“Obamacare Is Killing The GOP”: Republicans’ Opiate Obsession With The Law Will Be The Party’s Undoing
It’s not an exaggeration to say Republicans have bet their future on the disaster they expect from Obamacare. “The implementation of the law over the next year is going to reveal a lot of kinks, a lot of red tape, a lot of taxes, a lot of price increases,” RNC spokesman Brad Dayspring told The New York Times last month. “It’s going to be an issue that’s front and center [in 2014].” GOP intellectuals see Obamacare as the centerpiece of the party’s strategy even well beyond then. “Republicans are likely to seize on every sad [implementation] story as justification for dramatic changes—and in 2016, mount campaigns designed to replace the system in whole or in part with plenty of material to use in their cause,” the conservative wonk Ben Domenech wrote approvingly in March.
And, of course, the party’s base is completely, unremittingly, obsessed with the issue. The mere anticipation of an implementation quagmire is “reinvigorating the movement,” Jenny Beth Martin, a national Tea Party official, told The Hill in early May. “We’re doing street rallies and protests over the next month to three months, initially. We’re working to recruit candidates that can talk about this.”
I happen to be agnostic about whether health care implementation will help the GOP in 2014. On the one hand, anything that energizes conservatives in a low-turnout election should benefit Republicans, much as it did on 2010. On the other hand, as The Washington Post’s Greg Sargent points out, much of the public antipathy toward Obamacare is already baked into the polls. The people who disapprove haven’t liked it from the get-go; similarly for the people who approve. It’s possible that a series of implementation snafus will move those numbers at the margins—a new poll suggests public opinion has soured a bit lately, perhaps as a result of all the “train wreck” chatter. On the other hand, it’s also possible that implementation will go relatively smoothly and people will embrace the program, netting Democrats a few more votes.
What I do know is that the GOP’s health care preoccupation is absolutely destroying its long-term prospects. However well the issue may work in the midterms, when an uptick in conservative turnout can flip a few dozen House seats, 2012 proved that it’s at best a wash in a presidential election, when Democrats can swamp that turnout with their demographic edge, and when the GOP’s challenge is to win moderates and independents as a result. Conservatives argue that the only reason health care didn’t work in 2012 is that Romney was a flawed messenger, given his patrimonial link to Obamacare. But with the Supreme Court largely blessing the law last June, the issue was mostly settled in the public mind, making it at best a non-factor among swing voters.
Even if implementation goes terribly, it isn’t likely to rekindle widespread angst. Most people will be untouched by implementation—even a disastrous implementation—for the simple reason that they won’t be relying on Obamacare. As Bloomberg’s Josh Barro has explained, 78 percent of us get coverage through Medicare, Medicaid, or our employers, a figure isn’t likely to change very much, or at least very quickly. Meanwhile, my colleague Jonathan Cohn points out that life for many people who do end up on Obamacare will improve, however flawed the program is, because it translates into insurance they didn’t have before.
Having said all that, the real problem with conservatives’ Obamacare strategy isn’t that it won’t work. It’s that the Obamacare obsession is actively sabotaging the GOP. Earlier this week The Washington Post ran an article about the ongoing dysfunction among House Republicans. Easily the most telling anecdote had to do with a largely symbolic measure called the Helping Sick Americans Now Act, concocted by Majority Leader Eric Cantor to help Republicans look like they care about the problems of ordinary people. (The bill feinted at easing the lot of the uninsured.) That, apparently, is where Cantor erred. As the Post explains:
A few dozen Republicans opposed the modest Helping Sick Americans legislation because they said it came from nowhere. Instead, Cantor pulled the bill and held another vote to repeal Obamacare — their 37th attempt to repeal part or all of the landmark health-care law — to appease conservatives.
To put the problem in Marxian terms, Obamacare has become the opiate of the GOP. By its own admission, the party must broaden its appeal to Latinos, gays, and young voters. It needs an economic agenda that encompasses more than tax cuts for the rich and brutal spending cuts. It has to persuade voters it’s more than just a nihilistic force bent on triggering global financial apocalypse if it doesn’t get its way in Washington. And yet, when party leaders so much as broach these liabilities, conservatives revolt and the leadership caves, appeasing them with an issue whose political utility peaked two-and-a-half years ago. (Suffice it to say, after the last few years, the words “reinvigorating the Tea Party movement” won’t exactly help Cantor and Boehner sleep at night.)
