Barack Obama signs the Affordable Care Act into law in 2010. (AP Photo/J. Scott Applewhite, File.)
A key project of Obama’s second term will be implementing the major legislative accomplishment of his first term: the Affordable Care Act. Friday ended up being an unusually eventful day on this front.
First, the Department of Health and Human Services announced a slight compromise on the issue of contraception coverage under the new health laws—the issue that thrust Sandra Fluke into the spotlight last year. Under the compromise  announced back in February, churches would be able to opt out of the contraception coverage requirement entirely, and nonprofit religious-affiliated institutions would not have to cover employees, but their insurers would.
That principle remained largely intact, with two minor tweaks. First, a slightly larger group of non-profit religious-affiliated employers can opt out of paying for contraception coverage. Until now, there were four basic litmus tests  for which organizations could opt out, and have their insurer pay the contraception coverage costs instead:
the inculcation of religious values is the purpose of the organization
the organization is a nonprofit organization
the organization employs persons who share the religious tenets of the organization
the organization employs and serves primarily persons who share its religious tenets
The new qualifications are that the organization
holds itself out as a religious organization
is organized and operates as a nonprofit entity
opposes providing coverage for some or all of any contraceptive services required on account of religious objections
self-certifies that it meets these criteria and specifies the contraceptive services for which it objects to providing coverage
Importantly, the administration has refused to let for-profits opt out of contraception coverage, which some big chains like “Hobby Lobby” sought.
The other changes are still significant, however. Instead of needing to be an organization with primarily religious employees and patrons, objecting organizations must only have some sort of religious objection and “hold itself out as a religious organization”—a rather loose criterion, and one the organization is allowed to self-certify.
That said, even if a nonprofit opts out, employees are still guaranteed contraception coverage under the new rules—though HHS did tweak requirements about who pays for it. Instead of the objecting organization’s insurer picking up the tab, which religious nonprofits objected to on the grounds their premium payments would still be used for contraception, the insurance company must set up a third-party payer.
Reproductive rights groups were not bothered by the changes—NARAL, for example, said in a statement that it remained “optimistic that these new draft regulations will make near-universal contraceptive coverage a reality.”
But the administration made another decision on the Affordable Care Act on Friday that is far more pernicious—one that will, in the words of The New York Times, “deny federal financial assistance to millions of Americans with modest incomes.”
One basic premise of the ACA is that if someone can’t afford health insurance, the government will help you get it by providing subsidies. The administration has now decided to judge affordability based only on the cost of coverage for an individual—not his or her entire family.
So in other words, perhaps you can afford health insurance for yourself, but not for your spouse and three kids. In that case? Tough luck. No subsidies.
Advocates for expanded coverage are not pleased :
“This is bad news for kids,” said Jocelyn A. Guyer, an executive director of the Center for Children and Families at Georgetown University. “We can see kids falling through the cracks. They will lack access to affordable employer-based family coverage and still be locked out of tax credits to help them buy coverage for their kids in the marketplaces, or exchanges, being established in every state.”
A (very small) consolation is that the administration simultaneously ruled that families that fall into this trap will not face the tax penalties otherwise levied on those who don’t obtain health insurance. That’s good, but it’s also an open admission that the administration is quite aware of the coverage gaps that will be created by the new affordability guidelines. The White House is likely trying to bring down the cost of the ACA by reducing subsidies, but with disappointing collateral damage to millions of people that need health insurance.
A final interesting development broke  in Politico Friday morning: Organizing for Action, the new 501(c)(4) version of Obama for America, is teaming up with another group headed by insurance company executives and ex-administration officials to mount a campaign to get Americans to buy insurance. They’ll run it just like a political campaign:
They plan to use it to unleash the 20 million-address strong email list of Organizing for Action, to hire up to 100 people at Enroll America and to flood television, radio and social media with ads this fall. They even hope to go door to door, walking people through the sign-up process. “This is going to be run like a political campaign,” said Families USA Executive Director Ron Pollack, who helped conceive and fund Enroll America in 2010 and is chairman of the board.
There are several elements of that plan destined to provoke grumbling among lefties, but if you accept the already-settled premise that the ACA isn’t a single-payer healthcare system, this is a largely positive development. The more people that sign up for health insurance, the cheaper it will be for everyone else. And there are much worse things Organizing for Action could be getting involved with besides trying to rebut the idea, dutifully stirred by conservatives for years now, that Obamacare is a terrifying contraption that ought to be avoided.
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