One of the better bitter pills the right has had to swallow as a result of the election is that "Repeal Obamacare" was pretty soundly rejected as a rallying cry. The implementation of the Affordable Care Act continues, and conservatives are scrambling to try and figure out ways to revive their opposition and paint Obamacare as terrible, yet again.
Although I've never been thrilled with the ACA, or its organizing principle - that is, codifying the employer based health insurance system we have, and doubling down on it - I think we're obliged to see how it plays out. As I've said, I remain convinced that the real looming disaster in implementing the ACA is in Medicaid and the problems with expanding that program to everyone up to 133% of the poverty line, but the crunch time for that is probably months (though months, and not years) away.
Right now, the real developments in health insurance have to do both with the establishment of the "exchanges" - health insurance markets in every state that will help freelancers and small business employees get more affordable coverage, in theory - and seeing how employers react to new requirements for offering coverage.
What's interesting to me is that conservatives have settled on "outrage" and sympathy for an odd group of employers - midsize franchisees of chain restaurants like Applebee's and TGI Friday's. It's fascinating because the chains are frantic about the costs of offering insurance to wait staff and kitchen help, and because conservatives are trying to stake a "pro-business" claim by supporting the businesses in their whining about having to provide health insuarnce to workers.
In a similar vein came news this weekend that Wal-Mart (naturally) has decided to set 30 hours as the lower limit for insurance for its workers, provoking (naturally) new howls about how Wal-Mart pushes its workers onto welfare, or in this case, into the Exchnages, rather than take its own responsibility seriously.
The inetersting thing to me is that these stories are two sides of the same coin, and a reminder why the ACA, or some solution was needed - it's service workers in these semi-part-time jobs in these shadow fields of endeavor who have the hardest time accessing affordable health care. Restaurants have notoriously refused to pay decent wages, never mind benefits, to workers. And while wait staff - especially in top boites - can survive and even thrive on tips, the same is not the case for kitchen workers and support staff. Wal-Mart, too in indicative of a problem (especially pervasive in retail and other service work) that doesn't actually have a good answer: making insurance available to part time workers is a laudable goal... but where is the reasonable point to draw a line in regards to hours worked?
I work for a company that - for now - offers a pretty full benefit package to workers starting at 20 hours a week (it's a little more complicated, but basically this). Wal-Mart probably deserves some scorn for going with 30, rather than a more inclusive number like even 25, but any number will serve to keep some workers out of the pool. And force the into other choices.
It's easy to lambaste these business owners for trying to limit coverage, but I tend to be heartened by the reverse predicament: that the ACA has forced these notoriously cheap employers to provide at least some sort of basic health care coverage to their full time staff. The threats of layoffs and cuts to hours may happen, but these are business people who know enough to know that providing worse service will not help the bottom line. Wal Mart can run on a small crew... but it does need bodies at registers and manning the floors. And if the net result is fewer people working more hours... than we may have broken an especially bad model that was good for business, but terrible for workers looking for a living wage and benefits.
But liberals should see the arnings in all of this. First, as much we'd like it to be otherwise, these businesses have to make choices about costs and expenses against how much money they can make doing business. Less profit will force other choices. Raising prices will affect who comes and how they spend. Each equation comes with a trade off. And for workers, we shouldn't make progress for some the enemy of good for all. More coverage, even for only a subset of these workers, is itself a vast improvement.
A lot of this, though, will come back to those exchanges, and by extension to these questions of how and how well the Medicaid expansion is done. Businesses, in their plans, will be heloing to, in some ways, enhance the division between the "working poor" - those who have the jobs and the willingness to do the long hours - and a new tier of people, just under them, who choose or are pushed into situations with some hard choices and harsh realities. Will the exchanges and Medicaid provide good coverage (and if the Exchanges are that good... will employers simply push their workers onto them?) , or do they become, between them, insurers of last resort for those with the least income and the fewest choices? That question could have a painful answer, but if we're trying to decide whether a bit of something is better than nothing... well, I'd rather not have nothing.