“Stuck In The First Stage Of Grief”: GOP Reflexively Making Themselves Feel Better About A Reality That’s Causing Them Pain
At a press conference last week, President Obama announced a figure that was hard to even imagine a month ago: 8 million consumers signed up for private insurance through exchange marketplaces during the Affordable Care Act’s open-enrollment period. Obama also took a moment to chide Republicans for having been wrong about practically every aspect of the debate.
“I recognize that their party is going through the stages of grief,” he said, “and we’re not at acceptance yet.”
That sounds about right, though I’m not sure the GOP is “going through the stages of grief” so much as it’s stuck on the first one. If the process is believed to have five stages – denial, anger, bargaining, depression, and acceptance – we have quite a ways to go before “acceptance” is even on the horizon.
Rep. Tim Huelskamp (R-Kan.) said Monday he believes the uninsured rate in his state has increased since implementation of the 2010 health care reform law.
“It’s hard to get accurate numbers on anything,” Huelskamp told his constituents at a town hall in Salina, Kan., according to video posted by Eagle Community Television. “But the numbers we see today is that – as I understand them – we believe there are more people uninsured today in Kansas than there were before the president’s health care plan went into effect. And I thought the goal was to bring more people into insurance.”
There are a wide variety of counts when it comes to determining just how many uninsured Americans have been able to get coverage, but all of the reports have something important in common: they all show the rate of the uninsured going down, not up. We can discuss exactly how many, whether that’s in line with expectations, whether that’s enough to sustain the larger system, and why progress is happening faster in blue states than red states.
But to argue that the number of uninsured people is climbing is comparable to arguing that the federal budget deficit is getting larger; the planet is experiencing global cooling; and Obama has pushed use of executive orders to new heights.
Oh wait, conservative Republicans often believe all of those bogus claims, too.
Obviously, the problem isn’t limited to Huelskamp. On Friday, Sen. Dean Heller (R-Nev.) said he doesn’t believe the Obama administration’s enrollment totals, calling the figures “all smoke and mirrors.” On Thursday, House Majority Whip Kevin McCarthy (R-Calif.) suggested consumers receiving ACA subsidies to defray the costs of coverage may be engaged in “fraud.”
The right doesn’t bother with evidence to bolster any of this – evidence is irrelevant. Denial isn’t about rationality; it’s about reflexively making one feel better about a reality that’s causing them pain.
That said, GOP officials aren’t just embracing denial, they’re swimming in it in the most self-indulgent fashion possible. Republicans almost seem to be enjoying their distaste for health care reality, seemingly eager to one up their far-right colleagues.
Let’s also not brush past the “heads I win, tails you lose” problem – “Obamacare” critics believe the numbers are correct and reliable when they point to facts Republicans want to hear. Enrollment totals are low? This is proof that conservatives were right all along and that the ACA is a failure. Enrollment totals soared in March? This is proof that the White House is perpetrating a fraud – because conservatives were right all along and that the ACA is a failure.
It’s become effectively impossible under conditions like these for the two sides to even have a conversation about health policy. Paul Krugman’s take over the weekend rings true:
Not a day goes by without some prominent Republican politician or pundit insisting that the enrollment numbers are phony, that more people are losing insurance than gaining it, etc.. I know that’s what the base believes, because it’s what they hear from Rush and Fox. But you would think that important people would have someone around who has a clue, who knows that enrollment data and multiple surveys are all telling the same story of unexpected success. OK, maybe not – if famous senators don’t have anyone to clue them in about BLS data, they might really still be living in the bubble. But that’s really their choice.
And the point is that with enrollment more or less closed for 2014, there’s not much point in spinning. OK, maybe if you can keep up the pretense all the way to November, you can slightly sway base voters for the midterms. But even that’s doubtful – by the fall, we’re going to have a very clear picture of how things went; and the shape of that picture has already been determined.
I guess that what gets me is the – to use the technical term – wussiness of it all. Isn’t there any space on the right for people who sell themselves as tough-minded, who condemn Obamacare on principle but warn their followers that it’s not on the verge of collapse? Is the whole party so insecure, so unable to handle the truth, that it automatically shoots anyone bearing bad news?
