Opponents of Obamacare are trying to persuade people who are eligible for subsidized health insurance not to sign up. Let's consider what makes that campaign so offensive.
The logic, explains Twila Brase, president of the Citizens' Council for Health Freedom , goes like this: Obamacare depends on state insurance exchanges to expand health coverage, and those exchanges in turn depend on a sufficient number of young and healthy people to buy coverage. So groups such as hers are telling people not to buy coverage on the exchanges, in an effort to bring the whole law tumbling down.
(For more about the campaign, which includes encouraging people to make "Obamacare draft cards" and burn them on camera, go read Sarah Kliff'sarticle in the Washington Post.)
The problem with Brase's campaign isn't her goal -- in fact, I'm starting to admire people who continue to rail against Obamacare, defeat after defeat after defeat. Rather, it's how she hopes to accomplish it: On the backs of Americans with no health insurance, and no other options to obtain it. By seeking to exploit their ignorance about the law, the Citizens' Council is using deception to persuade them to defy their own interests.
I called Brase to ask what she would advise for a 22-year-old who can't afford insurance outside of the exchanges. She started by arguing that getting coverage on the exchanges doesn't guarantee access to care, and so may not be any better than going without insurance.
That claim is absurd on its face: Even if you believe that exchange-purchased insurance will offer fewer care options than other types of coverage, some insurance is leagues better than none. Forget about the penalty for not carrying insurance; what if that 22-year-old needs medical care? He can pay his doctors directly, Brase responded, or seek charity care.
Having dismissed the entire concept of insurance, Brase then tried a different argument: Thanks to the law's guarantee that nobody can be denied coverage, anyone who gets sick can simply sign up for insurance. But it isn't that simple. While you can't be denied coverage because you're sick, you still need to buy that coverage during the annual open enrollment period, as with employer-sponsored insurance. That ends March 31, 2014 .
So Brase's advice that people who can't afford insurance outside the exchanges simply go without makes perfect sense -- but only if you're rich, you never get sick, or you only get sick during open enrollment. And how about access to preventive care to keep you from getting sick in the first place, you ask? Well, if you're worried about that, you'd better reconsider your commitment to freedom, my friend.
This campaign would be amusing, if it didn't stand a significant chance of actually persuading people to sacrifice their own health and finances for somebody else's political cause. An April poll found that 42 percent of Americans didn't know that Obamacare was still law, and even doctors don't understand how the exchanges will work. Those seeking to mislead Americans about what Obamacare means for them are looking at a promising landscape.
Does that mean the Citizens' Council and others will succeed in tanking the law, validating the sacrifices of those who refuse to enroll in the exchanges? It seems unlikely. Brase is right that the exchanges will falter if not enough healthy people sign up -- but not right away. And as Brase acknowledges, she's going up against an enormous and equally determined pro-Obamacare marketing campaign.
And as the months go by, those who initially skipped buying coverage to make a political point may start to look at their friends and colleagues with insurance -- or, worse, their spouses and children without it -- and wonder just whose interests they're really serving.
To contact the author on this story:
Christopher Flavelle at firstname.lastname@example.org