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“Treading Carefully”: Paul Ryan’s Big, Tricky Budget Moment Is Here

Congress has been historically inactive this year. But with the clock winding down on 2013, there is still a glimmer of hope that bicameral negotiations could produce a modest budget deal that would replace some of the sequester cuts.

For Rep. Paul Ryan (R-Wis.), the House GOP budget guru and potential presidential aspirant, that presents both an opportunity and a challenge. A bipartisan deal could serve as a rare (for him) legislative achievement that pads his credentials and charts the GOP’s course heading into the next election cycle. Yet at the same time, Ryan would risk spurning the GOP base — and its vocal Ted Cruz types — if he’s perceived as bending too far to Democratic demands.

Ryan and his Senate counterpart Sen. Patty Murray (D-Wash.) are believed to be close to a very small deal that would eliminate some of the automatic budget cuts scheduled to go into effect over the next two years. Though nothing is finalized, the deal would reportedly nix about one-third of the sequester-mandated cuts, splitting the reinstated funds between defense and non-defense spending.

Since Republicans won’t go for tax increases, and Democrats won’t tackle entitlement reform without also touching revenue, Murray and Ryan have been reduced to “pulling together odds and ends to make a deal, including non-tax revenue like auctioning broadband spectrum and airport security fees, as well as increasing employee contributions to federal workers’ retirement programs,” wrote MSNBC’s Suzy Khimm.

In short: The negotiators are looking at a tiny deal, far less than the sweeping budget overhaul Ryan has famously proposed before in his spending blueprints.

Still, a deal would be a success for a Congress so dysfunctional it triggered a two-week government shutdown and flirted with debt default. Republicans would love to roll back some of the cuts to defense spending. And Democrats are eager for a deal that would wipe out some of the cuts to cherished domestic programs like Head Start.

Such a deal, if passed, would also be a significant accomplishment for Ryan to add to his otherwise unimpressive legislative record.

Though a noted policy wonk, none of Ryan’s radical budget bills have gone anywhere in Congress. In fact, only two Ryan-drafted bills, neither of which were anything truly groundbreaking, have become law in the congressman’s entire House career. One bill named a post office; the other amended a tax on arrows.

A deal would thus “burnish an image of someone willing to find — and tout — common ground in a historically divided Washington,” wrote Politico’s Jake Sherman and John Bresnahan. “It’s a credential that could serve him well as he looks to grab the chairmanship of the Ways and Means Committee or run for his party’s nomination before the 2016 presidential contest.”

Still, an agreement almost assuredly wouldn’t do anything about long-term GOP priorities Ryan has championed before, like cutting entitlement spending.

And there’s the rub for Ryan: A small deal could turn off both conservative lawmakers and voters.

Conservative House members dug in on their impossible demands during the shutdown even as it obliterated the party’s approval rating. Those same members could balk at a proposed deal that doesn’t cut deeper. And though a deal could still pass with the help of Democratic votes, Speaker John Boehner (R-Ohio) would risk further splitting his fragile caucus by cobbling together a Democratic-heavy coalition.

A mini-deal could also be problematic for Ryan’s perceived presidential ambitions if it causes the party’s right flank, which plays a disproportionately large role in the primary nominating process, to sour on him.

“If the Tea Party turns up the rhetorical heat, would Ryan risk a presidential bid to rescue the country from another government shutdown?” wrote Salon’s Joan Walsh. “I’ve never seen him stand up to that kind of ideological pressure from the right, but there could be a first time.”

If he’s keen on keeping his conservative hero status and pursuing a 2016 run, Ryan really ought to tread carefully.


By: John Terbush, The Week, December 4, 2013

December 5, 2013 Posted by | Budget, Paul Ryan | , , , , , , , | 1 Comment

“We Are All Fragile Beings”: Obamacare Saved My Family From Financial Ruin

House Speaker John Boehner and his tea party friends shut down the U.S. government because of people like me. I am the mother of an insurance hog, someone who could have blown through his lifetime limit of health coverage by the time he was 14. My son has managed to survive despite seemingly insurmountable challenges, and he wears his preexisting condition like a Super Bowl ring.

Mason, now 16, was probably born with his brain tumor. We discovered it six years ago. Biopsies showed a slow-growing mass, which was the good news. The bad news was that the tumor could not be removed because it had grown around essential structures in his brain. Under the care of some of the country’s finest specialists, Mason had frequent scans. There was little we could do between tests but hope for the best. Like other children his age, Mason played basketball, argued with his siblings and avoided cleaning his bedroom. He managed to undergo chemotherapy for eight months without getting too sick. He insisted on finding ways to laugh, saying things like: “I have brain cancer. What’s your problem?” It was an uneasy peace — until the tumor ruptured in December 2010, three years after his initial diagnosis, and Mason suffered a massive cerebral hemorrhage.