I’m going to assume those are rhetorical questions, because the answer seems pretty obvious.
By: Steve Benen, The Maddow Blog, April 21, 2014
Kevin McCarthy doesn’t have the best timing. The House majority whip released what he hoped would be the foundational document of Obamacare truthers, “Debunking Obamacare’s 7 million enrollees ‘success’ story,” the same day the White House announced that, in fact, 8.03 million Americans had enrolled in the insurance exchanges. Republicans will no doubt try to debunk the higher figure the same way, but the more we learn about who’s been covered under the Affordable Care Act, the harder it will be. It is, overwhelmingly, a success story.
I said the same thing back when the number was 7 million: Imagine how many more people might have been covered if shrill Republicans hadn’t made repealing and obstructing the ACA their top priority. The news that 35 percent of enrollees are under 35 is particularly heartening: it means many young people ignored the campaign to tell them not to sign up – remember that creepy Uncle Sam “doctor” and reports of cool campus keg parties? Yes, the president had Zach Galifianakis and Bradley Cooper – damn you, Bradley Cooper! Greg Gutfeld is still so angry at you – but imagine where we’d be without an organized national campaign to scare people out of signing up.
The campaign to discredit the act will continue. McCarthy’s dumb document lists five new metrics for measuring success, including how many enrollees have actually paid, and how many didn’t have insurance before. Those are old talking points, but they’ve added a new one – how many received subsidies — which is ugly in several ways. Republicans will use a high rate of subsidies, if that’s the case, to negate the act’s success, when in fact the subsidies were always key to it: You can’t have an individual mandate to purchase private insurance without making some provision to help those who can’t afford it. Affordability is why most didn’t have it in the first place.
But McCarthy also tacks on an ugly parenthetical, asking “how many received a subsidy (raising concerns about fraud).” Brian Beutler at the New Republic calls this an effort to “welfarize Obamacare,” to stigmatize it and also make it subject to the same hysteria about “fraud” that conservatives use to smear other social programs. Remember that Sen. Ted Cruz called the subsidies “sugar,” telling Sean Hannity that when Americans got a taste of it, they’d be “addicted to the sugar, addicted to the subsidies. And once that happens, in all likelihood, it never gets …”
“It’s over,” Hannity declared. “It never gets repealed.”
Still, a high rate of subsidies will let the GOP continue to demonize the “takers” vs. the “makers.” But some of them are going to have a big problem: A lot of the takers will turn out to be their voters. Poor Mitch McConnell: His own state of Kentucky, under the leadership of Democratic Gov. Steve Brashear, set up its own insurance exchange, expanded Medicaid and conducted a bold public health campaign to get folks into “Kynect.” Now Kentucky has reduced the number of uninsured by 40 percent – and many of those newly insured are McConnell’s aging white constituents.
McConnell seems appropriately alarmed. The man who has repeatedly pledged to “repeal” the law just this week told healthcare workers in Kentucky that repealing the law can’t happen while Obama is president, so “we’re going to figure out a way to get this fixed.” That softer tone isn’t sitting well with his Tea Party challenger Matt Bevin, who’s already accusing McConnell of being an Obamacare appeaser, but the Senate minority leader seems to be looking past Bevin to his November battle with Alison Lundergan Grimes.
The only thing that might get Republicans out of a mess of their own making is Democratic cowardice, and you can never underestimate the capacity of centrist and red state Democrats to sabotage themselves and their own party. We’ll see how hard Grimes hits McConnell over his role in obstructing the ACA; so far, it hasn’t been very hard at all. She needs to make him the man who’s trying to charge women more than men for insurance again; the man who’s trying to take healthcare away from 370,000 Kentuckians who have it thanks to Democrats.
Democrats have similar opportunities in Virginia and Arkansas. Republicans have been itching to make the midterms a referendum on Obamacare. Thursday’s news means that might not work the way they had planned.
By: Joan Walsh, Editor at Large, Salon, April 18, 2014
Holy seven million, Batman! The Affordable Care Act, a k a Obamacare, has made a stunning comeback from its shambolic start. As the March 31 deadline for 2014 coverage approached, there was a surge in applications at the “exchanges” — the special insurance marketplaces the law set up. And the original target of seven million signups, widely dismissed as unattainable, has been surpassed.
