WASHINGTON ― Republicans and various conspiracy theorists have said a lot of crazy things about the Affordable Care Act. Think death panels or microchips embedded under your skin. But Sen. Bill Cassidy (R-La.) appears to have come up with a brand-new one: Americans abuse heroin and painkillers because of Obamacare.
Yes, he actually made this argument.
Because it’s not enough for conservatives to say that the Affordable Care Act raised health insurance prices for some people, or that it costs the government too much money, or that the federal government shouldn’t legally mandate that people get health coverage.
No, when it comes to Obamacare, no accusation is too far out there, including blaming a law that expands health coverage for poor and middle-income people for a massive, deadly outbreak of drug addiction. We’ll come back to this in a moment, but some context is needed.
Cassidy appeared Monday at a Washington Post event, where editor Marc Fisher interviewed the senator, who is a physician, about health care. Fisher asked Cassidy about a disturbing report this month from the Centers for Disease Control and Prevention showing U.S. life expectancy declined last year for the first time in decades.
Cassidy responded by implying that Obamacare is a scam because Americans haven’t become immortal, or something.
“We were told that people were dying because they didn’t have health insurance. Now we have record numbers of people insured and our mortality rate has increased and life expectancy has decreased,” Cassidy said. “It kind of gives lie to the fact that somehow we’re going to enter into a wonderful new world once Obamacare was implemented.”
The fact that a man with a medical degree doesn’t seem to know the difference between correlation and causation is disconcerting. (”Doc Cassidy, it was raining when I got this rash.” “Well, rain obviously causes rashes. My prescription is you move to the desert.”)
Also bad is the logic behind an argument that a health insurance expansion that failed to improve life expectancy in less than three years means having health insurance has no effect on health. (”Doc, I’ve been on chemotherapy for almost five minutes and I still have cancer.” “Well, chemo obviously doesn’t work. Back to the drawing board!”)
OK, now let’s return to the opioids thing. Cassidy cited economic anxiety as the cause of “despair,” to which he attributed the rise in suicides among middle-aged white people and the opioid crisis. That seems fair enough, although it’s pretty hard to prove or disprove, and researchers aren’t actually sure why life expectancy went down.
But none of that matters, because this is when Cassidy’s Obamacare Derangement Syndrome flared up.
The law, Cassidy explained, requires businesses to provide health benefits to employees who work at least 30 hours a week. To avoid giving people health care, he continued, companies reduced workers’ hours. (This assumption is based on a huge exaggeration. More on that later.)
Here’s where Cassidy went next:
Those folks can no longer have a living wage. I think it’s easy to imagine those folks in despair, those folks perhaps going on disability, those folks perhaps becoming addicted to opiates. I can go on, but it’s easy to imagine.
No, please, go on.
This is how a United States senator, who is a doctor, explains a decline in life expectancy. Take a moment and contemplate the chain of events Cassidy outlined:
- President Barack Obama signs the Affordable Care Act (2010).
- Some companies reduce some employees’ hours when the “employer mandate” takes effect (2015).
- Despair. Something about disability benefits? (date unknown)
- America has an opioid addiction epidemic that now claims 78 lives a day, according to the Centers for Disease Control and Prevention (2000-2016).
- Bill Cassidy sits down with Marc Fisher for an interview (2016).
It’s also “easy to imagine” lots of things, because the human mind is an infinite playground.
For example, it’s easy to imagine people addicted to heroin or opioid pain medications getting treatment because Obamacare expanded Medicaid to more poor people ― including more than half a million Louisianans ― and offered others subsidies for private insurance. In fact, one doesn’t have to imagine this because it actually happened in real life.
Now back to those assumptions about what Obamacare did and didn’t do when it comes to workers. This is how Cassidy described it:
“There are employers who responded to the employer mandate by reducing the hours of their lower-paid workers from 40 hours a week to 30 hours a week to escape the mandate. And folks say, ‘Oh, no, it didn’t happen.’ Yes, it did. First, we look at in my office, look what the the Federal Reserve of New York did,” he said.
There are, in fact, some unknown number of workers who lost hours, and some businesses cited the employer mandate for that change.
Last year, FiveThirtyEight estimated this may have happened to a “few hundred thousand workers” of the roughly 150 million people in America with jobs. And in 2014, Investor’s Business Daily kept a running tally of companies that had announced plans to cut hours, although the newspaper stopped updating its count, so there’s no way to know what those employers are doing now without surveying all of them.
Nevertheless! The U.S. economy has been on a record streak of month-to-month job creation since February 2010, during which 15.5 million new jobs came into existence. Last month’s jobs report showed the unemployment rate to be 4.9 percent, down from 9.7 percent in February 2010.
