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Second Thoughts on Health Exchanges and Hill Staffers

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The other day I used a Politico story about Congressional staffers and health benefits to make some points about health reform. The Politico article was essentially a GOP-planted attack on "Obamacare" which exploited the fact that Representatives and their staffs are soon scheduled to receive their coverage through the law's health exchanges.

That's an oddity, since the law specifically bars employers with more than 100 employees from joining the exchanges until 2017. Hence the problem, and hence all the news stories. The idea to include Congressional employees in the law at all, much less this early in its roll-out, was the result of too-clever-by-half political machinations detailed here.

Unless the law is amended, all elected representatives and staffers will soon lose the employer contribution to their health premiums. Staffers then would be forced to pay a considerably higher premium for the same health coverage they're received for years.

I used this occasion to make the point that people purchasing individual coverage under the new law will typically be paying premiums that are, at least in my opinion, too high. This is an argument I've had with others in the health economics community for quite a few years, well before the election of Barack Obama or the passage of the Affordable Care Act. This story seemed like a good time to revisit that debate -- not because I think anybody should pay that much, but because I think nobody should.

In retrospect, I think that was a mistake. I've often chastised people for making a specific argument which is correct, but who do so by feeding a larger narrative that's conservative and wrong-headed. (The deficit debate is a classic example of this.)

That's the mistake I made the other day. While I acknowledged the technical nature of this particular situation, I only did so in passing. I'm concerned that the overall tone of the piece contributes to the false conservative narrative that it's unreasonable to provide working people with decent benefits.

In the context of the health reform debate, I have repeatedly made the case that reform should not undermine the relatively good coverage (at low cost) that many Americans still get from their employers, whether public or private. Public employees, whether they are teachers or firefighters, whether they work in a government agency or on Capitol Hill, work hard for the public good. They deserve to receive good coverage at low costs. I'm a strong supporter of union contracts (in the public and private sector) that mandates that kind of coverage. All Americans should be, since poor benefits drive people out of public-service jobs, where their efforts benefit us all.

As for Congressional staffers, they should be free to go about their work without living in fear that overpaid lobbyists for wealthy corporate interests will deprive them of decent health care coverage, either now or in retirement. In fact, every  working American should be free of those fears.

Decent benefits aren't the problem. They're the solution. Our nation enjoyed an unprecedented era of prosperity in the postwar years because it offered good wages and good benefits to a growing and thriving middle class. That's the nation we're trying to rebuild, and that's the story we need to keep telling.

The lesson of those years is this: A financially-secure middle class pays its bills, educates its children, and buys the goods and services that bring prosperity to other working people like themselves. Adequate health insurance, both during their working years and after retirement, is a critical element of their financial security.

We shouldn't be criticizing anyone who fights for decent health insurance, and that certainly wasn't the point of my piece. We should be fighting to make sure everyone  has decent coverage. In an ideal world, that would mean Medicare For All or some other form of national insurance funded by progressive taxation. That's what every other developed nation on Earth has, and that's why they receive much better health care at far lower cost than we do.

We're told that this goal's politically unachievable right now. Many of us plan to keep fighting for it until it becomes achievable, as I believe it will -- perhaps sooner than expected.

Until then, most Americans -- and certainly the vast majority of those under 65 -- will continue to receive health insurance through employer-sponsored coverage. That means we should be fighting to improve that coverage, not erode it.

The current law intends to define the bare minimum every American should receive, whether that minimum is defined as premium support for the coverage itself or the level of medical care that coverage provides. We should fight to prevent a race to the bottom in which those defined minimums for coverage become every working American's maximum, or the best that anyone can ever expect to receive. That, I believe, was the goal of the story planted in Politico.

I don't think I made these points clear enough when I wrote about it last Thursday.

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Host of 'The Breakdown,' Writer, and Senior Fellow, Campaign for America's Future

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