If you want to appreciate how truly incorrigible conservatives are on the subject, I recommend watching them grapple with the early news about Obamacare implementation, which has suggested the program could work better than anticipated. It’s a bit like watching a speculator learn he’s bet his life savings on a failing company—which is to say, chock full of denial and elaborate self-delusion.
For example, in late May, when the head of California’s insurance exchange announced that insurers were submitting cheaper bids than the state expected (and cheaper than many critics predicted), the conservative columnist Avik Roy tried to disprove the claims by visiting an online clearinghouse for private insurance plans. Roy solicited bids for a healthy 25-year-old male and a healthy 40-year old male, then pointed out that they came in far below what coverage would cost through the Obamacare exchange. All fine and good, except that Roy’s hypothetical bids were neither here nor there. The point of Obamacare is to provide affordable insurance to people who may be sick or older.
Alas, the fact that Roy basically affirmed the rationale for a program he set out to discredit—healthy, affluent young people are the one group that will do worse under Obamacare; everyone else will do better; no one has ever disputed this—didn’t stop every conservative outlet on the Internet from trumpeting his analysis. “Obamacare drives up insurance premiums by up to 146 percent in California,” screamed The Daily Caller. Even after a succession of wonks highlighted the glaring flaws, the editorialists at The Wall Street Journal leaned on Roy to declare an “ObamaCare Bait and Switch.”
The desperation here is palpable, but also understandable. If, instead of trying to fix your party’s deepest pathologies you wagered its entire future on a high-risk strategy that was starting to turn bad, you’d be a little desperate, too. Perhaps it’s a subset of Obama Derangement Syndrome that afflicts conservatives when they talk about health care—call it Obamacare Derangement Syndrome. Maybe one day, once the dust has settled, it’ll be covered under Obamacare, too.
By: Norm Scheiber, Senior Editor, The New Republic, June 7, 2013
“No Shedding Crocodile Tears Here”: Obamacare Critics Should Stop Using Young Men To Fuel Their Arguments
In January, one of Obamacare’s most controversial provisions will come into effect:
Every person in America will be required to either have health insurance or pay a penalty.
Overall, the effect will likely be a net positive: Because of subsidies, the cost of insurance will be kept down for many households, and in many states, a Medicaid expansion will help even more families pay for their health care. But while the outlook is great for millions of workers, things are going to be tougher for at least one group: healthy, financially secure men in their twenties.
So, guess which group Obamacare critics have focused on when they attack the effects of the program? I’ll give you three guesses, but you’ll probably only need one.
On Wednesday, New York magazine’s Jonathan Chait pointed out the surprising trend, noting that critics of the Affordable Care Act have almost universally cited the group in their attacks. Likening the move to an old-time patent medicine show (“You, sir – the healthy 25-year-old in front who has never been hospitalized or needed medication in his life! Step right up!”), he suggested that the attacks on Obamacare are, to put it mildly, skewed.
On the surface, targeting the law’s impact on healthy 25-year-old men seems like a masterstroke. After all, it’s hard to argue for the fairness of a system that charges healthy young people to pay for the health care needs of sickly older ones. The trouble is, today’s healthy 25-year-old male could easily become tomorrow’s hit-and-run victim, desperately in need of long-term medical care. And, barring that, today’s healthy 20-something will, with any luck, become a less-healthy 50-something, in need of an affordable method to cover his medications and regular doctor’s visits.
(Or, as happened to me when I was an uninsured man in my mid-20s, today’s healthy young 25-year-old could be tomorrow’s guy paying out-of-pocket for wisdom teeth extraction.)
Obamacare has numerous provisions that will extend coverage and make health insurance cheaper. Among other things, it will help cover the Medicare Part D coverage gap, will end exclusions for pre-existing conditions, and will require health care plans to cover preventative care.
