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Dan Rodricks: For Marylanders 18 to 34, a deal on health insurance and a brief history lesson | COMMENTARY

Local and regional leaders gathered to encourage uninsured Marylanders to sign for affordable health insurance coverage during a press conference in Ellicott City on Oct. 28.
Local and regional leaders gathered to encourage uninsured Marylanders to sign for affordable health insurance coverage during a press conference in Ellicott City on Oct. 28. (Brian Krista/Baltimore Sun Media)

If you are between the ages of 18 and 34 and do not have health insurance, the bottom of today’s column is for you. It’s a public service announcement about how to get insured at an incredible discount for a limited time and a limited time only. You’ll find the PSA in the penultimate paragraph. You can jump down and read it now, but, if you do, you’ll miss what I’m about to say about Democrats, Republicans and the quality of American life. It’s up to you.

Now allow me to provide some perspective on the headache-inducing mess in Washington over federal spending and President Joe Biden’s Build Back Better agenda. The last time we went through something like this — something big and bold and opposed by Republicans — we got health insurance for 20 million Americans. While the congressional calculus was different at the time, there’s still a lesson in recalling the fight over Obamacare: Big and bold can pay off.

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Going back nearly five decades, this country debated national health insurance for the millions of Americans who had none. That it totally made sense — a federally subsidized program, something like Medicare, that would make more people healthier and maybe even cost the rest of us less in premiums — made no difference. Fierce resistance came from Republicans who saw it as a costly expansion of the social safety net established during the New Deal. The opposition continued into the 1990s, when the Clinton plan for health insurance faced withering criticism from the right and crashed on takeoff.

Republicans resisted reforms into the 21st century and the Obama administration, and it made no difference that the market-based concept that was proposed had been a design of conservatives. But with a Democrat in the White House and Democratic majorities in the Senate and House, the Patient Protection and Affordable Care Act became law in March 2010.

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Constant attacks in Congress and the courts by Republicans, conservative think tanks and well-funded legal teams followed. But the ACA survived, and the number of uninsured Americans declined by 20 million (from about 50 million when Barack Obama became president).

During the Trump years, the number and percentage of uninsured started to creep up again. But we’re in a much better place than before the ACA. And even more Americans would be insured had Republican governors not refused Medicaid expansion for their low-income constituents and had congressional Republicans not tried repeatedly to kill the law. (Maryland Rep. Andy Harris, the state’s only Republican in the House, voted to repeal the ACA dozens of times though thousands of people in his district, including some of the poorest in the state, had signed up for insurance under the law.)

I mention all this because of where we are today, with another fight in Washington over whether the federal government should promote or seed major efforts to improve the lives of Americans at the low or middle rungs of the nation’s income ladder. Again, it’s Republicans (and a couple of ridiculous Democrats) who say no to a bold progressive agenda, even though many of their own constituents would benefit from it just as they did when the ACA went into effect.

Once upon a time, I seriously considered Republican concerns about government spending and budget deficits. But a party that gives tax cuts to the wealthy and corporations every chance it gets, a party that resists any progressive idea for the sake of partisanship, has no credibility.

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Susan Collins, the Republican senator from Maine, said Democrats made a “big mistake” when they passed the ACA without a single Republican vote.

Did they? If the opposition is strictly partisan and not about substantive objections, and if the stakes involve the actual quality of life in America — whether a person can afford a medical procedure, whether working parents can afford child care — then why is bipartisanship so precious?

Democrats are stuck right now, and Biden’s domestic agenda has been reduced in the push and shove of the last few weeks. But, as with the ACA a decade ago, if anything good comes out of this mess, it’s all on the Democrats. Republicans, on the other hand, are the do-nothing party; if they had their way, we’d still have 50 million uninsured Americans. Until more voters, particularly those in the working class, recognize the problem with that, we won’t see the big breakout in life quality that the nation deserves, yearns for and can well afford.

In Maryland, meanwhile, things are better because of the ACA and the establishment of the state’s health insurance exchange. In general, the percentage of uninsured is now about 6%. That’s down from 12% a decade ago. That’s good, but it could be even better if younger Marylanders get the following message:

If you are between the ages of 18 and 34 and still don’t have health insurance, you should look into it this month. There are millions of dollars in new subsidies, from the state and federal governments, that will make health insurance even more affordable, as low as $1 a month for someone making $30,000 a year. People making up to $50,000 a year are eligible for the discounts. For more information, go to marylandhealthconnection.gov.

There now. I provided some history and political perspective and gave a little personal advice. My job is done here. Go Ravens.

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