Right-wing extremists face new moral conundrum

When Healthcare.gov actually starts working, GOP will have to choose between politics or their constituents' health

Published November 25, 2013 12:44PM (EST)

Rand Paul, Ted Cruz, Michele Bachmann                                          (Reuters/Jonathan Ernst/AP/J. Scott Applewhite/Reuters/Mary Calvert)
Rand Paul, Ted Cruz, Michele Bachmann (Reuters/Jonathan Ernst/AP/J. Scott Applewhite/Reuters/Mary Calvert)

The confluence of two pieces of news last week will place Republicans at a moral crossroads -- either by this weekend, or whenever Healthcare.gov can legitimately be described as a "working" website.

The first came from Jeffrey Zients -- the Obama administration point person in charge of fixing Healthcare.gov -- who told reporters on Friday that the site will be able to handle 50,000 users at a time and 800,000 users a day by the the end of next week. That's double the current capacity, and right in time for an expected surge in demand just before the end of the year.

The second came from the pro-reform group Families USA, which examined options available to 15 million people who are currently covered on the individual market (many of whose policies have been canceled and will lapse by the end of the year) under the Affordable Care Act.

According to Families USA, over 70 percent of those currently insured will either qualify for premium tax credits on state-based insurance exchanges, or become newly eligible for Medicaid coverage under the healthcare law.

"Nationally, 71 percent of people in the individual market under age 65 have incomes at or below 400 percent of poverty," according to Families USA. "Under the Affordable Care Act, these people are income-eligible for financial help to purchase an insurance plan, either through new premium tax credit subsidies or through expanded Medicaid."

Together that combines all of the ingredients any marketplace needs to be successful:

1) An appealing product.

2) A large population of motivated shoppers.

3) Affordable prices, either by design or by discount.

4). A fast-moving checkout counter.

This is particularly excellent news for the 5-or-so million people whose existing policies are about to lapse. Many of them weren't aware that the Affordable Care Act offered them comparable or better deals. But even if they were, they didn't have easy access to those deals if they lived in states with federally facilitated insurance exchanges. Healthcare.gov's failure left even the most informed consumers without reliable access to replacement coverage. If the site had been working, the Families USA study suggests most of the people currently facing the prospect of a coverage gap would have actually been able to purchase similar or preferable alternatives right away.

For the past couple of months, the Healthcare.gov failure allowed Republicans to ignore the moral imperative they face to direct these constituents toward new options. The cash registers aren't working, they could tell themselves, so what good would we be doing by directing people to the market anyhow. This was always dodgy logic, but it enjoyed a real sheen of plausibility. And that's why Republicans have spent most of November soliciting Obamacare horror stories, rather than trying to help the narrators.

A working site that can service nearly a million people a day destroys that excuse. Some conservative groups have been craven and reckless enough to actively discourage people from enrolling in Affordable Care Act coverage. Elected Republicans have generally used their influence more subtly, by drawing attention to the hassles and supposed dangers of using Healthcare.gov. Manipulation vs. direct appeal. They've also maligned an administrative solution President Obama devised that will allow carriers in some states to reissue canceled policies.

But the real fix for 70 percent (or so) of people whose policies have been canceled is to get new, subsidized coverage through exchanges, or to enroll in Medicaid. Once Healthcare.gov is working at high capacity, they'll owe people with canceled coverage more than just the play-acting they've offered for the past month.

Democrats will be helping these people find such coverage. Will Republicans?

By Brian Beutler

Brian Beutler is Salon's political writer. Email him at bbeutler@salon.com and follow him on Twitter at @brianbeutler.

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