Was I on the edge of my seat, waiting for the Supreme Court decision on Obamacare subsidies? No — I was pacing the room, too nervous to sit, worried that the court would use one sloppily worded sentence to deprive millions of health insurance, condemn tens of thousands to financial ruin, and send thousands to premature death.
It didn’t. And that means that the big distractions — the teething problems of the website, the objectively ludicrous but nonetheless menacing attempts at legal sabotage — are behind us, and we can focus on the reality of health reform. The Affordable Care Act is now in its second year of full operation; how’s it doing?
The answer is, better than even many supporters realize.
Start with the act’s most basic purpose, to cover the previously uninsured. Opponents of the law insisted that it would actually reduce coverage; in reality, around 15 million Americans have gained insurance.
But isn’t that a very partial success, with millions still uncovered? Well, many of those still uninsured are in that position because their state governments have refused to let the federal government enroll them in Medicaid.
Beyond that, you need to realize that the law was never intended or expected to cover everyone. Undocumented immigrants aren’t eligible, and any system that doesn’t enroll people automatically will see some of the population fall through the cracks. Massachusetts has had guaranteed health coverage for almost a decade, but 5 percent of its nonelderly adult population remains uninsured.
Suppose we use 5 percent uninsured as a benchmark. How much progress have we made toward getting there? In states that have implemented the act in full and expanded Medicaid, data from the Urban Institute show the uninsured falling from more than 16 percent to just 7.5 percent — that is, in year two we’re already around 80 percent of the way there. Most of the way with the A.C.A.!
But how good is that coverage? Cheaper plans under the law do have relatively large deductibles and impose significant out-of-pocket costs. Still, the plans are vastly better than no coverage at all, or the bare-bones plans that the act made illegal. The newly insured have seen a sharp drop in health-related financial distress, and report a high degree of satisfaction with their coverage.
What about costs? In 2013 there were dire warnings about a looming “rate shock”; instead, premiums came in well below expectations. In 2014 the usual suspects declared that huge premium increases were looming for 2015; the actual rise was just 2 percent. There was another flurry of scare stories about rate hikes earlier this year, but as more information comes in it looks as if premium increases for 2016 will be bigger than for this year but still modest by historical standards — which means that premiums remain much lower than expected.
And there has also been a sharp slowdown in the growth of overall health spending, which is probably due in part to the cost-control measures, largely aimed at Medicare, that were also an important part of health reform.
What about economic side effects? One of the many, many Republican votes against Obamacare involved passing something called the Repealing the Job-Killing Health Care Law Act, and opponents have consistently warned that helping Americans afford health care would lead to economic doom. But there’s no job-killing in the data: The U.S. economy has added more than 240,000 jobs a month on average since Obamacare went into effect, its biggest gains since the 1990s.
Finally, what about claims that health reform would cause the budget deficit to explode? In reality, the deficit has continued to decline, and the Congressional Budget Office recently reaffirmed its conclusion that repealing Obamacare would increase, not reduce, the deficit.
Put all these things together, and what you have is a portrait of policy triumph — a law that, despite everything its opponents have done to undermine it, is achieving its goals, costing less than expected, and making the lives of millions of Americans better and more secure.
Now, you might wonder why a law that works so well and does so much good is the object of so much political venom — venom that is, by the way, on full display in Justice Antonin Scalia’s dissenting opinion, with its rants against “interpretive jiggery-pokery.” But what conservatives have always feared about health reform is the possibility that it might succeed, and in so doing remind voters that sometimes government action can improve ordinary Americans’ lives.
That’s why the right went all out to destroy the Clinton health plan in 1993, and tried to do the same to the Affordable Care Act. But Obamacare has survived, it’s here, and it’s working. The great conservative nightmare has come true. And it’s a beautiful thing.
By: Paul Krugman, Op-Ed Columnist, The New York Times, June 25, 2015
“GOP Bad Faith Legal Mischief”: Democrats Have Every Reason To Save Republicans From An Obamacare “Bloodletting”
Sometime this month, possibly as early as Monday morning, the Supreme Court will issue its ruling in King v. Burwell. If the Court ignores both the text and purpose of the Affordable Care Act, and rules for the challengers, millions of the law’s beneficiaries in 34 states will quickly lose their insurance subsidies and be forced off their health plans. The ensuing chaos would be the consequence not just of the ruling itself, but also of the Republican Party’s expected unwillingness to pass a one-sentence bill clarifying that Obamacare subsidies are available in every state, whether or not each state established its own health insurance exchange.
