In 2009 when President Obama first took office, America faced a serious healthcare problem that had been ignored for decades.  Significant changes needed to be made to address our nation’s problems, which included rising costs and inadequate care following a trajectory to insolvency.  At President Obama’s inauguration forty-five million citizens did not have access to insurance, using the emergency room as their primary care facility.  Medicare and Medicaid were facing default and driving federal deficits to record levels. The private healthcare industry accounted for 21 percent of total US GDP, contrasting with 11-13 percent for comparative nations.  In addition, the US healthcare budget faced $60 trillion in unfunded liabilities over the next 75 years, with no solution.  To compound the problem, private industry was leveraging tax-payer dollars for short term profits, disregarding long term accountability.

At first glance the challenge to obtain healthcare solvency appeared insurmountable.  Many demanded scaling back Medicaid, while others wanted to implement similar single-payer programs as found in Germany, Japan, Canada, or England.  Several blamed insurance and pharmaceutical industries for driving costs, and others cited frivolous lawsuits which drove doctors to provide unnecessary care.  Almost all voices aligned that cutting Medicare was not an option due to voter demographics, and any legislation to weaken private industry would be met with cries of socialism.  It was under these conditions that the Affordable Care Act (ACA) was debated and passed which brought together ideas from every political ideology.

The Affordable Care Act, also known as Obamacare, is one of the most significant pieces of legislation signed into law in the recent history of the United States. Although the law is complex and appears ambiguous, understanding the intent of this law is critical to evaluating its merits. Simply stated, the ACA can be broken into three areas of responsibility:

Business: Shifts healthcare responsibility away from the government to private industry.

Individual: Levels the playing field between private healthcare providers through the use of exchanges, thereby fostering competition for individual policies.

Government: Expands state Medicaid to cover families under 133 percent of the poverty line (Medicaid currently covers up to 100 percent).

Business Responsibility:

Large corporations with elastic goods depend on low cost structures and therefore low wages. In many regards these businesses are as dependent as the lazy, using government to subsidize their benefits and pocketing the difference. Almost half of the uninsured (46%) work full time with 28% working part time.  Many of these full time workers are employed by companies like Wal-Mart, whose average associate receives $1,000 in annual government entitlements.  Subsidizing benefits with governmental entitlements has allowed corporations and shareholders to enjoy record profits.  They also place greater pressure on government liabilities and drive up costs to taxpayers.

Obamacare (ACA) holds all businesses and corporations responsible for supplying healthcare.  If a business employs more than 50 full time workers, they are responsible for providing insurance or paying a penalty (the implementation of this mandate was recently postponed for a year).  If a company employs 25 people or less, tax credits are provided to subsidize coverage. Seventy percent of all healthcare costs happen in the final fifteen years of an individual’s life, typically while under the umbrella of Medicare.  Access to life-long preventative medicine is critical in lowering Medicare liabilities.  Shifting coverage to private industry also lowers the government’s emergency room expenses which the uninsured use in place of primary care physicians.

There has been significant reaction to the healthcare law’s corporate directive.  Mandating industry to provide insurance for their employees will increase costs for any entity not already doing so today.  This is a fair criticism, especially when it comes to small businesses that cross the fifty employee threshold.  However, looking at cumulative data and avoiding anecdotal arguments allows for a balanced discussion of the overall impact.  When it comes to small business, less than ten percent fall into that much-discussed mandated responsibility, as the other ninety percent currently meet Obamacare (ACA) requirements.  To assist both the ten percent and the 90 percent, Obamacare gives access to competitive exchanges (known as SHOP) which will drive down costs for employers currently offering healthcare.

Individual Responsibility:

When an individual is not covered by an employer or as a dependent, they are responsible for their own insurance.  Beginning in October 2013, the government will create a competitive vehicle where insurance companies meeting basic requirements can compete for business. Similar to websites Expedia or Lending Tree, once personal criteria is entered, insurers will publish rates and the consumer can choose a plan based on price or benefits.  Known as insurance exchanges, these will be launched nationally to help consumers make educated choices and provide a baseline for coverage comparison.  Exchanges will soften interstate requirements and prerequisites allowing for productive competition between insurance providers.

Similar to existing employer-provided healthcare, a person's individual policy will also allow access to preventative medicine. Even more important, individual healthcare will allow small firms (fewer than fifty employees) to compete with the benefits of larger firms when attracting employees as benefits are universally.