But what does it mean? That depends on whether you ask the law’s opponents or its supporters. You see, the opponents think that it means a lot, while the law’s supporters are being very cautious. And, in this one case, the enemies of health reform are right. This is a very big deal indeed.
Of course, you don’t find many Obamacare opponents admitting outright that 7.1 million and counting signups is a huge victory for reform. But their reaction to the results — It’s a fraud! They’re cooking the books! — tells the tale. Conservative thinking and Republican political strategy were based entirely on the assumption that it would always be October, that Obamacare’s rollout would be an unremitting tale of disaster. They have no idea what to do now that it’s turning into a success story.
So why are many reform supporters being diffident, telling us not to read too much into the figures? Well, at a technical level they’re right: The precise number of signups doesn’t matter much for the functioning of the law, and there may still be many problems despite the March surge. But I’d argue that they’re missing the forest for the trees.
The crucial thing to understand about the Affordable Care Act is that it’s a Rube Goldberg device, a complicated way to do something inherently simple. The biggest risk to reform has always been that the scheme would founder on its complexity. And now we know that this won’t happen.
Remember, giving everyone health insurance doesn’t have to be hard; you can just do it with a government-run program. Not only do many other advanced countries have “single-payer,” government-provided health insurance, but we ourselves have such a program — Medicare — for older Americans. If it had been politically possible, extending Medicare to everyone would have been technically easy.
But it wasn’t politically possible, for a couple of reasons. One was the power of the insurance industry, which couldn’t be cut out of the loop if you wanted health reform this decade. Another was the fact that the 170 million Americans receiving health insurance through employers are generally satisfied with their coverage, and any plan replacing that coverage with something new and unknown was a nonstarter.
So health reform had to be run largely through private insurers, and be an add-on to the existing system rather than a complete replacement. And, as a result, it had to be somewhat complex.
Now, the complexity shouldn’t be exaggerated: The basics of reform only take a few minutes to explain. And it has to be as complicated as it is. There’s a reason Republicans keep defaulting on their promise to propose an alternative to the Affordable Care Act: All the main elements of Obamacare, including the subsidies and the much-attacked individual mandate, are essential if you want to cover the uninsured.
Nonetheless, the Obama administration created a system in which people don’t simply receive a letter from the federal government saying “Congratulations, you are now covered.” Instead, people must go online or make a phone call and choose from a number of options, in which the cost of insurance depends on a calculation that includes varying subsidies, and so on. It’s a system in which many things can go wrong; the nightmare scenario has always been that conservatives would seize on technical problems to discredit health reform as a whole. And last fall that nightmare seemed to be coming true.
But the nightmare is over. It has long been clear, to anyone willing to study the issue, that the overall structure of Obamacare made sense given the political constraints. Now we know that the technical details can be managed, too. This thing is going to work.
And, yes, it’s also a big political victory for Democrats. They can point to a system that is already providing vital aid to millions of Americans, and Republicans — who were planning to run against a debacle — have nothing to offer in response. And I mean nothing. So far, not one of the supposed Obamacare horror stories featured in attack ads has stood up to scrutiny.
So my advice to reform supporters is, go ahead and celebrate. Oh, and feel free to ridicule right-wingers who confidently predicted doom.
Clearly, there’s a lot of work ahead, and we can count on the news media to play up every hitch and glitch as if it were an existential disaster. But Rube Goldberg has survived; health reform has won.
By: Paul Krugman, Op-Ed Columnist, The New York Times, April 3, 2014
Barack Obama has done many dastardly things to Republicans. He regularly ridicules their arguments. He insists on being treated as though he were legitimately the president of the United States. And most cruelly of all, he beat their standard-bearers in two national elections. Is it any wonder they loathe him so? But one thing Obama has done to the GOP has gone unnoticed: he made it impossible for them to be serious about health care policy.
