Wednesday, Jun 20, 2018
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David Kushma

ObamaCare debate must focus on benefits as well as costs

CAN two out of three Ohio voters be wrong about ObamaCare? Maybe not, but the debate isn't over.

This month, Ohioans approved in landslide numbers a ballot proposal primarily aimed at rejecting the most controversial element of President Obama's health-care reform law. That's the requirement that by 2015, almost all adult Americans must buy health insurance or pay a financial penalty.

Issue 3 will have no practical effect on the health-care measure or the so-called individual mandate; a state constitutional amendment can't supersede a federal law. But proponents say the Ohio vote sends a clear message: ObamaCare must go -- and, perhaps, voters should fire Mr. Obama next November as well.

They may not have to wait for the second outcome to achieve the first. The U.S. Supreme Court said last week it plans to rule, months before next year's general election, on whether the individual mandate is constitutional. If the high court trashes the mandate, supporters and opponents agree, the rest of the health-care law may fall as well.

As a citizen, I hope ObamaCare -- formally titled the Patient Protection and Affordable Care Act -- survives. The law needs improvement, but its goals are too important to abandon.

These include extending medical coverage to tens of millions of people who don't have it, providing valuable new health-care benefits and safeguards to all Americans, and improving the quality of care and the competitive efficiency with which it is delivered.

And I'm persuaded by legal experts who argue that the individual mandate is a proper expression of Congress' power under the Constitution to regulate interstate commerce -- which the national health-care market surely is.

It's appropriate that the Supreme Court soon will address the legal issue, and that voters will make a political judgment about ObamaCare. But we all should hope that the debate over health-care reform will be guided by facts rather than narrow ideology or partisan politics, and that it will fully consider the law's benefits as well as its costs.

The Issue 3 outcome was too one-sided to argue, as some die-hards still do, that Ohioans really didn't know what they were voting for. The proposal's language was misleading, and the campaign was overshadowed by the big-money brawl over Issue 2. But a 2-to-1 margin leaves little room for ambiguity.

The vote was largely a referendum on Mr. Obama, because Americans associate him so closely with the health-care law. That's apparent from a survey conducted by the Republican polling firm Magellan Strategies, which talked to more than 600 Ohioans after they voted this month.

Nearly half of the voters who supported Issue 3 -- and thus opposed Obama-Care -- said the President's involvement in the health-care law was a major factor in their decision. That's important, since Ohio may elect the next president.

"The voters wanted to send a message to the President -- they don't like this law, and they identify him with it," says Magellan Strategies CEO of David Flaherty. "That ballot result speaks for itself."

Mr. Flaherty told me that many of the surveyed voters who favored Issue 3 identified themselves as Democrats and members of union households, and opposed Issue 2. If the language of the ballot measure truly had confused voters, he says, they would more likely had voted no or not voted at all.

Still, what debate there was on Issue 3 focused almost exclusively on vague appeals to "freedom" and the cost and intrusiveness of the individual mandate, not on the law's benefits. And polls make clear that Ohioans like what ObamaCare provides.

They like knowing, for example, that an insurer no longer can cancel or deny coverage, or charge exorbitant premiums, because of a pre-existing condition. But such good things have to be paid for. That's where the individual mandate comes in.

Health care isn't optional; we all need it sooner or later. Insurers can't expand coverage to the extent the reform law calls for if young and healthy people get to opt out. If the only people who buy health insurance under the law are old or sick, the premiums will be so high that few could afford them.

The point of insurance is to spread the risk among everyone to keep premiums manageable. It's the same reason Ohioans must buy auto insurance -- so the rest of us aren't forced to pay all the costs for the bad effects of reckless drivers who also want to be free riders.

Otherwise, we'll continue to endure the health-care system we have now: People who can't afford insurance, or choose not to buy it, will wait until they get really sick. They they'll seek care in the emergency room or some other expensive venue. Those of us with insurance will pay higher premiums to absorb the bills for providing that care.

The Supreme Court's review of ObamaCare will turn on narrower legal issues. Opponents argue that Congress can't force anyone to buy a private product. If government tells us we have to buy health insurance, can it also compel us to buy an American car and green leafy vegetables?

The law's supporters say there is ample precedent for justices to approve the individual mandate. They argue that previous rulings by the high court have upheld laws that encroach on personal freedom and individual economic decisions more than the mandate does.

The high court's vote easily could go 5-4 either way. We can only hope that the ruling will respect long-standing legal precedent over immediate political concerns.

Whatever the Supreme Court does, voters ultimately will decide the future of health-care reform, including which president and party will guide it. And whatever the court does, the rest of us will need to take a balanced view.

David Kushma is editor of The Blade.

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