When King, and similar cases, were first conceived, they quickly became vessels of hope for conservatives, who recognized how difficult and punishing it would be to hobble or eliminate Obamacare through the legislative process. What many of them have come to recognize in the subsequent years is that farming out the job to the judiciary can’t spare them from the subsequent political cost: As decision day approaches, more and more of these conservatives are acknowledging candidly—and typically anonymously—that they will suffer badly if the Supreme Court does the very thing they’ve asked the Supreme Court to do.
“The most likely option is that Congress is unable to pass a fix,” an anonymous Republican Hill staffer told Joel Gehrke of the conservative National Review—a magazine that has beseeched the Court to void the subsidies. “Either Republicans won’t be able to settle on a fix or the president will veto whatever we do come up with. At that point, it will be up to the governors to pass their own laws deeming the national exchange a state exchange. That is the path of least resistance.”
Gehrke looks at the cross-pressures Republicans would face after a ruling for King and wonders whether they “could be in for a bloodletting.” Though they can’t admit it publicly, the promise of a bloodletting—compounded by the fact that every vulnerable Republican senator in cycle next year represents an affected state—is precisely why so many Republicans privately hope the Court will uphold the subsidies.
If the conventional wisdom which took shape after oral arguments—and to which I subscribe—is correct, the government will win, and this painful exercise in bad faith legal mischief will come to nothing. But if the challengers win, and a bloodletting ensues, Democrats won’t be able to stand back while Republicans absorb the political damage. Bloodletting or no, Obamacare will be crippled in most states. It could easily remain crippled indefinitely. Its fate will turn on the question of whether the political consequences for Republicans resemble the consequences of a government shutdown or collision with the debt limit. But either way Democrats will have to play an active role in bringing about a resolution.
The best-case scenario for Democrats is a public outcry so severe and sustained that Republicans cave, and agree to restore the subsidies with a clean fix.
Republicans have tacitly acknowledged that they won’t be able to sit on their hands while state insurance markets collapse. They have introduced legislation in both the House and Senate that would restore subsidies, but only for existing beneficiaries, and only on conditions Democrats could never accept, like the repeal of the ACA’s individual mandate.
You can interpret these offers in two ways. The first, as Greg Sargent of The Washington Post has noted, is that these bills are designed to be vetoed, allowing Republicans to blame an uncompromising Obama for perpetuating the crisis. But they could also serve as bases for a compromise, or surrender. If the public responds to a ruling for King the way they’ve responded to other GOP-instigated crises, Republicans would have to scale back their demands and eventually agree to reinstate the subsidies, perhaps for a modest price.
Two different forces will push in that direction. Even if sprinkled liberally with poison pills, and even if its proximate purpose is to invite a veto, Republican-sponsored legislation to partially reinstate ACA subsidies probably can’t pass. Democrats aren’t going to vote for an ersatz fix and neither will many rank-and-file conservative members of Congress. “As soon as the messaging is out there saying, ‘Look, a half-a-sentence fix saves millions of people from either losing their coverage or having massive spikes,’ we as a party won’t be able to sustain that pressure very long — certainly not through the August recess,” another Republican aide tells Gehrke.
But that doesn’t mean Democrats will win a standoff outright. Though their case for a clean fix will be compelling, they will also be highly motivated to reinstate the subsidies immediately, even if it means Republicans get to pocket unreciprocated concessions. Those can’t include structural damage to the core of the law, but could include eliminating things like the medical device tax and the employer mandate.
Real danger arises if, per Gehrke’s other source, an adverse King ruling registers somewhere below a government shutdown on the political Richter scale, inflicting damage on the GOP but not enough to make them seek a solution in earnest. Against the backdrop of a paralyzed Congress, Obamacare would begin to unravel in dozens of states, and would continue to do so until at least 2017. A ruling for the challengers would boomerang violently on Republicans, but Democrats have every reason in the world to want them spared from it.
By: Brian Beutler, Senior Editor, The New Republic, June 8, 2015
“The ‘I Don’t Wanna’ Caucus”: Who The Hell Gave Republicans A Monopoly On Morality And Spending Of Public Dollars?
Of all the arguments put forth against everything from the Affordable Care Act to social safety net programs, the “I don’t want to pay for X” argument from the right has to be the most asinine. The upcoming decision on the Supreme Court’s King vs. Burwell case – which could yank subsidies out from under anyone using the federal health care exchange – is a prime example.
