is successful, wouldn't that lead to millions of young people living without health insurance, and older and sick people paying higher health insurance premiums? And since Obama will never repeal his signature law, we're talking about at least three years of intentionally inflicted misery, all for a shot at repealing Obamacare sometime in the future and replacing it with something that doesn't even exist yet. What about the human toll?
We asked Dean Clancy, the vice president of FreedomWorks who is spearheading the effort. "Yes, we would like to hasten the collapse of the exchanges, but the purpose is not to drive up anybody's insurance. The purpose is to get this law defunded or delayed so we can get to a patient-centered system," Clancy said in a telephone conversation Thursday evening. "Without young people, Obamacare can't work."
Regardless of intention, wouldn't it have the effect of driving up premiums? "I would not say it will drive up premiums for older Americans, I would say it will allow premiums to rise," he said. "It would allow premiums to rise faster than they otherwise would if everybody bought the overpriced coverage, including the younger, healthier people."
And what about young people who currently lack insurance -- 90 percent of whom will qualify for subsidies in the Obamacare exchanges -- what should they do? "You can get coverage outside the exchanges," Clancy said, pointing to catastrophic care plans, healthcare savings accounts, or even Medicaid.
Even without the subsidies, which are only available through the exchanges, Clancy said, it would still be cheaper for young people to pay the fine and go their own way. "We encourage people to go for a health savings account with a high deductible policy, and to pay cash for repeat medical expenses. It's a great way to save money and helps the system be more efficient," he said. Plus, there's always free-riding: "And they have to take you when you get sick, that'll be in the law now."
What if you get in a car accident or something and don't have time to sign up for insurance? A pause as he consulted with the communications director, who was also on the call. "In that case, you may incur some costs," Clancy acknowledged. "You may have to deal with, as people do today who don't have funds available, paying it back in installments, or uncompensated care, or you can sign up for Medicaid." In other words, you're on your own. Most uninsured people can't afford medical bills.
"Just to be clear, we're telling people: 'Do what you think is best for you,'" he added. "But understand that if Obamacare continues, you're going to have to pay more and more to get less and less."
For Judy Feder, a prominent health policy expert at Georgetown who supports the health reform law, this approach is "crazy." "It's not even killing the patient to save the patient -- it would stick with killing the patient. They just want to kill the law, which doesn't save anybody," she said.
It's hard to overstate how nihilistic this plan is. If the scheme succeeds -- which it will not, since more than enough young people are saying they'll purchase insurance through the exchange -- not only would some people lack good health coverage they'd otherwise be entitled to, but costs would be higher on everyone else. "It is as outrageous as you say it is," Feder confirmed.
This is basically the "Cloward–Piven strategy" Glenn Beck always rants about, but 1) applied to healthcare instead of the economy, and 2) real.