Live Fat, Die Young!

Ted Cruz's Shutdown Leap

Last year Crystal Wilson, a poor white Arkansas woman, died of "natural causes" -- untreated diabetes -- at age 38. Life expectancy for uneducated white women in Southern states has dropped five years in the last generation. Mostly because they're obese and lack health care. Instead of "Live fast, die young!" it's "Live fat, die young!"

Most people in Crystal's situation, if they can work, work part-time jobs. And so, when the shutdown fight was still about Obamacare, before they admitted it was all about their pride, Republicans tried fleetingly to appeal to fears about the "part-timing" of America. The slant is that companies are making full-time employees work part-time so that they can escape the requirements of the Affordable Care Act.

Some companies may be saying they're doing this because of Obamacare, but this part-timing of America was in full swing when Barack Obama was still in law school. In the 1980s and 1990s companies sent work overseas, fired some employees and cut others to part time. Companies like Walmart have been turning full-time employees into part-time and cutting back part-time hours to increase profits for decades, in part to avoid paying full-time benefits: they hire twice as many people for half the cost. Twenty years ago many high-tech companies like Microsoft hired employees as "independent contractors," to avoid paying health insurance, vacation, stock options, laws concerning working hours, etc. They were sued by those employees and eventually settled for $97 million. Many long-haul truckers and delivery drivers are paid not by the hour, but as "private contractors" paid by the mile.

Republicans point to Trader Joe's and Home Depot's decisions to drop insurance coverage for part-time employees and let them get their health insurance on the exchanges as proof of the damage Obamacare has done. The thing is, Obamacare is a good deal for most of these employees: these companies don't have enough employees in an area to get the best rates (health care is highly localized), so they can't compete with rates offered on the exchanges which will cover a much larger risk pool. Trader Joe's logic is straightforward (from a Time article):

Stated quite simply, the law is centered on providing low cost options to people who do not make a lot of money. Somewhat by definition, the law provides those people a pretty good deal for insurance … a deal that can’t be matched by us — or any company. However, an individual employee (we call them Crew Member) is only able to receive the tax credit from the exchanges under the act if we do not offer them insurance under our company plan.

First off, Trader Joe's was never required to provide part-timers health care -- they do it because they are a great company. Second, only 23% of Trader Joe's employees are part-time. Third, companies like Trader Joe's and Home Depot never paid full freight for part-timer's insurance: some employees have to pay as much as $4,000 dollars a year. Most health care exchanges will offer policies that are cheaper than what Trader Joe's can provide, and since they can get a tax credit under the ACA most employees will save thousands of dollars a year.

Most, but admittedly not all. Employees in states that have been antagonistic to the ACA, have not set up their own exchanges and have not adopted the Medicaid changes will probably wind up paying more. Trader Joe's estimates that 70% of their employees will get a better deal. Their employees in Texas are being screwed by Rick Perry's stubbornness, not Obamacare. This is why guys like Ted Cruz are shutting down the government to stop Obamacare before it gets started: their own voters are going to turn on them when they realize everyone else is getting a better deal.

Now, because of Obamacare, part-time employees of Walmart who were never able to get decent health care will now be able to get the same deal that workers at Trader Joe's can get. And it turns out that Obamacare isn't the job-killer that Republicans say it is: Walmart is making 35,000 employees full-time.

The real question isn't why Trader Joe's is dropping health care for part-timers, it's why any company is offering health insurance. It never really made sense, but it wasn't so bad when companies footed the whole bill. But as soon as they started making employees pay for it, any cost containment went out the window. Since employees aren't the customer of the insurance company, they have no say in the negotiations; they have no leverage and no choice, but they get stuck with the price increases. The employer makes their decisions for them based on what's best for the company, not the employee. It's no better having your company dictate who your doctor is than the government.

Here's another example of the "terrors" of the health care exchange: my wife and I left the corporate world more than ten years ago, and that meant getting our own health insurance. It's very expensive: the day before the health care exchange in Minnesota opened we got a notice from Blue Cross that our policy will go up 22%, to $995 a month (that's with a $6,000 deductible). We never got tax breaks for this plan because we're not a corporation -- corporations get tax breaks for their CEOs' Cadillac health insurance plans, but we had to pay the full cost for our bare-bones coverage.

So my wife went to the MNsure website (the local health care exchange), and found an identical plan -- same company, same coverage, same deductible -- for only $775. And that's the top price, without tax credits based on income.

That must be the magic of the marketplace conservatives keep talking about.

One reason exchanges can offer lower prices is competition: there are now millions more customers in the marketplace who can directly compare prices on the Internet. Another is that there are fewer middle men: no insurance agents and brokers are needed. As many as 100,000 insurance agents may be out of jobs. We were forced to buy our current plan through an agent several years ago, who still gets a monthly commission and has done absolutely nothing ever since. This worthless overhead is the sort of "job" Republicans refer to when they talk about "job-killing" Obamacare. Our Republican state senator happens to be a licensed insurance agent who opposes Obamacare and tried to use his position as chairman of a Senate committee to torpedo the state exchange.

The fact is, the system set up by the ACA is exactly the sort of health care solution conservatives have been pushing since Clinton's health care initiative 20 years ago. Obama made huge concessions to conservatives when he gave up single-payer and accepted the individual mandate with the ACA. Mitt Romney signed Obamacare's godfather into law in Massachusetts in 2006. The only reason Republicans are fighting it now is to display their hatred of Obama and wreck something he fought tooth and nail to make happen.

Republicans claimed to be shutting down the government now to "repeal and replace" Obamacare. But what would they replace it with? Exactly the same thing. They want to stomp on it, tear it apart and piss on it just because Obama tricked them and gave us the health care solution conservatives have been demanding all along.

In the end the people who will be hurt the most by Republican opposition to ACA are poor uneducated whites who live in Southern states -- the most reliable Republican voters. People like Crystal Wilson.

And that's the future Tea Party Republicans want for all of us.