Obama hardly helps the poor by Heike Buchter

America quarrels stubbornly about Obamas signature legislation, the health care reform. Already its clear millions of Americans will fall though the safety net. The Schadenfreude was immense: beginning this week American citizens and firms can inform themselves about health insurance policies on new websites. These online marketplaces are a fundamental piece of Obamacare. But there have been technical problems; the sites were not always accessible. With relish, Fox News reported error messages on the website. The TV network, which sometimes openly promotes the positions of the Tea Party, set up an extra online section of its own to collect reports of failures and problems of the new service. Opponents like Orrin Hatch, an ultra-conservative Senator from Utah, spoke of the glitches as proof that Obamacare is not yet mature enough. Obama should have taken the many warning signs and problems seriously, and postponed the changes. About no other law do the US Democrats and Republicans argue as embittered as on Obamacare. The ultra-conservative representatives of the Tea Party want to bring about the downfall of Presidents health care reform at any price. To that end, they have brought the entire US Government and many federal agencies to a standstill. And they are even possibly in the position to risk the countrys ability to repay its debtsand with that, a recession. The law is Obamas biggest triumph. It is the largest American social reform in the last fifty years. If successful, it fundamentally changes the US economy. The health care system currently accounts for 18% of the US GDP. Rush on the online healthcare exchanges But its unclear even for its advocates if Obamacare can satisfy the optimistic promises. It begins with the technical reconfiguration of the healthcare exchanges, a change which was jolting. Insurers should compete against each others with offers for customers on the market. The system should provide for more transparency and lower premiums. Users can use the site to calculate how much a subsidy toward premiums will shed off. Until now it has been very expensive or impossible for self-employed people to get private coverage. The President construed the technical problems as a consequence of the large rush of demand, and thus as evidence of the urgent need for his reform. All the same, in the first hours, 2.8 million users visited www.healthcare.gov, the largest online insurance marketplace. But the fact is, at present only nine of the 50 states have their exchanges ready, although the responsible administrations had three years to construct them. 34 states left the task to the federal government, and forwent the option to create state exchanges.

States dont want to expand Medicaid But even if these obstacles are overcome, many Americans who have waited eagerly for health insurance will be left out. Of all people, the poor and those belonging to households with low incomes will fall through the cracks of the health care reform. The reason for that is the refusal of many republican-led states to expand the state healthcare, Medicaid. The individual states are responsible for Medicaid, the expansion of which is a part of Obamacare. At least for the first years, the costs for the expanded coverage will be offset by the federal government. Nevertheless, 26 states refused to participate. It is in these states, of all places, where 70% of Americans who survive at or under the federal poverty line live, and 60% of those who are employed, but earn too little to afford health protection, according to an investigation done by the New York Times. Many are black. The requirements for Medicaid in these states are draconian. In Mississippi, a family of four must have an annual net household income of less than $5,300 to be eligible. People with no children are ineligible. Eight million Americans could fall through the cracks But federal subsidies to purchase a health care policy are only available to those who have a higher income. So there is a gaping hole in these states: affected people are too poor for Medicaid, but earn too little for a subsidy under Obamacare. According to the New York Times study, this is the case for eight million Americans. This jeopardizes Obamas promise to bring about universal health care coverage. Obamacare could further stress precisely those whom it was intended to help. So starting in 2015, firms with more than 50 full-time employees must offer health insurance to their full-time workers, or pay a fine. Consequently, union leaders warn that firms will create more part-time positions. This will particularly affect workers in gastronomy and retail jobs, who already belong to some of the worst-paid and under-insured sectors. The fast-food chain White Castle, for example, already announced they will offer more part-time jobs than full-time jobs in the future. Obamacare threatens to destroy the 40 hour-workweek, and with it the backbone of the middle class, complained union leaders in a letter to the party leadership of the Democrats in Congress. The answer that the labor representatives have in mind: a subsidization of employer insurance contributions. In the face of the bitter debates regarding budget cuts, this suggestion hardly has a chance. Hardly any knowledge about Obamacare While many Americans futilely hope for Obamacare, others asked simply know nothing about its chances. According to a survey, roughly half of Americans did not even know the law was put into effect. While its opponents warned of the reform with TV campaigns and protests, the government remained largely silent. The officials reasoning: they didnt want to create an advertisement for a product that

never yet existed. That only would have created confusion, said Marilyn Tavenner, the responsible chief administrator. This reticence could have dire consequences. If not enough Americans join, especially young and healthy ones, the system threatens to collapse. To the opponents it is apparently clear: Generation Opportunity, an organization significantly funded by the Koch Brothers, targets the generation ages 20-30. Dont join! urge the organizers, with appropriately drastic videos. In an exam room, Uncle Sam appears instead of a gynecologist, and wants to fiddle around between the legs of a young woman, visibly shocked.
This article appeared in ZeitOnline on October 4, 2013 and was written by Heike Buchter. Translated from the German by Dave Herr. Original available at http://www.zeit.de/wirtschaft/2013-10/obamacare/komplettansicht