Since the bulk of uninsured individuals are under 35 years (65%), providing coverage for them is critical to lowering costs for all private insurance companies, given their healthy age demographic.  These younger, healthier participants are needed to offset high risk individuals, much like auto insurance or Medicare.  Because the inclusion of low risk individuals is critical in driving down costs, it is imperative they sign up.  One of the concerns is that uninsured individuals will forgo purchasing their insurance until they need it.  At this point, the only penalty they will face is an $89 annual tax, which is not very persuasive.  However, if the exchanges are able to drive down prices making health insurance affordable and attractive, this concern should be overcome (we will know in October).

Government Responsibility:

On the government side, Obamacare (ACA) legislation mandated that State Medicaid programs cover individuals whose annual earnings fell within 133 percent of the Federal Poverty Level (FPL). The FPL currently covers at 100 percent, so the ACA provided funding to cover the increase; however, this mandate was struck down by the Supreme Court.  States can now opt out of expanding Medicaid, forgoing federal subsidies and leaving millions of their state residents uninsured.  Since those  in this demographic tend to be part of the healthier population, the aforementioned balance between the healthier individuals providing offset to sicker individuals will be more difficult to obtain, and insurance prices may not reach their full potential.

Living in Arizona and watching the fight over Governor Brewer’s decision to expand Medicaid, it’s hard to understand why any state would opt out.  The expansion will bring additional funding, jobs, and access to healthcare. States rejecting the Medicaid expansion will lose out on $8.4 billion in federal funding, exclude coverage for 3.6 million uninsured, and see $1 billion more in uncompensated spending.  Even more problematic, states rejecting expansion will see non-reimbursable emergency room and Medicare costs grow.

Political Blowback:

While I have argued that healthcare coverage is a three-pronged responsibility, many feel that a single payer healthcare system is the preferred model. This caused some to level the charge that President Obama did not fulfill one of his signature promises from the 2008 campaign: obtaining single payer healthcare.  Instead he took Governor Romney’s framework from Massachusetts, authored by the conservative Heritage Foundation, and leveraged the plan in a spirit of compromise. Initially this infuriated supporters as they felt betrayed on an issue they believed was mandated from the decisive election victory.  While President Obama may have expected this, what he probably didn’t expect was the venomous backlash from the right, even though the ACA is based on a healthcare plan they helped create, implemented by a popular centrist Governor.

Perhaps what opponents are politically afraid of is not the demise of the American healthcare system, but the potential success of Obamacare (ACA).  Currently three states have released preliminary pricing for their healthcare exchanges with better-than-anticipated results.  By October all states will see competitive pricing on the exchanges and citizens across the US will begin shopping for their preferred rates and cutting through political propaganda. For the governors of states that rejected the expansion of Medicaid, they will have to explain to 3.6 million employed voters why similar citizens in other states have healthcare and they do not.

Final Thoughts:

While no legislation is perfect, the ACA improves access to healthcare, not only for the uninsured, but also sets guidelines to improve care and protect consumers through some of the following benefits:

• Pre-existing conditions will not be a barrier to coverage.

• Preventative medicine will be included by every approved insurer saving billions of dollars on Medicare.

• A defined percentage of insurance revenue must be applied to the actual care.

• Parents can keep their dependent kids on their insurance until the age of 26.

• Insurers cannot drop coverage due to personal changes in healthcare.

• Doctors will be paid with Medicare rates, currently higher than Medicaid rates.

• The “lifetime cap” for individual reimbursements is removed.

Perhaps the biggest criticism is the expense of the Affordable Care Act (ACA). But according to the non-partisan CBO, Obamacare (ACA) is deficit neutral.  If Obamacare was to be repealed, there would be no change to our annual deficit or national debt.  Any additional costs associated with the law are offset primarily by scale and penalties paid by those unwilling to buy private insurance.  In fact the latest projections by the CBO resulted in $150 billion budgetary savings over 10 years versus the system currently in place. Opponents also charge that Obamacare is a tax for those who remain uninsured.  This is a fair statement; however the receipts collected will help offset emergency room liability for the uninsured that all taxpayers subsidize today.

To understand the new healthcare law, it is imperative to ask the right questions in order to open up honest debate.  Obamacare (ACA) is a far cry from socialism; its main purpose is to reduce Medicare and uninsured emergency room expenditures through access to care.  It uses tax penalties to push citizens away from government and into the hands of private insurance companies.  Obamacare (ACA) also delivers improved quality of life due to access to health care, unattainable for most Americans due to cost -- a significant benefit to society. Finally the most compelling argument for the ACA is our inability to call the United States the greatest country when our healthcare expenditures are the highest in the world and millions of our citizens lack basic insurance coverage.  The Affordable Care Act still needs revision, but it is a much needed improvement over the previous status quo.

