The New Republic

You’re probably getting tired of reading about Mitt Romney’s distortions on health care. I’m certainly getting tired of writing about them.

We should be having a serious discussion about health care policy. And that discussion ought to include the very real flaws of the Affordable Care Act. Obamacare will provide financial security to tens of millions of Americans, while pushing the providers and financiers of medical care to operate in a more efficient way. Still, the law is far from perfect. We should be talking about why and what to do about it, so that someday every single American truly has access to quality, affordable medical care. But that's not a goal Romney wants to pursue and it shows in the arguments he keeps making. 

A case in point is the press release from Romney headquarters that arrived via e-mail on Sunday: “Another Obamacare Failure.” The release recycles some familiar pieces of Republican propaganda, but the lead item this time is a New York Times editorial about a very real problem in the health care law.

As readers of this space know, the Affordable Care Act is complicated in part because because, rather than blowing up the whole health insurance system, the law’s architects decided to keep existing arrangements largely in place. That meant providing new insurance, directly through Medicaid or indirectly through subsidized private coverage, only to people who couldn’t otherwise get affordable health benefits from an employer.

But how do you define “affordable”? That’s where it gets complicated. The law says health insurance is affordable if you can pay the premiums for less than 9.5 percent of your household income. But the law doesn’t specify whether the premiums are for individual coverage or for family coverage. For some families, that's going to be a big difference.

Imagine you’re the chief breadwinner in a couple with about $30,000 a year in total income. Now imagine that annual premiums for a family policy from your employer are $5,000, which is more than 9.5 percent of household income, but annual premiums for an individual policy are just $2,000, which is less than 9.5 percent of household income. If the basis for the affordability calculation were individual premiums, rather than family premiums, then neither you nor your spouse could get subsidized coverage. You’d probably end up taking the individual policy from your employer, but not the family policy, which could very well leave your spouse with no coverage at all. (Yes, this is the exact same issue I wrote about a few weeks ago, after that infamous anti-Romney ad about the former steelworker whose uninsured wife died from cancer.)

The Obama Administration will settle this issue when it writes the final regulation on affordability. And writing the regulation in a way that makes these people eligible for assistance won't be easy, because of the law’s many moving parts. The best response would probably be the one the Times editorial mentions: Writing the regulation in such a way that, in these sorts of situations, employees got coverage from employers but spouses were eligible for subsidies. But some administration lawyers are reluctant to interpret the law that way. And if those lawyers prevail, between 2 and 4 million people lower-income people would lose out on government assistance, at least according to a pair of independent estimates.

So what does Romney have to say about this? Is he urging the Administration to write the regulation so that people in this situation have access to subsidies? Of course not. Is he proposing to replace the Affordable Care Act with a plan that would provide these people with some alternative source of widely available coverage? Of course not. Instead, his campaign is simply attacking the administration, arguing that “Confusing Language In Obamacare Has Jeopardized The Availability Of Insurance Coverage For Millions Of Americans.”

That line is doubly hypocritical because it implies that, because of Obamacare, people will lose health insurance. That’s not the case. These are people who for the most part, can’t get coverage now. The issue here is whether they’ll remain uninsured or whether, come 2014, they'll be among the millions who benefit from Obamacare.

It’s one more reminder that, to Romney, the uninsured aren't a group of people in need of help. They're a pawn in his campaign strategy.

follow me on twitter @CitizenCohn 

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