A million words will be written about the impact of Obamacare on the 2014 election cycle. Voters will be bombarded with television ads. Mailboxes will be stuffed with propaganda on both sides.
Obamacare may be a good idea. But we live in an era when practicality is more important than ideology for more and more voters. Whether the Affordable Care Act is a good idea or a bad idea has been trumped by whether it works or not.
If Obamacare was the only storm, candidates in California could dance in between the raindrops. But two 2014 state ballot initiatives will make it harder for candidates to avoid getting hit by lightning or just soaking wet.
Californians will be confronted with two health care ballot initiatives, neither of which seems to have gotten the central message from the whole Obamacare debate: Competency matters.
Both ballot initiatives have a hook, a line and a sinker.
The first initiative is titled “Approval of Healthcare Insurance Rate Changes.” The title is a good hook. The line is obvious – why not require insurance rate increases to be approved by the elected insurance commissioner?
But the sinker is the very last paragraph of the initiative. It exempts all major employer health insurance plans from any review, regulation or approval. It exempts three-quarters of the private sector plans covering Californians who aren’t receiving government assistance.
So if Wal-Mart raises insurance premiums or co-pays on its employees – it’s exempt. If all the banks, phone companies, oil refineries, manufacturing, high-tech, retailers or large construction, hospital, trucking, railroad, shipping companies cut benefits or eliminate family coverage – they’re exempt. All of them.
The irony in all of this is that the proponents submitted two versions of their initiative to the attorney general. One with no exemptions. The other full of exemptions. They dropped the first one. They put the second one on the ballot.
The campaign rhetoric will be the same. The results will be dramatically different.
The second health care initiative has a great hook – “Drug and Alcohol Testing of Doctors. Medical Negligence Lawsuits.”
It also has an even better line. By linking the first part of the title with the second, one could conclude that the “medical negligence lawsuits” relate to “drug and alcohol” use by doctors.
Clever. Just not exactly true. Which leads to its sinker.
The initiative will raise the cost of insurance on all community clinics, including Planned Parenthood. No exemption for them. No cost control on what they are forced to pay for malpractice insurance.
How ironic. One initiative has exemptions it shouldn’t have. The second initiative doesn’t have exemptions it should have.
The first initiative says it will regulate health insurance costs, but it won’t regulate the malpractice insurance premiums paid by community clinics that serve the underserved and Planned Parenthood that serves millions more.
Before all of this makes you dizzy, let me sum up the politics and impacts in simple terms.
When the employer mandate kicks in, all hell will break loose. The premiums for health insurance provided by employers will increase, co-pays will skyrocket, family coverage will get reduced and benefit levels cut. The “Approval of Health Insurance Rate Changes Initiative” won’t stop any of this because of the larger-than-life exemption loophole the proponents wrote into it.
Obamacare specifically and permanently excludes undocumented people even if immigration reform is adopted. But the community clinics that serve immigrants will see their own insurance rates skyrocket because the “Medical Negligence Lawsuit Initiative” doesn’t give them any exemption no matter how sober or safe their doctors are.
California candidates’ lives are a lot more complicated than Obamacare. Explaining ballot initiatives that at best don’t do anything to fix Obamacare and arguably make it worse won’t be easy.