On New Year’s Day, Obamacare became a staunch reality. The White House reported that over two million people had enrolled in private health care plans through state and federal marketplaces, and that millions more gained coverage through Medicaid and the Children’s Health Insurance Program. That means, among other things, free preventative care visits for people with pre-existing conditions and cheaper prescription drugs that will make treatment more affordable for millions.
But that reality isn’t stopping the health law’s skeptics from continuing their war on Obamacare. Here are five ways that the GOP is continuing to fight reform in the first days of 2014:
1. More efforts to defund and delay.
While major congressional efforts to fully repeal Obamacare seem to have finally hit a wall, the law’s opponents haven’t given up on chipping away at its funding or dismantling its individual provisions.
On Tuesday, Senate Minority Leader Mitch McConnell (R-KY) attempted to hold an extension of unemployment benefits hostage in exchange for a one-year delay of Obamacare’s individual mandate — a move that would destabilize statewide insurance marketplaces, raise premiums, and leave millions of Americans uninsured. Later on the same day, Senate Republicans staked out an opening bid on an omnibus spending bill that would strip all discretionary funding for Obamacare — a position that, as The Hill points out, is similar to the one that resulted in a 16-day government shutdown last fall.
2. Suing to strip Obamacare’s congressional subsidies.
Sen. Ron Johnson (R-WI) is waging a war against Obamacare’s subsidies, which are meant to help congressional lawmakers and their staff pay for health insurance. Johnson, who received the official blessing of the Republican National Committee for his lawsuit on Tuesday, claims that the subsidy amounts to special treatment for lawmakers and staffers.
That argument is highly disingenuous. Obamacare was never meant to push people away from the employer-sponsored insurance that federal employees have long enjoyed. But, during the debate over the health law, Senate Republicans introduced an amendment forcing congressional employees out of their plans and into the Obamacare marketplaces, and it wound up in the final bill. The amendment — which was meant more as a political tool than well-formed policy — didn’t specify how lawmakers and their staff would be recompensed for their health plans. Without access to the subsidies that other Americans can get under the law or the employer contribution they are accustomed to, many Congressional staffers would likely find health insurance unaffordable.
To resolve this issue, the Office of Personnel Management (OPM) ruled that lawmakers and staff would have to buy insurance through the Obamacare marketplaces, but would still be eligible for their usual employer contribution. That’s the very measure that Johnson is now taking to the courts.
3. Raising concerns over “security.”
This Friday, House Republicans will vote on an Obamacare “security” bill that would require federal officials to inform consumers of any data breach that occurs on any of Obamacare’s statewide or federal marketplaces. The bill is ostensibly meant to give Americans peace of mind about their personal information, such as Social Security numbers. But the lack of any actual, serious security breaches on Obamacare’s portals calls the legislation’s motives into question.
“No person or group has maliciously accessed personally identifiable information from the site,” said Obama administration spokesman Aaron Albright last Thursday.
Some Republicans have also previously argued that the Internal Revenue Service could use Obamacare as a platform to delay or deny politically conservative Americans from getting timely medical treatment — even though the IRS will have zero access to actual medical records and has no part in the actual administration of health care under the law.
4. Targeting the people helping Americans sign up for Obamacare.
“Navigators” are the people who staff Obamacare’s call centers and assist uninsured Americans looking for coverage under the law. They are also the target of Republicans’ ongoing state and federal efforts to undermine a crucial Obamacare resource.
On Monday, GOP leaders in Texas proposed strict new requirements on the people who can be certified as navigators. Hospital officials and advocates for the poor have argued that the proposed rules are so broad that just about anybody who tries to educate people about their insurance options could be forced to comply with strenuous training and registration requirements. “The navigator rules are overly broad and may be interpreted to require registration of anyone — family members, neighbors, co-workers, a member of the clergy, even my own legislative staff,” said Sen. Sylvia Garcia (D) in an interview with Dallas News.
5. Refusing to expand Medicaid.
Studies have shown that GOP-led states’ opposition to Obamacare’s optional Medicaid expansion will leave over five million of the poorest Americans in a coverage gap in which they make too little money to qualify for private insurance subsidies, but too much to be eligible for their state’s Medicaid program.
This gap will disproportionately harm people of color — particularly black people — and widen the gulf between the healthiest and sickest states, since the 24 Republican-led states forgoing Medicaid expansion also have some of the highest numbers of sick, poor, and uninsured Americans in the nation. A report from the Kaiser Family Foundation released on Tuesday also found that over four in 10 uninsured HIV-positive Americans who are currently in treatment won’t qualify for expanded Medicaid coverage in the states refusing expansion.
The states that have expanded Medicaid have seen massive success during Obamacare’s open enrollment season. In fact, Medicaid applications spiked by more than 15 percent in expansion states in October compared to the previous three months, and an estimated four million people were deemed eligible for Medicaid or the Children’s Health Insurance Program (CHIP) in the first three months of open enrollment.