Thanks to Elizabeth Eastmond for her edits.

A great example of our nation’s partisan politics is the careless discussion of the Supplemental Nutrition Assistance Program (SNAP) or food stamps. Lately there have been several measures passed by the House of Representatives which feed on misinformation or play upon voter’s perceptions. As citizens we are left to dissect rampant talking points and blatant fabrications with little help from our media outlets. In general, misinformation has become a lucrative industry with talk show hosts, pundits, and politicians selling unsubstantiated data and twisted logic.  This leads to conversations driven by 45 second sound bites, 140 character tweets, and out-of-context statements which are shallow and divisive. 

SNAP has expanded rapidly under the Obama administration making it a popular talking point with right-wing pundits.  The guilty-by-association rhetoric leaves out critical information needed to understand the trends, and focuses entirely on the “what” and not the “why”.  Republicans are correct to point out food stamp participants have grown 65 percent since 2008 increasing spending to an all time high of $74B (2 percent of budget), but when asked the cause they fall into the trap of popular propaganda.  They do not know that 50 percent of food stamp recipients are under the age of 18, or 15 percent are elderly. They do not understand that 20 percent of food stamp households support the disabled. They incorrectly believe that President Obama has passed legislation that enables the expansion of the program or incentivizes participation.

In addition, Republican's association of food stamps with left-leaning blue states lacks credible data.  The highest SNAP participating state is Mississippi with 22.5 percent of their residents receiving assistance.  7 of the 10 highest SNAP participating states are red and primarily in the South. The state with the most people on food stamps is Texas, which is surprising given California has 12 million more residents.  Even the reddest of states, Utah, has seen participation double in the last five years (from 5 percent to 10 percent).  Regardless of state targeted data, food stamps are distributed somewhat evenly. Currently 16.8 percent of red state residents are receiving food stamps compared with 14.3 percent of blue state residents.

The solitary driving force behind the expansion of SNAP was the rapid unemployment spike from 2008 - 2010 which led to more households applying for assistance.  In the final year of President Bush’s administration unemployment jumped from 4.9 percent to 8.7 percent and continued to 9.8 percent under President Obama.  The doubling of the unemployment rate corresponds with the doubling of food stamp participants under President Obama’s tenure.  As families were left without employment they turned to the government for support.

It is not fair or reasonable to hold the Obama Administration accountable for SNAP participation increases.  It is fair to hold the Obama Administration accountable for households leaving the program now that unemployment is improving (7.8 percent).  Moving people off of government assistance is a sign of progress and should be the desire of every Democrat who understands the bridging role of social programs. However, decreasing participation needs to be persuaded, not forced, as any mandated cut in SNAP will disproportionately impact the elderly, disabled, and children.

Food stamp talking points, like all issues, need to be challenged and understood.  Focusing too quickly on the “what” will lead us into a partisan spin zone and dull our problem solving ability.  We need to ask the right questions, understand the impact of our choices, and weigh the impact to our fellow citizens. Accepting popular talking points to support an ideology is not only disingenuous, but undermines the need for solution-oriented conversations to tackle our country’s major challenges.

The American people and press have been slapping the suffix “gate” on any real or pretend political scandal since the famous political burglary at the Watergate Hotel in Washington, D.C. That “second-rate” burglary was followed by obstruction of justice in several ways; the payment of cash money from illegal campaign funds to silence the burglars hired by Nixon campaign officials, the attempt to have the CIA cut off the FBI investigation by claiming it was a national security operation arising out of the conflicts with Cuba, the destruction of investigative records by high officials of the FBI, perjury, and various other political dirty tricks in support of Nixon’s reelection in 1972. This led to Nixon’s resignation while articles of impeachment were being prepared.

One of the less known fall-outs from the initial “gate,” was that Senator Frank Church, Democrat of Idaho, headed a committee to investigate the intelligence agencies of the United States. The Church Committee was wide-ranging and delved into and exposed such activities as attempts to poison Fidel Castro with his own cigars (like exploding cigars out of the Three Stooges) to the less humorous wire-tapping and letter-opening by FBI Director, J. Edgar Hoover who tried to link the Civil Rights Movement to a world-wide communist conspiracy. The Church Committee was certainly controversial in many respects but it was also bi-partisan and investigated abuses in both Democratic and Republican Administrations. There are legitimate doubts as to whether the current House Committee on Benghazi has the same bi-partisan interest or possibly represents the political and constitutional threats of Watergate itself.

