AHCA: The Morning After

With a night to read the America's Health Choice Act, the reaction is mostly as expected. Progressives are truly excited, while the best conservatives can do is warn that the program is heavily backloaded, costing the most between 2014-2019 (which is true.)

But it's the surtax on the wealthiest 1.2% of Americans that is bringing out the long knives. Leading the charge against, The Village, starting with the Washington Post:

Mr. Obama praised the House bill yesterday without addressing the surtax. A far better way to pay for health care would be to end the tax break for employer-provided health benefits, a subsidy that not only artificially pumps up demand for expensive treatments but also disproportionately benefits upper-income earners. Eliminating or, at least, capping it would be good health-care policy as well as good tax and budget policy. Pretending that "the rich" alone can fund government, let alone the kind of activist government that the president and Congress envision, is bad policy any way you look at it.

Which makes even less sense, ending the tax break on employer-provided health benefits would of course have employers not have employer health benefits, driving everyone to the public option and leaving nobody behind to pay for it.

The WSJ screams it would destroy American employers.

Under the House measure, employers with payrolls exceeding $400,000 a year would have to provide health insurance or pay the 8% penalty. Employers with payrolls between $250,000 and $400,000 a year would pay a smaller penalty, and those less than $250,000 would be exempt. Certain small firms would get tax credits to help buy coverage.

The relatively low thresholds for penalties triggered the sharpest criticism yet from employer groups, who said the burden on small business is too high and doesn't do enough to help them expand insurance coverage.

"This bill costs too much, it covers too few and it has way too much government involvement," said Michelle Dimarob, a lobbyist with the National Federation of Independent Business, the main trade group for small firms. "Small business doesn't want any of those things."

According to 2006 data from the federation, businesses with between five and nine workers, representing about one million employers, had an average payroll of around $375,000 a year. A report from the Kaiser Family Foundation found that only about half of firms with three to nine workers offered health benefits in 2008.

In other words, this would force small businesses to sign up for, well, something or pay fines. But it's far more intersting to note that these smaller busnesses with 7.5 million employees or so, only half of them are even offered health coverage. How does this "cover too few" when small businesses already skimp on the health insurance because the cost is right now too high? Wouldn't businesses in this category be the most obvious group to benefit from a robust public option?

And it looks like Obama's finally getting rid of the fantasy of a "bipartisan" health care bill.

President Barack Obama may rely only on Democrats to push health-care legislation through the U.S. Congress if Republican opposition doesn’t yield soon, two of the president’s top advisers said.

“Ultimately, this is not about a process, it’s about results,” David Axelrod, Obama’s senior political strategist, said during an interview in his White House office. “If we’re going to get this thing done, obviously time is a-wasting.”

Both Axelrod and White House Chief of Staff Rahm Emanuel said taking a partisan route to enacting major health-care legislation isn’t the president’s preferred choice. Yet in separate interviews, each man left that option open.

“We’d like to do it with the votes of members of both parties,” Axelrod said. “But the worst result would be to not get health-care reform done.”

Good. As I've said on numerous oocasions, the GOP has to kill this bill or they're done in this country for a generation, the way they were all but buried after Social Security and the New Deal were passed. They have to block it, and they've got the health care industry and the Village on their side too.

The battle is truly on. The reformers aren't lying down, either as Steve Benen notes:

In what I believe is the OFA's first television ad, "It's Time" will run on cable over the next two weeks -- the time period between now and the August recess -- as well as local stations in Arkansas, Florida, Indiana, Louisiana, Maine, Nebraska, North Dakota, Ohio, and Washington, D.C., calling on policymakers to support reform.

I'm going to go out on a limb and guess that these states were not chosen at random. The ad might as well begin, "Dear Sens. Lincoln, Martinez, Bayh, Landrieu, Nelson, Snowe, Collins, Conrad, and Voinovich...."

The ad is obviously going with an emotional pitch, highlighting the plight of five regular Americans, each of whom were among hundreds of thousands of people who shared their stories with OFA. There's a mom whose four year old son has cerebral palsy and epilepsy. She has insurance, but the co-pays, durable medical expenses and other out-of-pocket costs are just brutal for her family's finances. There's the healthy young woman whose employer doesn't offer insurance, so she bought her own. When she was diagnosed with low blood pressure, her monthly premium jumped more than 50 percent, forcing her to move in with friends when she had to decide between insurance and rent.

Each of the people featured in the ad insist that "it's time" to finally reform the system. They're right, and it's good to see that the OFA has the resources to put an ad like this on the air.

And finally, the Senate is moving on health care as Teddy Kennedy's committee passed its version of the Senate HELP bill.

Things are going to move fast in July. They will have to.