First, lest my point here be misinterpreted as a condemnation of the Affordable Care Act, let me state emphatically and unequivocally that I support the ACA. Let me take that back just a bit. I support it with all the enthusiasm that any of its strongest supporters do. That is, it is the best system we have devised so far. No one says it is perfect. In a real sense, the ACA is the grandest of policy inkblot tests: for better and for worse, it elicits what each viewer is predisposed to see.
That said, I do not believe I have seen the following commentary elsewhere. One of the most common talking points from the left against the stillborn Republican “alternative” was that it amounted to a huge tax break for the wealthy. It was ‘reverse Robinhood.” It took from the poor and gave to the rich.
It would have.
Think about this for just a moment and you will see what this inherently implies. The ACA took from the wealthy and gave to the poor. It contains multiple taxes that redistribute costs of care. In many circles, this is an inconvenient truth.
There are many examples of taxation within the ACA, but here I will point to the most obvious and irrefutable. I mean the tax that saved the ACA when it went to the Supreme Court in 2011. Though I was delighted by the result, my response to that inkblot of a decision was that Roberts proved to be a consummate contortionist. The key results were that (a) the individual mandate at the federal level is legal and (b) the mandate for the states to “accept” the Medicaid expansion is not. But (a) occurred because, by definition, the mandate is a tax.
The individual mandate is a tax. “Chief Justice Roberts delivered the opinion of the Court…concluding that the individual mandate may be upheld as within Congress’s power under the Taxing Clause….the shared responsibility payment may for constitutional purposes be considered a tax…the payment is not limited to willful violations, as penalties for unlawful acts often are; and the payment is collected solely by the IRS through the normal means of taxation…It may also be read as imposing a tax on those who go without insurance. (NFIB et al., v. Sebelius, Decided June 28, 2012).
Actually, the mandate is perhaps the most regressive tax imposed by the ACA. And it carries the cynically euphemistic label “shared responsibility.” This is the tax those on the left — erstwhile defenders of individuals who can least afford added financial burdens — should be most offended by. However, it is well known that the ACA rests on this essential leg in its structure. Without the mandate (or mechanism creating the same result), the system really will collapse. Everyone has to be in.
Beyond the individual mandate, the rest of the taxes in the ACA go to those whom its architects believed “could afford” to pay, or “should pay” or with whom they could get away taxing — device manufacturers, employers, employers who offer “Cadillac plans,” tanning salons, others. And most of the beneficiaries are at various levels of limited means to cover their own costs to purchase insurance.
The left needs to candidly admit the redistributive nature of the ACA by taxation to those of more limited means. Such candid declarations are not common. It would be much more honest and helpful in the broader discussion of whether and how to provide access to care to those among us who cannot afford it to admit that the ACA’s fix was to take from everyone — especially those who “could” and “should” afford it — and transfer that to those less able. Not admitting this is frankly hypocritical, especially when the discussion moves readily to decrying the late Republican “alternative” as a “tax break for the wealthy.”