And just what did the Federal Reserve Bank of New York have to say about the Affordable Care Act and part-time jobs? The bank conducted two surveys of New York-area companies about how they were adapting to the Affordable Care Act and released its findings in August. Here’s what the New York Fed concluded about the question of companies shifting from full-time to part-time employees because of Obamacare:
The vast majority of respondents in both surveys said they were not changing the proportion of part-time workers or the amount of work outsourced to other firms.
The data have been clear for some time now that, despite Republican rhetoric, the economy is not shifting toward widespread part-time jobs for workers who would rather work full time, because of Obamacare or anything else.
These two charts show the share of workers with part-time jobs who want more hours dating to the beginning on Obama’s presidency in January 2009, and to the enactment of the Affordable Care Act in March 2010, via the Federal Reserve Bank of St. Louis.
Every trend comprises the individual stories of businesses and workers across the country, so those people ― however many of them there are ― who lost hours because their employers didn’t want to provide them with health benefits are included in the data that made up the charts above.
Yet it’s impossible to look at the lines on those graphs and make the deductions Cassidy did about employment, “despair” and opioid addiction on any kind of scale. It’s almost as though he began with his conclusion ― Obamacare is terrible ― and worked his way backward.
(Finally, for anyone who thinks these quotes from Cassidy may have been taken out of context, this is his entire exchange with Fisher. Video is available here.)
Fisher: There was a report last week from the National Center for Health Statistics that showed the life expectancy in America is actually declining ― the only Western, industrialized country in the world where that’s happening. And it’s happening among white men, white women and black men alike, and it’s happening despite the decline in the death rate from cancer and despite a decline in smoking. When you see that, what does it say to you about the quality and availability of health care in this country?
Cassidy: First, we were told that people were dying because they didn’t have health insurance. Now we have record numbers of people insured and our mortality rate has increased and life expectancy has decreased.
Fisher: So, we should have less health care?
Cassidy: No, but I think it kind of gives lie to the fact that somehow we’re going to enter into a wonderful new world once Obamacare was implemented. And I say that not with joy. I say that with kind of ― those are my patients. Those are working families who now have been unemployed.
Proverbs said, “The people have no hope, they despair.” And in their despair, the suicide rates among white men and white women who are middle-aged and above is at all-time highs. The opioid epidemic is incredible. The metabolic syndrome ― if you will, another form of addiction, a cohort addiction, if you will ― is also kind of limiting life. I think it’s incredibly sad. We need our economy going again.
Going back to how I started ― maybe, I think, I mentioned this earlier ― there are employers who responded to the employer mandate by reducing the hours of their lower-paid workers from 40 hours a week to 30 hours a week to escape the mandate. And folks say, “Oh, no, it didn’t happen.” Yes it did. First, we look at in my office, look what the the Federal Reserve of New York did. Not if you look at all workers. Of course it doesn’t apply to a CEO or an engineer. It applies to that lowest quintile. Those people who are already paid the least because those are the folks whom a mandated benefit substantially increases their wage. Therefore, it was decreased. Example after example.
Those folks can no longer have a living wage. I think it’s easy to imagine those folks in despair, those folks perhaps going on disability, those folks perhaps becoming addicted to opiates. I can go on, but it’s easy to imagine. Again, these are patients ― for 30 years I had patients like this who were addicted in the kind of scenario I described. I think we have to give them hope. We have to give them hope.
Fisher: Well, along the lines of that comment, there was a fascinating analysis last week of the election that showed that Donald Trump performed better than Mitt Romney had four years ago in many places, but he compared best of all to the Republican nominee from four years ago in those counties that have the highest drug, alcohol and suicide mortality rates, and that sounds awfully like a mandate to attack the heroin and opioid abuse problems that ravage so many American communities. So what do you see the incoming administration doing on that front to make a real difference?
Cassidy: It doesn’t surprise me. Going back to my practice ― kind of a working-class practice. And if you listen to them, if you hear what they’re saying, but also if you look at the statistics. Statistics are that when employment decreases, the number of people on disability goes up, and as the disability population goes up, you end up with a kind of ― you’re permanently unemployed. And statistic after statistics, it’s an inverse relationship. Employment goes down, lagging but going up concomitantly would be the number of people on disability. Those folks want hope.
When the people have no vision, they despair, and they want a vision of America that will give them their lives back. Good jobs, good benefits, a job to go to, every morning kissing their wife or their husband goodbye, dropping your kids off. And now they stay at home with nothing to do. We need an economy that works for them again.