For tens of millions of people, these provisions, and others, will translate into lower medical costs, a previously unimaginable access to health care, and a generally improved quality of life. Given the huge potential benefits, maybe it’s time for Obamacare’s critics to stop shedding crocodile tears for the relatively small portion of the populace that is going to have to take one for the team — and, in the process, get insurance that may well make them safer and healthier.
By: Bruce Watson, Business Insider, Originally Published in DailyFinance, June 10, 2013
“Really, Really Free Enterprise”: California To Wal-Mart, No More Taxpayer Subsidized Profits For You
For years, Wal-Mart—and other large retail operators—have been piling up huge profits by controlling their labor costs through paying employees sub-poverty level wages. As a result, it has long been left to the taxpayer to provide healthcare and other subsidized benefits to the many Wal-Mart employees who are dependent on Medicaid, food stamp programs and subsidized housing in order to keep their families from going under.
With Medicaid eligibility about to be expanded in some 30 states, as a result of the Affordable Care Act, Wal-Mart has responded by cutting employee hours—and thereby wages—even further in order to push more of their workers into state Medicaid programs and increase Wal-Mart profits. Good news for Wal-Mart shareholders and senior management earning the big bucks—not so good for the taxpayers who will now be expected to contribute even larger amounts of money to subsidize Wal-Mart’s burgeoning profits.
But, at long last and in a move gaining popularity around the nation, the State of California is attempting to say ‘enough’ to Wal-Mart and the other large retailers who are looking to the taxpayers to take on the responsibility for the company’s employees—a responsibility Wal-Mart has long refused to accept.
It’s about time.
Legislation is now making its way through the California legislature—with the support of consumer groups, unions and, interestingly, physicians—that would levy a fine of up to $6,000 on employers like Wal-Mart for every full-time employee that ends up on the state’s Medi-Cal program—the California incarnation of Medicaid.
The amount of the fine is no coincidence.
A report released last week by the Democratic staff of the U.S. House Committee on Education and the Workforce, estimates that the cost of Wal-Mart’s failure to adequately pay its employees could total about $5,815 per employee each and every year of employment.
“Accurate and timely data on Wal-Mart’s wage and employment practices is not always readily available. However, occasional releases of demographic data from public assistance programs can provide useful windows into the scope of taxpayer subsidization of Wal-Mart. After analyzing data released by Wisconsin’s Medicaid program, the Democratic staff of the U.S. House Committee on Education and the Workforce estimates that a single 300- person Wal-Mart Supercenter store in Wisconsin likely costs taxpayers at least $904,542 per year and could cost taxpayers up to $1,744,590 per year – about $5,815 per employee.”
Says Sonya Schwartz, program director at the National Academy for State Academy for State Health Policy, “There are concerns that employers will be gaming this new system and taking less and less responsibility for their workers. This may make employers think twice.”
Of course, the California Retailers Association, where Wal-Mart Stores, Inc. is listed as a board member company, is not quite so pleased with the legislation. According to Bill Dombrowski, chief executive of the Association, ”It’s one of the worst job-killer bills I’ve seen in my 20 years in Sacramento, and that says a lot. The unions are fixated on Wal-Mart, but that’s not the issue here. It’s a monster project to implement the Affordable Care Act, and having this thrown on top is not helpful.”
One wonders if we will ever see the day when Americans will stop falling for the hostage-taking narrative consistently put forward by those whose job it is to defend the indefensible. At the first suggestion of finally putting a chink in Wal-Mart’s policy of profiting at the taxpayers’ expense—a practice that should have every American thinking about what passes for free-enterprise in the United States today—the response is to always threaten to take away jobs if we dare to challenge their business practices, even if those practices cost us billions.
While the unions may, indeed, be “fixated” on Wal-Mart, it is hard to miss the fact that Mr. Dombrowski did not even attempt to explain why it is acceptable policy for taxpayers to continue subsidizing Wal-Mart’s ever expanding profits. Nor does Dombrowski attempt to deal with the fact that, according to a Los Angeles Times report, an additional 130,000 people working for large and profitable firms will go onto California’s Medi-Cal rolls over the next few years, bringing the total number of Medicaid recipients in the Golden State who are employed by large companies to just under 400,000 people.