"You will see the Constitution of the United States almost destroyed. It will hang like a thread as fine as a silk fiber.... I love the Constitution; it was made by the inspiration of God; and it will be preserved and saved…” – Attributed to Joseph Smith, May 1843

Across congregations of the Mormon Church the above quote has become a rallying cry among the conservative members. I have been approached by several wanting to discuss the destructive nature of the Constitution by our current administration. “Today the constitution hangs by a thread,” always concludes each episode as the definitive reason for their political posturing.  Stepping aside from the fact that the bloody Civil War was on the horizon in 1843, which truly challenged the foundation of the Constitution, there is merit to this quote today.

The Framers designed the Constitution to equalize representative power across the states, strengthen the voice of the minority, and drive equality. The Senate functions as a contained democracy using majority rule, with equal representation across the states regardless of population. The House is designed to represent the people, equalizing votes across the collective population of our country. The House Representatives are “of the people” with short two year terms to align with the changing demands of the constituents they represent. The Framers designed our government with an inspired balance of power, representing the minority to a point, and using the legislative branch as a check for executive power.

Two changes in rules and actions threaten the balance of the Legislative Branch and the Constitution today. The filibuster changes the entire intent of the Senate and gerrymandering has removed the representative equality of the House. Our government has moved to an extreme representation of the minority which suffocates the will of the majority. In the Senate, Senators representing a mere 20 percent of the population can stop legislation and bring the chamber to a crawl. In the House, a populous minority retains control and abuses their influence to table popular legislation and misdirect funding.

The Senate filibuster is not found in the Constitution and was first used in 1837 exploiting a change in debating rules made in 1806. The filibuster was used just a handful of times until 1970, and as a last resort. Today it is part of the process on almost every bill or appointment. What the Framers intended to be a simple majority in the Senate has now become a 60 vote super-majority. Couple this with the already imperfect representative balance of the Senate, and it is easy to understand why gridlock has ensued.

Today Republicans use the filibuster to oppose legislation and bring the legislative process to a crawl. There have been several bills these past four years, that after receiving the 60 votes needed to end the filibuster, passed 99-0. One of the most egregious examples came last December when Republican Minority Leader Mitch McConnell filibustered his own bill wasting time and tax payer resources. The real problem with this obtuse Senate rule is 40 minority Senators can represent less than 20 percent of the US population. Eliminating the use of the filibuster still meets the intent of minority representation as 45 Republican Senators represent 30 percent of the population.

On the other side of the Legislative Branch the House has deviated from Constitutional intent due to progressive gerrymandering by Republican governors. As the majority of the states were controlled by Republicans after the 2010 census, a $30 million dollar redistricting action plan was executed further skewing the House’s representative characteristics. In 2012 there were 1.5 million more votes for Democrats yet there are 33 more Republican Representatives in the House. The US is 64 percent white but 4 percent of Republican Congressman are minorities. 51 percent of the population are women but only 8 percent of Republican Representatives. The abuse of redistricting is so widespread I see little chance of overturning House control even with a healthy voting majority in the near future.

Between the House and Senate actions by the minority party it’s easy to understand why the Constitution is being tread on. The American government has been hijacked by a party that relies on abusing rules and redistricting to push an unpopular agenda. Legislation like firearm background checks and immigration reform should be a slam dunk given the overwhelming support by the majority of the people, but the government has failed to perform even the most mundane functions. The Constitution is crippled and the balance of power upset because the minority party does not respect the Framer’s intent.

In Mormon congregations across the country my Republican friends are correct; Joseph Smith’s quote is just as applicable today as it was at the time of the Civil War. The Constitution hangs by a thread and they are the ones holding the scissors.

Recently the US Senate fell short of passing the most reasonable gun control measure ever brought to the Congressional floor by six votes (54 votes -- just a few shy of blocking a filibuster).  The legislation was centered on closing background check loopholes involving private sellers at gun shows and through online sales.  The legislation would not create a national registry of gun owners (although this was the main point of the disinformation campaign of the NRA), nor did it ban any specific weapon or magazines.  The legislation was written by a bi-partisan senatorial duo, Republican Pat Toomey and Democrat Joe Manchin, and was supported by 85%-90% of American citizens according to every major poll.

