The Unending War On Obamacare: Count On Republicans To Stand In The Way Of Fixing Whatever’s Wrong With It
I’m not a historian, so maybe there’s something I don’t know, but it seems to me that there may never have been a piece of legislation that has inspired such partisan venom as the Affordable Care Act. Sure, Republicans hated Medicare. And yes, their rhetoric at the time, particularly Ronald Reagan’s famous warning that if it passed, “We are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free,” was very similar to what they now say about Obamacare. But once it passed, their attempts to undermine it ran more to the occasional raid than the ongoing siege.
I bring this up because Kevin Drum makes an unsettling point today about the future of Obamacare:
No, my biggest concern is what happens after 2014. No big law is ever perfect. But what normally happens is that it gets tweaked over time. Sometimes this is done via agency rules, other times via minor amendments in Congress. It’s routine. But Obamacare has become such a political bomb that it’s not clear that Congress will be willing to fix the minor problems that crop up over time. There’s simply too big a contingent of Republicans who are eager to see Obamacare fail and are actively delighted whenever a problem crops up. This has the potential to be a problem that no other big law has ever had to face.
It’s hard to overstate just how enormous a symbolic presence Obamacare has come to occupy in Republicans’ minds. They’ve invested so much time in not just criticizing it but telling their constituents that it is the worst thing to ever happen to America—and yes, sometimes they literally say things like that—that they’ve lost all moral perspective. To them, trying to fix a feature of the law so that it works better or helps people more would be a horrifying moral compromise, tantamount to sending fur coats to the guards at Stalin’s labor camps in Siberia. If you say to them, “Look, it’s the law now—why don’t we make sure it works as well as possible?” it just won’t register.
Combine that with the fact that in general, congressional Republicans have stopped caring much about policy at all, and they never cared about health care in the first place. They don’t want to know the details of issues; it just isn’t their priority. In the House, conservatives are spending their time clamoring for an opportunity to cast yet another vote to repeal Obamacare. “The guys who have been up here the last two years, we can go home and say, ‘Listen, we voted 36 different times to repeal or replace ObamaCare,” said Mick Mulvaney of South Carolina. “Tell me what the new guys are supposed to say?” Your tax dollars at work.
You can look at this state of affairs and assume that as new difficulties with the law come to light, it will be possible for the Obama administration to address them with administrative action, through the Department of Health and Human Services. And that may be true to an extent. But other changes could require legislation, and it’s a fair bet that no matter what is involved, Republicans in Congress would reject anything having to do with the law that didn’t involve repealing it. You could tell them that there was a typo in the bill which was causing orphans to be turned into Soylent Green and all it would require to fix was a quick voice-vote, and they’d say no, because Obamacare kills freedom.
And let’s not forget, it’s entirely possible that 45 months from now, there will be a Republican president. If that happens, it’s possible that in order to get confirmed, his or her nominee to be secretary of Health and Human Services will have to pledge to Senate Republicans to work every day to dismantle Obamacare. The clock is ticking.
By: Paul Waldman, Contributing Editor, The American Prospect, April 25, 2013
“Bullet Backdrops”: Arkansas Republican “Most Likely Won’t Try To Kill” Lawmakers Who Support Medicaid Expansion
Arkansas may become the first red state to accept the Obamacare Medicaid expansion, which the Supreme Court made optional in its decision last year, if the Department of Health and Human Services accepts its privatized plan.
(Of course, the states turning down Medicaid expansion are generally the ones that need it most.)
The notion of expanding government to improve health care outcomes apparently drove Chris Nogy of the Benton County Republican Committee a little nutty. In a recent newsletter, he encouraged his fellow Republicans to seek “Second Amendment” solutions against those who had voted for the expansion, and expressed dismay that he can’t actually back up these threats:
We need to let those who will come in the future to represent us [know] that we are serious. The 2nd amendment means nothing unless those in power believe you would have no problem simply walking up and shooting them if they got too far out of line and stopped responding as representatives. It seems that we are unable to muster that belief in any of our representatives on a state or federal level, but we have to have something, something costly, something that they will fear that we will use if they step out of line. If we can’t shoot them, we have to at least be firm in our threat to take immediate action against them politically, socially, and civically if they screw up on something this big. Personally, I think a gun is quicker and more merciful, but hey, we can’t.