Note that these are not people who rely on ‘government handouts’ because they do not wish to work. Rather, these are people who show up to do their jobs for as many hours a week as their employer will permit them to work.
Interestingly, the federal law imposes a penalty on companies with more than 50 employees who do not provide health insurance to an employee working over 30 hours per week. The feds also penalize a company when its workers buy their own healthcare coverage on an exchange and receives a government subsidy to do so.
However, there is no penalty imposed by the federal government on a company when a company’s workers become eligible for Medicaid.
Think that this ‘oversight’ had anything to do with Wal-Mart’s early support of the Affordable Care Act?
The result is that companies like Wal-Mart are actually encouraged by the federal policy to pay their workers even smaller sums without providing healthcare benefits so that even more of their workers will qualify for Medicaid.
What I always find fascinating is that the very people who are so critical of the subsidies provided by Obamacare to lower-earning Americans (how many times have these people reminded us that “someone is paying for these subsidies”) never seem to have much of a problem with the subsidies we pay to support Wal-Mart’s massive profits by picking up the healthcare tab for so many of the company’s employees. But then, those who support taxpayers doing the job that Wal-Mart should be doing tend to be the same folks who are quick to suggest that nobody is forcing workers to take a job at Wal-Mart. Apparently, these people are operating under the opinion that a Wal-Mart worker earning below the federal poverty level wouldn’t readily move to a better paying job if such a job were available to that worker.
The good news is that the proposed California legislation has a very good chance of becoming law. While the proposed legislation will require a 2/3 vote in both the Senate and Assembly, Democrats currently have supermajorities in both legislative bodies in the state.
Let’s hope that California gets this done and other states are quick to follow California’s lead. This is legislative action whose time is long overdue.
By: Rick Ungar, Op-Ed Contributor, Forbes, June 3, 2013
House Republicans have voted 37 times to repeal ObamaRomneyCare — the Affordable Care Act, which creates a national health insurance system similar to the one Massachusetts has had since 2006. Nonetheless, almost all of the act will go fully into effect at the beginning of next year.
There is, however, one form of obstruction still available to the G.O.P. Last year’s Supreme Court decision upholding the law’s constitutionality also gave states the right to opt out of one piece of the plan, a federally financed expansion of Medicaid. Sure enough, a number of Republican-dominated states seem set to reject Medicaid expansion, at least at first.
And why would they do this? They won’t save money. On the contrary, they will hurt their own budgets and damage their own economies. Nor will Medicaid rejectionism serve any clear political purpose. As I’ll explain later, it will probably hurt Republicans for years to come.
No, the only way to understand the refusal to expand Medicaid is as an act of sheer spite. And the cost of that spite won’t just come in the form of lost dollars; it will also come in the form of gratuitous hardship for some of our most vulnerable citizens.
Some background: Obamacare rests on three pillars. First, insurers must offer the same coverage to everyone regardless of medical history. Second, everyone must purchase coverage — the famous “mandate” — so that the young and healthy don’t opt out until they get older and/or sicker. Third, premiums will be subsidized, so as to make insurance affordable for everyone. And this system is going into effect next year, whether Republicans like it or not.
Under this system, by the way, a few people — basically young, healthy individuals who don’t already get insurance from their employers, and whose incomes are high enough that they won’t benefit from subsidies — will end up paying more for insurance than they do now. Right-wingers are hyping this observation as if it were some kind of shocking surprise, when it was, in fact, well-known to everyone from the beginning of the debate. And, as far as anyone can tell, we’re talking about a small number of people who are, by definition, relatively well off.
Back to the Medicaid expansion. Obamacare, as I’ve just explained, relies on subsidies to make insurance affordable for lower-income Americans. But we already have a program, Medicaid, providing health coverage to very-low-income Americans, at a cost private insurers can’t match. So the Affordable Care Act, sensibly, relies on an expansion of Medicaid rather than the mandate-plus-subsidy arrangement to guarantee care to the poor and near-poor.
But Medicaid is a joint federal-state program, and the Supreme Court made it possible for states to opt out of the expansion. And it appears that a number of states will take advantage of that “opportunity.” What will that mean?