As Robert Schlesinger has pointed out, the lawsuit’s proponents are relying on a known falsehood about the intent of the law because they don’t want taxpayer support going to people who otherwise couldn’t afford health insurance. It’s “I Don’t Wanna” as a Supreme Court test case.
Newsflash to the right: I don’t want to pay for a lot of things either, starting with Exxon subsidies, Bush’s wars and the millions we paid to sociopaths to come up with torture techniques for the CIA. Who the hell gave you a monopoly on morality when it comes to spending public dollars? Do you think you’re the only ones who object to where our tax dollars go? Because if we only have to pay for the things of which we approve, I’ve got a long veto list.
The I Don’t Wanna Caucus is willfully oblivious to the fact that a whole lot of people pay for them, too. Texas is more than happy to accept Federal Emergency Management Agency money – they actually got more than any other state in 2011 and 2012 – at the same time Texas Gov. Greg Abbott deploys the state guard against an imaginary Obama takeover and sues the federal government over the environment and health care.
Here in Colorado, as the Colorado Springs Gazette has reported about its home of El Paso County, “The county is more dependent on federal money than most other places in Colorado and the nation … Federal spending accounts for one-third of the local economy.” Yet Colorado Springs would rather have its parks go brown and its streetlights fade than increase taxes locally to pay for them.
The I Don’t Wanna Caucus is not only ideologically hypocritical, it’s also irresponsible. The I Don’t Wanna Caucus of Colorado Senate Republicans killed our highly-successful program that slashed the teen birth and abortion rate by providing free long-acting reversible contraceptives to low-income women. Every $1 invested in the program saved the state $5.85 in Medicaid costs. The Colorado Department of Public Health and Environment estimates that the program could have saved Colorado $49 million to $111 million in Medicaid dollars per year in birth-related costs.
Likewise, insurance is cheaper than no insurance. People without insurance end up in the emergency room, where they have to be treated and where the cost shifts onto someone else. Guess who pays for that? People with insurance. But now, thanks to the Affordable Care Act, hospitals saved at least $7.4 billion in 2014, according to the Department of Health and Human Services.
All of us have someone else paying for us in some form or another, through paved roads and clean drinking water and home mortgage tax deductions. Those of us without kids subsidize schools and teachers for other people’s children. Living in a civilized society means we all share in the cost and responsibility. Living in a civilized society also means we all pay for things we find morally objectionable – conservatives and liberals alike.
Because the alternative – the I Don’t Wanna Caucus – doesn’t belong in a first world country.
By: Laura Chapin, U. S. News and World Report, June 12, 2015
“Vitter’s Mind-Boggling Obamacare Crusade”: Cutting Benefits For Congressional Staffers Could Have Real Consequences
For those who oppose President Barack Obama’s health care reform law, there’s a lot to campaign against. Many of the arguments in the health care debate arise from differences in philosophy and opinion about the future of health care in this country. For example, there’s the ongoing discussion over the appropriate size of the federal government’s role in the provision of health insurance.
Some arguments, however, are mind boggling. One Republican senator’s recent campaign seems to fall in this category.
For about two years, Sen. David Vitter of Louisiana has been on a mission to eliminate the employer subsidy that members of Congress and their staffs receive to buy their health insurance. Thanks to a provision added on to the Affordable Care Act during its consideration, members of Congress and their staffs are required, for the most part, to get their health insurance from the exchanges established by the new law. According to Politico, a ruling by the White House allowed members and staffers to retain the employer health insurance subsidy that they had been receiving before the changes in the Affordable Care Act took effect. Vitter objects to the ruling and claims that it effectively gives Congress an “exemption” from the law.
Although Vitter’s effort may be a good talking point, from a policy perspective, it doesn’t make sense. The senator is clearly approaching the issue from the standpoint of good government and making sure that Congress adheres to the laws it passes for the rest of the nation. However, if he is successful, his efforts will not make government better and they will not make Obamacare better or prove a weakness in the law. All he will accomplish is putting a thorn in the side of the staffers who work hard to make Congress run.
For most staffers, the loss of the subsidy would result in a substantial pay cut. As a former congressional staffer myself, I know that’s a cut many won’t be able to afford. Further, the White House’s actions didn’t give congressional staff a new benefit, nor did it “exempt” them from the Affordable Care Act. They are still required to purchase their insurance from the exchange. Additionally, as Sen. Lindsey Graham, R-S.C., pointed out to Politico, Congressional staff “aren’t getting anything that any government workers don’t get.” Or anyone else who works for a large employer, for that matter. Under the health care law, employees of large employers still receive health care subsidized by their employer. Members of Congress and their staff should be treated the same way.