Nogy’s wife is the group’s secretary and she claims the article was placed in the newsletter without her husband’s approval.
Medicaid expansion will provide health insurance for up to 250,000 Arkansans, ultimately saving dozens if not hundreds of lives, while driving down the costs of the state’s insured — who already subsidize the uninsured through higher rates.
Most of Arkansas’ estimated uninsured 401,100 are working families who simply can’t afford coverage.
Several Arkansas Republicans made it clear that they were appalled by Nogy’s comments.
“I’m embarrassed for the Benton County Republican Committee for including this article in their newsletter,” said State Senator Jon Woods (R). “I would think the Benton County Committee would have better judgment and not allow this to be sent out.”
The Benton County Republican Committee offered a statement:
“The letter was not approved and Mr. Nogy had no authority to submit it through the newsletter. As a committee, we respect the right of our legislators to vote based on their knowledge and feedback from the voters they represent. We will discuss this issue further with our executive committee.”
Nogy later clarified his comments in a letter to KFSM News.
He explained why he is more angry at Republicans than Democrats:
I don’t feel the same way about the Democrats as bullet backstops as I do about the Republicans who joined them. The Democrats were doing what their party told them they had to do because they were elected to do that job.
He concluded by saying that his threats were only meant to attract attention and he “most likely” won’t kill those Republicans who supported the Obamacare provision. He simply thought it was important to put a face behind his threats so lawmakers will take him seriously:
And for the record, I didn’t advocate violence. I mentioned violence to get people’s attention, and it worked. I advocated a serious political and social stand, an assured and significant negative response to any politician who breaks a primary voter/elected official promise contract. We have only one mechanism to maintain the ‘government of the people, by the people, and for the people’, and that is to elect those who promise to do as we demand they do. If we cannot make these people understand that we will not tolerate this kind of breach of contract, then we lose our ability as the people to control the government. And in this age of death threats from nameless, faceless thugs, we need these folks to know that while we most likely won’t try to kill them or harm their families, they should be much more certain of our response than fearful of the actions of those who will not identify themselves.
The contentious battle over expansion has shown that Republicans are eager to take the federal funds without getting any Obama on them. Lawmakers are so afraid to be caught pandering to the president or “takers” that they’ve officially declared that Medicaid expansion is not an entitlement.
Mr. Nogy should be happy to know that another feature of Obamacare is mental health parity.
By: Jason Sattler, The National Memo, April 22, 2013
“A New Round Of Shame”: Michele Bachmann’s Confusion Bubbles Over
Dorsey Shaw noted late yesterday that Rep. Michele Bachmann (R-Minn.) has had a “horrible, no good, very bad week.” It’s true — even by Bachmann’s awful standards, the ignominious congresswoman has had it rough lately.
Her CPAC speech was ridiculous, and left in tatters by fact-checkers. Asked for an explanation, Bachmann literally fled from a reporter confronting her with her own words. Bill O’Reilly invited her on to get back on track, but when Bachmann refused, he turned on her.
This, however, was the moment that arguably mattered most.
“Let’s repeal this failure before it literally kills women, kills children, kills senior citizens,” Bachmann said on the House floor. “Let’s not do that. Let’s love people. Let’s care about people. Let’s repeal it now while we can.”
I’m sure this probably makes some sense to Bachmann, but for those of us living in reality, it’s just crazy.
She went on to say, “What [President Obama] demanded and insisted upon is that the government have 100 percent control over health care,” Bachmann said. “100 percent control? The American people lose control? What did they get? They get health care — health insurance, I should say — that is more expensive than anything they’ve ever paid for before. And they get less for it. Well what a deal, Mr. President, Mr. Speaker. What a deal.”
For anyone with a rudimentary understanding of the issue, this is complete gibberish. Under current law, government doesn’t have “100 percent control over health care,” but rather, private insurers have a key role providing coverage for tens of millions of people. What’s more, consumer costs are lower, not higher, and they have more expansive coverage, not less.