By now you’re well familiar with how the core of the Affordable Care Act—a ban on insurance companies denying coverage for pre-existing conditions (also known as “guaranteed issue”), accompanied by an individual mandate and subsidies for people of moderate incomes to purchase private insurance—was originally a conservative proposal. The idea was that unlike in most other western countries where a large government program like Medicare covers all citizens, you could achieve something close to universal coverage and health security through the use of markets. When Mitt Romney installed it in Massachusetts, it worked quite well and everybody was pleased. But then Barack Obama came along and embraced it, so all good and true conservatives had to conclude that it was not only a terrible idea in practical terms but a vile and wicked plot to rob Americans of their freedom.
And that has left Republicans in a difficult spot. They would very much like to have market-based health care ideas they could rally around, if nothing else than to demonstrate to the public that they sincerely want to fix what’s wrong in America’s health care system. But the theft of the guaranteed issue-plus-mandate-plus-subsidies framework has left them with nothing but unappetizing scraps off the health care table, none of which will do much of anything to address problems like the large number of uninsured Americans.
There’s a ritual people like me have taken to of late. Republicans announce that they’re about to release a health care plan. Then we say sarcastically, “Gee, let me guess. It involves 1) tort reform; 2) letting people buy insurance across state lines; 3) incentives for more use of health savings accounts, and 4) high-risk pools for people with pre-existing conditions” (here’s a recent example). And we’re always right, because those are the Big Four conservative health care ideas, and nobody can come up with anything different.
Here’s the thing about these ideas: neither any of them individually, nor all of them collectively, would even begin to tackle the things that ail the American health care system, the things the Affordable Care Act was meant to address. Tort reform—which means making it difficult or impossible for patients to sue for malpractice—won’t bring down costs like conservatives think it will. We know this because a number of states have enacted the kind of tort reform Republicans advocate for the whole nation, and it had no impact on spending. Realistic assessments of the effect of tort reform on medical spending conclude that if there’s any impact at all, it would be tiny (I discussed this issue at length here).
Letting people buy insurance across state lines would be fine if it was accompanied by national standards for policies; you’ve surely forgotten it by now, but the more liberal House version of the ACA created a national insurance exchange instead of 50 state exchanges, in which you could have bought insurance from anywhere. But a well-regulated system isn’t what conservatives want; they propose to remove the ACA’s regulations and then initiate a race to the bottom, where the least-regulated state would offer cheap insurance to lure customers who wouldn’t realize the limits of what they had bought until they got sick (here’s an explanation of just how bad an idea this is).
As for health savings accounts, we already have them. They’re a great deal for people who are healthy, but not so much when you actually need care. And high-risk pools are a terrible solution as anything other than a temporary stopgap—they put all the sick people in the same pool, meaning covering them is extremely expensive. That’s no help to the tens of millions of Americans with pre-existing conditions.
Which brings us to Louisiana governor Bobby Jindal, who is almost certainly running for president in 2016. There aren’t a lot of Republicans who have a good understanding of health care policy, but Bobby Jindal is one of the ones who do. Back in 1996, at the tender age of 24, he was appointed the head of the Louisiana Department of Health; George W. Bush later made him an assistant secretary of health and human services. So he’s well familiar with this issue, and surely has a reasonably good understanding of which policies are likely to have a large impact and which are likely to make no difference at all.
But Jindal is hamstrung, like all Republicans, by the fact that they can’t advocate anything Barack Obama has ever supported. So when he released a health care plan yesterday, it was a predictable mixture of small-bore proposals (Wellness incentives! Eliminate fraud!), and the Big Four conservative ideas. For good measure, he threw in a version of Paul Ryan’s plan to turn Medicare from an insurance program into a voucher program, where the government would give seniors a certain amount of money and then they’d seek private insurance, with the invisible hand of the market bringing prices down, all previous evidence to the contrary notwithstanding.
In fairness to Jindal, he has tweaked a few things from the standard conservative playbook. He would require insurance companies, once they’ve sold you insurance, to continue your plan even if you get sick—but doesn’t say how he’d protect the tens of millions of Americans with pre-existing conditions who would have trouble getting covered in the first place, other than state high-risk pools. And there are a few smaller features of his proposal that make sense. For instance, he’d change the tax treatment of health insurance so everyone could get the same favorable treatment that people with employer-provided insurance get. That would increase the fairness of the system, even if Jindal’s assertions that it would magically cut the ranks of the uninsured by 9 million and dramatically slow health care spending are absurd on their face.