It’s also possible that the senator’s efforts, if successful, could hurt Congress. Faced with a significant reduction in benefits, many staff would probably choose to leave the hill and recruiting for their replacements would become more difficult. Less effective Congressional staff ultimately means a less effective Congress and, at the end of the day, that only hurts the country further. Although it may seem a bit intangible for people outside of Washington, Vitter’s drive to eliminate health care subsidies for members of Congress and their staffers has real consequences for the people who serve the institution and their families. The crusade should be dropped. There are more important things to do than take health care away from government workers.
By: Cary Gibson, Government Relations Consultant, Prime Policy Group; Thomas Jefferson Street Blog, U. S. News and World Report, May 15, 2015
“Boehner Struggles With His Failed ACA Predictions”: He Should At Least Try To Discuss The Substance Of The Issue Honestly
House Speaker John Boehner sat down with NBC’s Chuck Todd on “Meet the Press” yesterday, and the host asked a good question about the Republican leader’s failed predictions about the Affordable Care Act. Regrettably, the Speaker couldn’t respond with an equally good answer.
TODD: You made some dire predictions about health care. 2014 you said fewer people would have health insurance. According to plenty of surveys, more people have health insurance today than they did before it went down from – the uninsured rate went down 17 percent to just under 12 percent. You said it would destroy jobs. The first year it was implemented, the country added 3 million jobs. Why…
BOEHNER: Obamacare made it harder for employers to hire people. The economy expands and as a result, you are going to have more employees because businesses have to. But if you can ask any employer in America, and ask them whether Obamacare has made it harder for them to hire employees, they’ll tell you yes. Because it’s a fact.
When you look at – you know why there are more people insured? Because a lot more people are on Medicaid. And giving – you know, we expanded Medicaid in a big way. And giving people Medicaid insurance is almost like giving them nothing. Because there aren’t – you can’t find a doctor that will see Medicaid patients.
The Speaker soon added that, as far as he’s concerned, the Affordable Care Act is “not working.”
Boehner might have a credible argument, if we abandoned the agreed upon meaning of “working.”
Look, I realize that health care policy has never been the Ohio Republican’s strong suit, and the Speaker isn’t a wonk deeply engaged in policy details. I can also appreciate why he’s a little embarrassed about making all kinds of ACA predictions, each of which turned out to be wrong. It’s just not realistic to think Boehner will fess up on national television to getting the entire fight over health care backwards.
There’s just no avoiding the fact, however, that Boehner’s comments on “Meet the Press” were woefully incorrect.
According to the Speaker, “it’s a fact” that the Affordable Care Act has “made it harder for employers to hire people.” There’s simply no evidence to support this. None. The U.S. economy saw a jobs boom coincide with the implementation of the ACA. Indeed, the reform law has actually created plenty of jobs within the health care industry by spurring “unprecedented” levels of “entrepreneurial activity.”
At the same time, Boehner believes the drop in the uninsured rate is the result of Medicaid expansion, but that’s wrong, too – millions of consumers have gained private coverage by way of exchange marketplaces. This is even true of the Speaker’s home state of Ohio, which is prepared to create its own exchange if the Supreme Court makes it necessary.
As for the benefits of Medicaid, coverage through the program is not the practical equivalent of “nothing.” Many Americans who’ve gained health security through Medicaid have benefited greatly from affordable care.
Boehner’s conclusion – that “Obamacare” is “not working” – is only true if one closes their eyes, sticks their fingers in their ears, and refuses to consider the evidence. The law is pushing the uninsured rate to new lows; it’s succeeding in satisfying consumers; the law’s price tag is lower than expected; it’s producing impressive results on premiums and enrollment totals; we’re seeing the lowest increase in health care spending in 50 years; the number of insurers who want to participate in exchange marketplaces keeps growing; there’s reduced financial stress on families, the efficacy of Medicaid expansion is obvious, as is the efficacy of the medical-loss ratio and efforts to reduce medical errors system-wide.
The maligned law is even becoming more popular.
Boehner doesn’t have to like the law. He doesn’t even have to admit he was wrong. But he should at least try to discuss the substance of the issue honestly.
By: Steve Benen, The Maddow Blog, May 4, 2015