It’s almost as if Michele Bachmann, after having been caught saying ridiculously untrue things, has no qualms about making matters worse, bringing a new round of shame to her and her constituents.
Of course, she can at least take some comfort in the fact that the House Republican leadership kept her on the House Intelligence Committee, inexplicably giving this deeply strange and unhinged lawmaker access to the nation’s most sensitive, highly-classified secrets.
By: Steve Benen, The Maddow Blog, March 22, 2013
“Ideology Over Sound Policy”: Republican Governors No Longer A Force For Moderation
Republican governors, who actually have to govern, used to be a moderating force on the most extreme aspects of Republican ideology. No longer. In major areas such as health care, taxes, and jobless benefits, ideology is trumping sound policy judgment in many gubernatorial mansions and state legislatures.
Healthcare
Antipathy toward “Obamacare,” not reasoned analysis, seems to be why many governors have expressed hesitation, if not outright opposition, to the Medicaid expansions under the Affordable Care Act, even though the federal government would pick up almost all of the costs. A similar antipathy (and probably a hope before the Supreme Court decision and 2012 election that the law would go away) led many governors to pass on the chance to use the flexibility that the it afforded them to design their own health insurance exchanges—new competitive marketplaces in which individuals and small businesses can choose among an array of affordable, comprehensive health insurance plans that the Affordable Care Act requires.
I’ve previously explained why Medicaid expansion is a good deal for the states. But as the map below from the Center on Budget and Policy Priorities’ report on the healthcare law’s Medicaid expansions shows, many states remain undecided or are leaning against expansion:
The Center’s report on the state health insurance exchange implementation shows that 26 states, including most of the states leaning against Medicaid expansion, have declined to either operate a state-based exchange or partner with the Department of Health and Human Services in designing their exchange. Under the law, that means they default to a “Federally facilitated exchange” that HHS will establish.
Taxes
In another disturbing development, numerous states are considering—or have already enacted—sweeping tax and budget proposals that follow recommendations of the American Legislative Exchange Council, also known as ALEC. As this CBPP report explains, ALEC’s recommendations for deep tax cuts and limits on revenues and spending reflect extreme “supply side” and antitax arguments that mainstream economic research discredited long ago.
CBPP’s most recent assessment finds that at least five states (Kansas, Louisiana, Nebraska, and both North and South Carolina) are considering eliminating income taxes. At least 11 others (Idaho, Indiana, Missouri, Montana, New Mexico, North Dakota, Ohio, Oklahoma, Pennsylvania, Texas, and Wisconsin) are considering deep tax cuts. And at least three states (Arizona, Arkansas, and Kansas) are considering harsh revenue limits.
Unemployment Insurance
Unemployment Insurance is a joint federal-state program in which states have traditionally offered up to 26 weeks of benefits to qualified workers who lose their jobs through no fault of their own, and the federal government typically provides additional weeks of emergency unemployment compensation when national unemployment is high. In the current jobs slump, by far the worst since the 1930s, seven states have cut back on the maximum number of weeks of regular benefits they offer. Because the maximum number of weeks of federal emergency benefits is proportional to the maximum number of weeks of state benefits, that means jobless workers in those states have seen a significant reduction in support while they look for work in what remains a tough labor market.
Research shows that Unemployment Insurance is valuable not only to unemployed workers and their families but also for the additional spending that it injects into the economy. States that have cut back on it are hurting struggling families and their own economic recovery.
The North Carolina Trifecta
North Carolina is the poster child for these disturbing trends in state governments.
The Tar Heel State is one of the five considering eliminating its income tax. The new Republican governor supports legislation that would prevent the state from expanding Medicaid or establishing a health insurance exchange. And, in July, the state will become the eighth to have reduced the maximum number of weeks of Unemployment Insurance it offers. Moreover, North Carolina also cut the maximum level of benefits which, under the “maintenance of effort” requirement for receiving emergency federal benefits, requires the federal government to cut off all emergency Unemployment Insurance to North Carolina.
Republican governors used to fight for Medicaid and Unemployment Insurance because they recognized how much their states benefited. Now, many are leading the effort to cut valuable programs in order to finance tax cuts for high-income households and businesses, while letting the chips fall where they may for those of more modest means.