Mason spent most of eighth grade in the hospital. In the six months he was hospitalized, he spent 65 days in the pediatric intensive care unit. He underwent four brain surgeries. Halfway through his hospitalization, the Affordable Care Act was passed, alleviating lifetime limits on coverage and saving us from the financial abyss. Mason moved to a rehabilitation hospital where he was retaught the most basic skills — sitting up, eating and standing. We faithfully paid the premiums on the employer-sponsored plan through which our family is covered, along with the rest of our bills, thanking God and whoever else would listen for our good fortune to have coverage.

The biggest fear for families such as mine is that we will lose our health insurance and be rendered uninsurable because one of us has been sick. The Affordable Care Act does away with dreaded clauses barring preexisting conditions. It also enables us to keep Mason on our insurance until he is 26; then, he will be able to purchase his own coverage on an insurance exchange. At least, that was the plan until last Tuesday, when the government was shut down in protest of such excesses.

As far as the brain tumor goes, our family might have drawn the short straw. Maybe our story lacks a certain universal appeal. People might be thinking to themselves, “I’m so sorry that happened to you, but odds are it won’t happen to me.” I hope it doesn’t, really.

But having lived in hospitals with Mason for months, I have seen that bad things — accidents, freak illnesses — happen to smart, cautious and otherwise undeserving people. It’s one thing we all have in common. We are fragile beings. So what is wrong with allowing us to purchase a financial safety net? What’s so un-American about that?

If I could get John Boehner and Ted Cruz on a conference call, I would explain this to them. I would tell them that, while they were busy trying to derail the Affordable Care Act over the past two years, Mason has again learned to walk, talk, eat and shoot a three-point basket.


By: Janine Urbaniak Reid, a writer in the San Francisco Bay Area, is working on a memoir about her son’s diagnosis; October 9, 2013; Published in The Washington Post Opinions Section, December 4, 2013

December 5, 2013 Posted by | Affordable Care Act, Obamacare | , , , , , , , | Leave a comment

“Reality Be Damned”: Do Republicans Need A Plan B On ObamaCare?

For years, Republicans have trotted out the same message: ObamaCare is a massive disaster, and the public knows it. And when crashed out of the starting gate, that message proved quite resonant.

Yet as ObamaCare begins to turn the corner, Democrats are going back on the offensive, touting the law’s benefits and successes in hopes of boosting support for it — and the party — ahead of the 2014 elections. Republicans, meanwhile, have so far stood by the same critiques, betting that the law will still be seen as a failure come Election Day.

Which raises a thorny question for the GOP: What if ObamaCare works?

Undoubtedly, ObamaCare is now functioning better than it was in October. Though problems remain for the exchange site — the back end is still a mess, often sending bogus or incomplete information to insurers — enrollments are reportedly surging through both the federal and state-run marketplaces.

Good news in hand, the White House and congressional Democrats this week launched a campaign of daily pro-ObamaCare messaging to promote the law ahead of the December 23 enrollment deadline for coverage that kicks in January 1, 2014. Their goal is to present a “raw two-sided picture,” according to Politico, with “Democrats delivering benefits on one side, and Republicans trying to deny them on the other.”

“My main message today is: We’re not going back,” Obama declared in a reboot speech Tuesday.

If ObamaCare keeps improving, the GOP’s “we told you ObamaCare was a mess” pitch could quickly wear thin. And if it does, Republicans will find themselves in need of a new argument or a legislative alternative.

So far, they don’t really have either.

On the messaging front, House Speaker John Boehner (R-Ohio) on Tuesday repeated boilerplate GOP criticisms that the law is “fundamentally flawed,” and that it “continues to wreak havoc on American families, small businesses, and our economy.” Other GOP leaders similarly contended that the law is still a problem-plagued failure.

That the message hasn’t changed despite ObamaCare’s turnaround proves that “Republican complaints of two months ago were purely opportunistic,” wrote Jamelle Bouie over at the Daily Beast.

“For them, it just doesn’t matter if is working, since ObamaCare is destined to fail, reality be damned!” he added. “At most, the broken website was useful fodder for attacks on the administration. Now that it’s made progress, the GOP will revert to its usual declarations that the Affordable Care Act is a hopeless disaster.”