Currently there is a background check system in place that is used by all licensed sellers.  In the past year there were 150,000 firearm applicants denied.  Since 1994 a staggering 1.9 million applicants have been rejected.  These applicants were denied because of mental illness, criminal record, drug usage, illegal alien status, domestic abuse, and various other reasons.  Even more telling, only 1% of all firearm rejections are ever appealed; revealing the applicant always complied with the verdict.

Even in the face of such overwhelming data I have heard opinions from several friends that background checks do not work, and a criminal will find a way to purchase a gun regardless of laws.  This same type of argument was used against The Brady Bill in 1994 in regards to waiting periods.  President Ronald Reagan responded “Critics claim that ‘waiting period’ legislation in the states that have it doesn't work, that criminals just go to nearby states that lack such laws to buy their weapons. True enough, and all the more reason to have a Federal law that fills the gaps.”  Background check legislation, like the Brady Bill legislation, is designed to “fill the gaps."

It appears that Congress has fallen for the faulty logic of the opposition.  While I agree with critics that motivated criminals will find ways around laws, they will have a tougher time navigating market dynamics.  If background checks prohibit a single purchase, the price of firearms will rise for those unable to go through licensed sellers.  A criminal will have to find a different way to acquire a weapon than from an online seller or an unlicensed dealer at a gun show.  Expanding background checks will also facilitate responsible sales between family, friends, and acquaintances.  These constraints on the supply will have negative pressure on price, and increase the risk of a potential gun buyer being caught through illicit acquisition.

If opponents to background check legislation believe that any such law is inefficient and impacts our second amendment rights, would they be willing to support a total repeal of all background checks?  Highly unlikely.  Why? Because opposing this legislation has little to do with the implied efficacy of the law or the second amendment, and more to do with political ideology.  Background check legislation died with the divisive spirit of our representatives, who would rather shoot themselves in the foot than shake hands in the center.

The primary election process is the greatest cancer on our political landscape.  They have become a moral issue, driving politicians to make choices based on survival instead of reasonable policy and personal conviction.  Primaries have driven moderate thinking out of the mainstream, and created an environment where compromise is the new four letter word.  Primaries are the breeding ground for ideologues who pander relentlessly to the small selection of voters showing up to the preliminary polls.  The primary system trades strong candidates for weak ones, swaps reasonability with extremism, and switches compatibility for hostility.

Although both parties are faced with the primary gauntlet, the Republican Party seems to be disproportionately impacted.  Over the last two elections Republicans have given up potential control of the Senate, two presidencies, and the potential ousting of Majority Leader Harry Reid due to Tea Party meddling.  There have been five different Senate seats that have either flipped or maintained Democrat control due to weaker Republican candidates beating stronger, more electable, Republican candidates in the primaries.  For example, in the race for the presidency, both McCain and Romney had to move away from their moderate rhetoric seeking party election, which crippled their electability in the general election.  Romney specifically moved from a being a “compromising moderate” to "severely conservative".

The Media National Journal has tracked conservative and liberal members across parties for several decades.  In 1982 the Senate had significant overlap in their political leaning.  The eleventh most liberal member of the chamber was a Republican, Lowell Weicker. The thirty-first most conservative member of the chamber was a Democrat, Edward Zorinsky.  In between these two men fell fifty-eight Democrats and Republicans, each committed to their party and to their constituents.  The House of Representatives shared a very similar markup, with over 60% of the members falling between the most conservative Democrat and the most liberal Republican.  It was under this environment that President Reagan found significant compromise with Speaker Tip O’Neill passing tax laws and social reform.

Today there is significant polarization in political representation which accentuates gridlock and divides government.  Political representatives know that any give and take will be fodder for the next primary, and grounds for unemployment. One idea to cure Washington’s curious dysfunctional behavior is opening up primary elections to independents.  We should also consider California’s primary system where the top two vote-getters run against each other in the general election.  Whatever the solution, we voters need to line up at the polls in the summer like we do in the fall.  We need to elect candidates that will be reasonable and thoughtful government representatives, beholden only to those that elected them, rather than a proscribed ideology.

When Barack Obama was re-elected to the presidency last November, House Speaker John Boehner observed, "the American people have spoken. They have re-elected President Obama. And they have again elected a Republican majority in the House of Representatives." Republican House Minority Leader Mitch McConnell noted that the voters, "have simply given [Obama] more time to finish the job they asked him to do together with a Congress that restored balance to Washington after two years of one-party control." President Obama was re-elected with nearly 5 million more votes than Mitt Romney. Democrats deepened their grip on the Senate by capturing two additional seats. Democrats also gained 8 seats in the House, but were far from recapturing it.