Saturday morning we sat in on U.S. Rep. Michael Burgess’ presentation, “The Case Against Obamacare.” Overall I thought the discussion lacked clarity. Both Rep. Burgess and moderator Scott Braddock seemed more interested in a discussion of the politics surrounding the bill than its merits as a policy measure. I was encouraged by the audience participation and for the most part it seemed like the people in attendance had a pretty nuanced understanding of the implications of the Affordable Care Act (ACA ) for Texas.

Rep. Burgess’ argument is very much opposed to the ACA, but provides little in the way of a positive account for how health care reform should look. Burgess takes issue with the individual mandate to purchase health insurance on ideological grounds and asks why his liberty –presumably to opt for not purchasing health insurance– should be compromised because other people are incapable or unwilling to buy insurance. He also adamantly disagrees that expanded Medicaid coverage, with its low reimbursement rates and narrow scope of coverage, is the correct method for insuring more Texans.   Instead, Rep. Burgess would make health care more “personal” by encouraging the purchase of largely private insurance policies. He indicated that once an individual has some “skin in the game” they are more likely to make rational decisions regarding their health.

Under the ACA traditional Medicaid will only expand to cover individuals and families up to 133% of the poverty line. A much larger cohort of people between 133% and 400% of poverty will receive federal subsidies on a sliding scale to help purchase insurance in state-regulated exchanges. This of course is consistent with Rep. Burgess’ insistence on people having “skin in the game.” Audience members also noted that the theory that people make more economically informed decisions about their health if they contribute to the cost of health care really only works in the context of acute illness. It often does not translate to more severe chronic conditions like many serious mental illnesses.