October Surprise

by Diana Zuckerman, PhD, president of the Cancer Prevention and Treatment Fund

In politics, an October surprise is when a candidate has dirt on his or her opponent that they save for the last few weeks before the election, so that the opponent’s media coverage will be negative just as people are deciding about their vote.

This year’s October surprise will be different, since there are few elections. Instead, this year the surprise will be:

1. Will millions of Americans lose the opportunity to buy affordable health insurance?
2. Will the government be shut down on October 1, October 17, or not at all?

We live in a democracy, but the decision about this October’s surprise is going to be made by a very small group of Congressman. How did 2-3 dozen Tea Party members in the House of Representatives get that power in a Congress of 535 people, and should they be applauded for their principles, or shunned for their bullying?

Let’s first remember what’s at stake:

• If the government closes down, some essential services will continue (such as Social Security checks) but hundreds of thousands of workers won’t be paid (a blow to the economy) and services will be curtailed (national parks closed, disability, passport services, etc.)
• U.S. healthcare is the most expensive in the world, and Americans don’t live as long as those in 16 other countries, including Canada, Portugal, and Japan. The purpose of the Affordable Care Act is to save lives by providing affordable health insurance to millions of Americans.

For those who (understandably) have tried not to think about the looming crisis, here’s a short “October Surprise for Dummies” version:

• The federal government and the services it funds (military, Social Security, cancer research, veterans’ health care, grants to public schools, etc.) are funded for one year at a time, starting Oct. 1 each year. This year, none of the funding bills have passed for the coming year, so the government will close on October 1 (today) if a bill isn’t passed by then.
• The funding bill for the year starting October 1, 2013 did not pass when it was supposed to (months ago) because 2-3 dozen Tea Party Republicans have refused to vote to support a budget unless it specifically removes funding for the Affordable Care Act, which they derisively call Obamacare.
• You might ask: don’t we live in a democracy where a bill in the House of Representatives needs a simple majority (218 votes) of the 435 Members to pass?  How can even a few dozen people stop a bill if more than 218 want that law to pass? The answer is that Speaker of the House John Boehner is going by a different set of rules. Instead of allowing a vote for the entire House of Representatives, which would certainly pass a budget that the Senate and President would agree to, the Speaker won’t allow a vote on a bill unless it has the support of a majority of just the Republican Members of Congress—not including the Democrats.  For hundreds of years, laws have passed only because of bipartisan cooperation, but that is not even possible now. Without support from enough Tea Party members, the Republicans can’t get 218 votes to prevent the government from shutting down unless the bill cuts funding for Obamacare.
• Hence, no bill yet (as I write this the day before Oct 1) and the strong possibility of a shutdown. The irony is that even if the government shuts down in October, the new health care law will continue. The only way to stop health care changes is if a law is passed to specifically cut funds for health insurance (see below for what that entails).
• Maybe a shutdown will be avoided. If this is the case, the next crisis date is October 17, when our country’s debt ceiling is reached. Our government borrows money every year, because we spend more than our taxes can pay for. Congress then votes for a new amount of debt that it considers acceptable. Like the annual budget, the debt ceiling has been held hostage by the same Tea Party Congressmen (and women) who refuse to vote for it unless—you guessed it—Obamacare is repealed, or at least loses the funding it needs to provide health insurance for people who can’t afford it.

Is this any way to run a country?

Some people believe that the Tea Party opponents of the 2013 funding bill should be applauded for their principled stand. After all, they ran for office promising to gut the health care legislation. But, what is it about “Obamacare” that’s so terrible that it is worth shutting down the government or letting our country default on the money it owes.

Under Obamacare, health insurance plans must now provide:

• Free preventive services for women, such as mammograms, Pap smears, and birth control pills
• Prescription discounts for seniors
• Family insurance policies must cover all children under 26, even if they don’t live at home
• Starting in January, insurance policies must cover all pre-existing conditions, such as cancer and heart disease. And they can’t stop paying for coverage when a disease gets very expensive (no yearly limits or lifetime limits on coverage, which in the past have bankrupted many families)

Also starting in January:

• States can get free Medicaid coverage for adults and children up to 133% of the poverty level (about $30,000 for a family of 4)
• People who don’t have insurance through their employer or Medicaid will be able to go to state “Insurance Exchanges” that offer affordable health insurance. The federal government will help pay the annual cost of insurance for people earning up to 400% of the poverty level.

Sounds good, doesn’t it?  There is a catch, though. The “mandate” in the law requires every American to buy health insurance, starting in January. The Tea Party hates the mandate, but the penalty if someone doesn’t comply is only $95 for the entire year. That means that those who don’t like the law and don’t want to buy health insurance would get away with the equivalent of a depressingly large parking ticket.

Is a mandate requiring insurance coverage (as is done with car insurance) fair?  Unfortunately, it is the only way to keep prices down, because now that pre-existing conditions are covered for health insurance policies, a person could otherwise delay buying health insurance until they know they will have major medical expenses. (That would be like buying retroactive flood insurance to pay for flooding damage that already occurred—a major saving for you, but untenable for insurance companies).

And, let’s not forget that Obamacare became law because of the affirmative votes of most Members of Congress, and that the numerous efforts to pass a law repealing it have been unsuccessful, because it does, in fact, benefit millions of Americans.

By the time you read this, you may know something I don’t know as I write this: what will this year’s October Surprise be? Let’s hope it will be a pleasant surprise—a Congress that respects its citizens enough to preserve majority rule, the linchpin of our democracy.

Diana Zuckerman is the president of the National Research Center for Women & Families and the Cancer Prevention and Treatment Fund. She received her PhD in psychology from Ohio State University and was a post-doctoral fellow in epidemiology and public health at Yale Medical School. After serving on the faculty of Vassar and Yale and as a researcher at Harvard, Dr. Zuckerman spent a dozen years as a health policy expert in the U.S. Congress and a senior policy adviser in the Clinton White House. She is the author of five books, several book chapters, and dozens of articles in medical and academic journals, and in newspapers across the country.

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