By: Chad Stone, U. S. News and World Report, February 22, 2013
“Another Right Wing Freakout”: Sorry Rush, Gun Violence Is A Health Care Issue
How illogical has the right-wing media ‘debate’ about gun control become this week in the wake of President Obama moving forward on a host of violence prevention measures?
So illogical that conservative media voices expressed outrage, while spreading constant misinformation, about the role doctors might play in addressing gun violence in America. The right-wing Noise Machine cranked up the indignation because the Obama administration wants to make sure health care professional are allowed to communicate with their patients about guns and gun safety.
In other words, the right-wing Noise Machine is furious that the White House is treating gun violence, in part, as a health care issue when it so transparently is one.
Fact: The United States’ life expectancy rate is far lower than most other affluent countries, in part because of our rate of gun violence far outpaces those other countries.
Meanwhile, taxpayers here spend billions each year paying health care costs to treat gunshot victims, the strong majority of whom, research indicates, are uninsured. Taxpayers spend even more money covering societal costs, such as long-term psychological problems, disability, and the loss of productivity suffered by approximately 70,000 Americans who suffer non-fatal gun shot wounds annually.
Following the school gun massacre in Newtown, Conn. last month, Bloomberg News reported:
The cost of U.S. gun violence in work lost, medical care, insurance, criminal-justice expenses and pain and suffering amounted to as much as $174 billion in 2010, according to data compiled by the Pacific Institute for Research and Evaluation in Calverton, Maryland.
That averages out to more than $644 in costs for every gun owned in America. As economist Ted Miller, the Institute’s principal research scientist, told Bloomberg, “Gun ownership is like smoking, an expensive and dangerous habit.”
So yes, gun violence is America represents an epic and costly health care problem, which is why it makes sense to include health care providers in any comprehensive attempt to combat the crisis. (On Wednesday, the White House announced the administration would “issue guidance clarifying that the Affordable Care Act does not ban doctors from asking patients “about firearms in their patients’ homes and safe storage of those firearms.”)
As the Firearm & Injury Center at the University of Pennsylvania has concluded, “Healthcare providers have a vital role in preventing intentional and unintentional firearm injuries and their impact on patients, families and communities.” And that’s why the group Doctors for America applauded Obama’s gun violence imitative this week.
Meanwhile, the far-right allegation that Obama now requires physicians to press patients about gun use represents a complete fabrication. So was Rush Limbaugh’s claim that Obama’s trying to turn doctors into “snitches,” and Lou Dobbs’ fearmongering about the president turning doctors into “an agent of the federal government.”
The right-wing freak-out is built around the fake premise of, how dare Obama recruit doctors to fight his war on gun violence. (Drudge Report headline: “War on Crazy: Obama Deputizes Doctors”) That may be a conservative attempt to keep the gun debate focused on the issue of gun rights and the Second Amendment and away from the catastrophic, real-life costs that gun violence registers each year.
However, the right-wing media’s baseless assertion ignores the obvious fact that the health care industry in this country — doctors, hospitals, emergency rooms, mental health centers -remains inundated with gunshot wounds daily and deals with the life-changing crisis all the time. (Nearly 300 people are shot everyday in America.) Doctors don’t have to go snooping around acting as “snitches” in order to find the problem.
And the financial costs of those gunshots wounds is rising; improved trauma care means hospitals now save more gunshot victims, which in turn adds to larger, long-term health care and rehabilitation costs.
A 2005 study of hospital charges for firearm injuries in Pennsylvania found that the average charge for inpatient hospitalization due to firearm injuries was $30,814. That figure was more than double what gunshot injuries cost hospitals between 1996-1998.
An in-depth investigation on gunshot violence by the Milwaukee Journal in 2006 reported that the average bill for a shooting patient treated at the city’s Froedtert Hospital was $38,000. For gunshot victims who suffered spinal damage, the bill regularly reached six figures.
Truth is, any attempt to reduce gun violence in America must include a health care strategy, no matter how much whining Fox News and Rush Limbaugh do about it.
By: Eric Boehlert, The Huffington Post, January 18, 2013
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