A new study from the RAND Corporation, a nonpartisan research institution, examines the consequences if 14 states whose governors have declared their opposition to Medicaid expansion do, in fact, reject the expansion. The result, the study concluded, would be a huge financial hit: the rejectionist states would lose more than $8 billion a year in federal aid, and would also find themselves on the hook for roughly $1 billion more to cover the losses hospitals incur when treating the uninsured.
Meanwhile, Medicaid rejectionism will deny health coverage to roughly 3.6 million Americans, with essentially all of the victims living near or below the poverty line. And since past experience shows that Medicaid expansion is associated with significant declines in mortality, this would mean a lot of avoidable deaths: about 19,000 a year, the study estimated.
Just think about this for a minute. It’s one thing when politicians refuse to spend money helping the poor and vulnerable; that’s just business as usual. But here we have a case in which politicians are, in effect, spending large sums, in the form of rejected aid, not to help the poor but to hurt them.
And as I said, it doesn’t even make sense as cynical politics. If Obamacare works (which it will), millions of middle-income voters — the kind of people who might support either party in future elections — will see major benefits, even in rejectionist states. So rejectionism won’t discredit health reform. What it might do, however, is drive home to lower-income voters — many of them nonwhite — just how little the G.O.P. cares about their well-being, and reinforce the already strong Democratic advantage among Latinos, in particular.
Rationally, in other words, Republicans should accept defeat on health care, at least for now, and move on. Instead, however, their spitefulness appears to override all other considerations. And millions of Americans will pay the price.
By: Paul Krugman, Op-Ed Columnist, The New York Times, June 6, 2013
Millions of Americans battling cancer are facing obstacles to recovery that have nothing to do with the disease’s toll on their bodies. According to a new study, national shortages of cancer drugs are threatening the health of the people who rely on them to stay alive.
According to the survey, presented at an oncology conference in Chicago on Monday, about 83 percent of cancer specialists have experienced a drug shortage at their clinics in the past six months. Of those doctors, 92 percent said the shortage had some effect on their patients’ care.
A little over a third of the doctors facing a shortage ended up switching their patients from a cheaper, generic version of that drug to a more expensive brand-name version. Considering the fact that cancer care is already exorbitantly expensive — Americans battling cancer are twice as likely to wind up bankrupt compared to those who don’t have the disease — that could represent a serious strain on those patients.
But cancer patients are facing much more than potential financial hardship. Thanks to the shortages, some cancer specialists can’t find the drugs their patients need at any price. When that happens, doctors are forced to make some painful choices. Nearly 80 percent reported that they switched patients to a different, and potentially less effective, chemotherapy regimen. Some have been forced to give cancers more time to spread further by delaying patients’ treatment or reducing their doses. And 37 percent of the study’s participants even had to choose between their patients, deciding which ones could receive life-saving medication and which ones would have to go without.
William Li, the executive director of a foundation that sponsors research into blood vessel growth, told USA Today that some hospitals are forced to hold lotteries to decide which patients will be able to receive the cancer drugs that are in short supply. “It baffles the mind that this is happening in a modern society,” Li said, pointing out that the FDA should do more to avert drug shortages.
Currently, drug manufacturers can alert the FDA when they suspect an impending shortage, and the federal agency can take steps to try to mitigate the effect on the market, like approving the same kind of drug from a different manufacturer. But so far, that hasn’t been enough to avert the situation. Largely due to manufacturing errors in drug-production facilities across the country, the U.S. faces limited supplies of everything from ADHD medications to painkillers — and cancer patients end up being hit the hardest.
Much of the blame may lie with powerful pharmaceutical companies. One of the co-authors of the new study, Keerthi Gogineni, noted that cancer doctors are concerned drug manufacturers may be prioritizing the most profitable medications over the most life-saving ones. “Some manufacturers have diverted existing production capacity from less profitable agents to more expensive agents,” Gogineni explained. Similarly, a group of over 100 doctors recently criticized Big Pharma for “causing harm to patients” by continuing to sell cancer drugs at unsustainably high prices.
By: Tara Culp-Ressler, Think Progress, June 3, 2013