But if we repealed the ACA and instituted all of Jindal’s proposed reforms, we’d still have all the problems we had before the ACA was passed. And I suspect that if you gave him a truth serum, he’d admit that none of what he proposes would have much of a salutary effect. But that’s where conservatives are. Barack Obama stole the one market-based idea they had that might actually bring us to something close to universal coverage. They have no idea where to go from there, and that’s how it’s going to be for the foreseeable future. They’ll feel the need to keep saying, “We have a plan too!” And when everyone says, “OK, tell us what it is,” it will be the same old thing, and no one will take them seriously.
By: Paul Waldman, Contributing Editor, The American Prospect, April 3, 2014
The cynicism of the GOP’s anti-Obamacare strategy has been obvious forever, but some particular kinks in it only became clear as the enrollment deadline approached and it seemed the Obama administration would not just meet but beat its public-exchange enrollment target. Republicans went from shrieking about what an awful program it was to complaining that not enough people had signed up, and then, when the goal was met, complaining that not enough uninsured people had gotten coverage, and of course lying about that, too.
The lunacy of their complaint – “This program is a nightmare – but not enough people are being helped by it!” – is like the old joke about the kvetchy restaurant patron who complains the food is terrible, and the portions are too small. It would be funny if it weren’t sad.
I confess that the freakout over the federal exchange’s rocky start had me convinced the administration would miss its enrollment target. So hitting the seven million mark is cause for elation, but also anger: Imagine how many people might have enrolled if the entire Republican Party coast to coast hadn’t spent the last six months telling them not to?
Let’s take it further: Imagine if all 50 states had implemented their own exchanges, instead of just 17 of them. Imagine if all 50 states had expanded Medicaid, instead of just 27. Imagine if a well-funded noise machine, from Fox to Rush to the online swarm hadn’t publicized every glitch and every allegation of someone losing their insurance, often fabricating the problems, sometimes lying outright, while ignoring every positive story.
It’s absolutely true that this first enrollment period still leaves most of the uninsured without insurance. Still, at least 9.5 million of the uninsured now have care, thanks to the state and federal exchanges, Medicaid expansion and people buying coverage privately. (On Fox, Charles Krauthammer simply lied when he says it’s only 1 million.) It must be noted that states that built their own exchanges and expanded Medicaid did much better when it comes to covering the uninsured. The Los Angeles Times estimates that at least 27 percent of the newly insured were previously uninsured; in Kentucky, it’s 75 percent and in New York it’s 70 percent. If Republican governors and legislatures hadn’t sabotaged the program in roughly half the states, we would see numbers like that nationwide.
When you add in young people covered by their parents’ insurance and people with pre-existing conditions who can now get coverage, the number goes higher still. As President Obama noted in his Rose Garden victory lap, 100 million people have received free preventive care under new regulations for insurance plans. It’s no wonder that the latest Washington Post/ABC News poll showed approval of the Affordable Care Act topping disapproval for the first time ever, with approval jumping from 40 percent in November to 49 percent last week. Barring a major meltdown, those numbers are likely to climb too.
This is, of course, what the GOP feared – not that the plan would fail, but that it would work. Again, it’s not perfect – we still don’t know exactly who signed up, and whether the balance of young and old, sick and well will make plans affordable. But this enormous milestone should make Democrats smarter about how to make Republicans pay for their obstruction in 2014. The conventional wisdom is that Obamacare will be a millstone in the midterms, especially for red state Democrats, but conventional wisdom is often wrong.
Democrats should challenge Republicans to take away that free preventive care from 100 million Americans. Challenge them to transfer money from women back to men, by letting insurance companies once again charge women more, sometimes much more, for health insurance. Take insurance away from people with pre-existing conditions; kick young people off their parents’ plans. Roll back Medicaid expansion in the 27 states that participated. Go on and tell the American people you’re going to do that, Republicans. The midterms might not be the cakewalk you think.
By: Joan Walsh, Editor at Large, Salon, April 2, 2014