Republicans have spent nearly six years promising to repeal Obamacare and, for most of that time, they have refused to acknowledge what that would mean for the millions who would lose their health insurance.
On Saturday afternoon in Iowa, for at least a few minutes, one Republican couldn't get away with it.
It happened at a Ted Cruz campaign event in Hubbard, a small town smack in the middle of the state. According to reports in The New York Times, The Washington Post and Politico, Cruz fielded a question from Mike Valde, a Democratic voter who had come to the event with a story to tell and a simple question to ask.
The story was about his brother-in-law, a barber named Mark. As Valde told it, Mark was a small business owner who worked so hard that he didn't even take paid days off. But Mark was unable to afford health insurance until the Affordable Care Act became law. When it did, Mark bought insurance and then, when he started feeling ill, saw a physician -- who promptly diagnosed him with cancer with no hope for recovery. He died last year.
"He had never been to a doctor for years," Valde said, reportedly on the verge of tears. "Multiple tumors behind his heart, his liver, his pancreas. And they said, ‘We're sorry, sir, there's nothing we can do for you.'"
The room fell silent, according to the Times' account, and then Valde, who later told reporters that he was a Hillary Clinton supporter, posed his question: "Mark never had health care until Obamacare. What are you going to replace it with?"
Cruz offered Valde his condolences before launching into the same basic argument that Republicans always make. "Under Obamacare," Cruz said, "millions of Americans have lost their jobs. Millions of Americans have lost their doctors, have seen their premiums skyrocket." He pointed out that Obama had promised families would see average savings of $2500 from health care reform, and joked that he'd gladly encourage anybody who'd actually reaped such savings to vote for Clinton -- a quip that drew laughter from the audience.
Valde, apparently less amused, kept at it. "My question is, what are you going to replace it with?" he said. Cruz responded that he'd get there, but first he wanted to talk some more about the "millions of stories on the other side" -- people who'd had to give up their old plans and, as a result, ended up with higher premiums or co-pays, narrow networks of providers or some combination thereof.
Eventually Cruz suggested that if Valde's brother-in-law couldn't afford health insurance premiums previously, it was probably because government regulation had driven up the price -- and that the best solution, at this point, was to wipe the slate clean and build a new health care system, one in which people could purchase coverage across state lines.
It mirrored the answer Cruz had given just two days before, when Fox News host Bret Baier posed a similar question during Thursday's presidential debate in Des Moines. And Cruz's description of Obamacare's effects hadn't gotten any less misleading in the interim.
It's true that President Barack Obama's signature health care law rewrote the rules for how insurance companies sell policies directly to individuals -- requiring that all policies include comprehensive benefits, for example, and prohibiting carriers from charging higher premiums or denying coverage outright to people who pose greater medical risks. And it's true that, because of those changes, insurers cancelled some existing policies.
But early reports suggesting as many 5 million people lost their old policies appear to have been exaggerated. Subsequent studies estimated that the actual number was less than half of that.
Meanwhile, those people were able to get new coverage through the law's marketplaces. And the best available research suggests that the majority ended up paying less money, not more, for their policies, while enjoying guarantees of coverage nobody had previously.
Overall, fewer and fewer Americans are reporting difficulty with medical bills and the proportion of Americans without coverage has fallen to historic lows. In Iowa specifically, the proportion of residents without health insurance fell by nearly half from 2013 to 2015, according to Gallup.
As for the claim that the Affordable Care Act has either destroyed jobs or turned millions of full-time positions into part-time ones, it appears to be just plain wrong. Anecdotal stories of employers capping hours got a lot of attention in 2014 and 2015, but experts have now had time to examine the data and they see no signs of a significant trend towards part-time work. (Also of note: the private sector has created jobs in every month since the Affordable Care Act became law.) Based on conversations with several well-respected economists, the website Politifact recently rated this favorite Republican argument "Pants on Fire."
Allowing people to buy insurance across state lines, as Cruz proposed, is something conservatives have long favored. It would allow insurers to start acting like credit card companies, relocating to whatever states have the least onerous regulations and selling all policies from them.
Like other efforts to gut existing rules on how insurers operate, it'd allow the industry to sell cheap, skimpy policies that might appeal to some healthy people, but would offer nothing to people need comprehensive coverage. In short, it's a way of allowing insurers to act like they did before health care reform -- not a way to make sure millions get insurance.
There's a reason Cruz didn't have a better answer for Valde, and it's the same reason Republicans never have a satisfying response to this question.
The Affordable Care Act has its pluses and minuses, with plenty of people legitimately aggrieved about what it's done or how it's worked out for them -- and plenty more opposed for philosophical reasons. But any alternative that provides similar (or better) access to health care protection from medical bills is bound to require a similar combination of regulation and government spending. Republicans oppose such measures on principle -- which is why, when they talk about Obamacare, they exaggerate the downsides, ignore the upsides, and pretend they have better alternatives.
While Valde never got a real answer from Cruz, he had a chance to ask another candidate his question later in the evening. He showed up at a rally for Clinton in Cedar Rapids and was called onstage while she was speaking. Clinton noted that millions would lose their insurance if Cruz and the other Republicans have their way. "That's fine with them," she said. "That's not fine with me."
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