Point Austin: The Irresponsible Opposition

U.S. Health and Human Services Secre­tary Kathleen Sebelius made a whirlwind visit to town last week, part of a multicity tour to help plan and promote the Oct. 1 rollout of the federal Affordable Care Act. She met with local officials and health care professionals, then held a brief City Hall press conference to declare that "Obamacare" remains on track to provide health insurance coverage to millions currently without it. More specifically, she anticipated the insurance "exchanges" – online policy markets to be available at healthcare.gov that will allow people without employer-based insurance to compare plans and purchase coverage – to begin Jan. 1, 2014. Sebelius said that early feedback – in states that have been proactive in setting up the exchanges – reflects costs coming down due to competition, that nationwide as many as 120 insurers are entering the markets, and that applicants should have as many as 15 plans to choose from when the exchanges are up and running.

By right and logic, of course, Sebelius should have been meeting with state officials, collaborating with a Texas effort to develop a state exchange. Instead, Gov. Rick Perry had already issued a sneering dismissal of the secretary's visit before she even arrived. "Today, Secre­tary Sebelius is back in Texas to again explain the increasingly convoluted and increasingly delayed implementation of the federal exchange system," declared the governor in a press release. "With due respect, the secretary and our president are missing the point: It's not that Amer­icans don't understand Obamacare, it's that we understand it all too well. In Texas we've been fighting Obamacare from the beginning, refusing to expand a broken Medicaid system and declining to set up a state health insurance exchange."

Meanwhile, Perry's would-be successor, Attorney General Greg Abbott, also used the opportunity for some grandstanding: "Obamacare is the wrong prescription for American health care, and I will never stop fighting against it," he told Capitol reporters. "We don't want a sales job from Secretary Sebelius. We just want employers and employees, doctors and hospitals, to be able to continue doing their jobs."

Cruz Control

Perry and Abbott have nothing on fledgling Sen. Ted Cruz, who has been demagoguing Obamacare on the wannabe presidential stump. Denouncing Sebelius' "Obama­care promotion tour," Cruz claimed the prospect of expanded health care has forced employers to cut jobs and work hours, and will raise premiums or cause "young Texans" to "lose their current health coverage." "Texans know better," he declared. "They want Obamacare defunded and repealed. I am committed to working with my colleagues in Congress to do just that."

Cruz has embarked on that quixotic task with all the energy of a Fort Stockton weatherman predicting rain, and with about as much prospect of success. But the point, of course, is not so much to repeal Obamacare – no more than the 40 House votes to do the same – as to sabotage its implementation, and to rile the hard-right GOP base while he's at it.

Note that neither Perry, nor Abbott, nor Cruz, while they feverishly denounce the existing federal law, have anything to offer in terms of actually improving or expanding health care for the more than six million Texans who have no health insurance and rely instead on desperate and expensive emergency care. Indeed, Perry has spent his administration blocking any expansion of Medicaid, and in a symbolic but dishonest war on Planned Parent­hood, with the help of the Republican-dominated Legislature, he has done whatever he can to unravel the Women's Health Program, leaving many thousands of women and their families without access to basic health care services.

The Party of No

This is not at all to say that Obamacare is a perfect solution for Texas health care, nor that the existing law couldn't be improved by an active involvement of the people most dissatisfied (on the left as well as the right), as in the past has been routine with new federal legislation. Those of us who have already enjoyed the law's early benefits – e.g., coverage of children until age 26 – can testify that even small changes can mean a great deal in peace of mind. And those of us who have family members with no job-based insurance – or who are being kept on short hours by employers unwilling to provide benefits – know what it's like to fear medical emergencies without recourse, and to risk financial disaster.

In that context, it makes perfect sense that Sebelius should be consulting with local officials, for the actual costs of this state's abdication are pushed down upon local communities, where we all pay exorbitant rates for uninsured emergency coverage. Travis County has responded, to a degree, through our Central Healthcare District, which over time should make it easier to handle the preventative and emergency burdens for which state government accepts no responsibility.

Once upon a time, opposition parties accepted their obligations to governance, and to do what they could to improve laws they found faulty or inadequate. The current Republican Party, as exemplified in its Texas leadership of Perry, Abbott, and Cruz, looks at substantive national crises – like 48 million Americans without health insurance – and offers only one, irresponsible answer: No.