The GOP has also yet to offer a credible legislative alternative to ObamaCare. Though there are several Republican bills that would reform the health-care system, they’re generally considered suspect, and none have consensus support within the GOP. Boehner on Tuesday tellingly dodged a question about whether he would even bring up such a bill up for a vote, saying only, “We’ll see.”

Polls have shown that while voters aren’t too keen on the health-care law, they’re willing to give it a chance. Indeed, the first few months of ObamaCare’s disastrous rollout could be a distant memory once coverage and benefits kick in next year.

Which points to another problem for Republicans: Their anti-ObamaCare crusade will be tough to sustain once people begin to see the law’s benefits in action. Mother Jones‘ Kevin Drum sussed out that point, writing, “Once the benefits of a new program start flowing, it’s very, very hard to turn them off.”

By the middle of 2014, ObamaCare is going to have a huge client base; it will be working pretty well; and it will be increasingly obvious that the disaster scenarios have been overblown….

Given all this, it’s hard to see ObamaCare being a huge campaign winner. For that, you need people with grievances, and the GOP is unlikely to find them in large enough numbers. The currently covered will stay covered. Doctors and hospitals will be treating more patients. ObamaCare’s taxes don’t touch anyone with an income less than $200,000. Aside from the Tea Partiers who object on the usual abstract grounds that ObamaCare is a liberty-crushing Stalinesque takeover of the medical industry, it’s going to be hard to gin up a huge amount of opposition. [Mother Jones]

Republicans have so far committed themselves to staunchly opposing ObamaCare no matter what, even producing a playbook for attacking the law from here to November 2014. But if ObamaCare continues to improve, the GOP might need to draw up a new play — or risk getting burned at the polls.


By: John Terbush, The Week, December 4, 2013

December 5, 2013 Posted by | Affordable Care Act, Republicans | , , , , | Leave a comment

“Unsatisfying To The Media And Republicans”: Surprise, Obamacare Now Projected To Cost Hundreds Of Billions Less Than Expected

Amidst the dark skies of the launch, some daylight may finally be emerging with respect to one of the critical goals of the Affordable Care Act—bending the cost curve of America’s expensive healthcare system.

According to a New York Times report out Tuesday, the Congressional Budget Office has quietly removed hundreds of billions of dollars from the projected costs of Obamacare, primarily the result of an anticipated decrease in the federal government’s contribution to the Medicaid expansion program along with the projected cost of the subsidy payments to those buying private insurance policies on the healthcare exchanges.

Why the good news?

The more favorable projections are the direct result of the slowing trend in the growth of healthcare spending over the past five years leading to a slowdown in rising costs. While, ten years ago, per-capita spending on healthcare had been growing by an average annual rate of 5 percent, that number was dramatically cut to 1.8 percent during the 2007-2010 period and reduced even further to 1.3 percent in the years following 2010.

Do we have Obamacare to thank for this highly successful “bending” of the cost curve?

Naturally, the answer depends upon who you ask as there simply is no definitive way of knowing—yet.

While most economist believe that the lion’s share of the reduction is due to the sluggish economy—making Americans far more careful when it comes to making decisions regarding when or if to spend money on medical care—others believe that some of the plans built into the ACA designed to get people to spend less may actually be working.

Among Obamacare inventions that do appear to be paying off in lower healthcare costs is the government’s refusal to pay hospitals more when patients are re-admitted within 30 days of their initial discharge. Additionally, new plan designs engineered to reward providers for quality of care rather than for quantity of care may well be paying off in terms of lowering the overall cost of care.

According to the Kaiser Family Foundation—widely regarded as an honest, non-partisan broker when it comes to healthcare issues and analysis—the declining increases in the cost of healthcare is 75 percent the result of economic factors and 25 percent a benefit of the cost cutting measures in the ACA that do, in fact, appear to be working.

Of course, the big question is whether or not these cost lowering provisions of Obamacare will continue to do the job once the economy regains its more typical trajectory.

There are reasons to be hopeful that healthcare spending can be held down once the economy kicks into higher gear.

For starters, while many Americans shopping for new health insurance policies may be decrying the higher deductibles they are discovering in the new offerings, higher deductibles should have a meaningful impact on the decisions people make when determining whether or not a visit to the doctor or agreeing to a given procedure is really necessary. While a $250 deductible will likely not cause a patient to ask how much a suggested CT Scan is going to cost, a $3,000-$5,000 deductible is far more likely to cause the patient to ask a few more questions and make more focused decisions when payment for the test is coming out-of-pocket.

Not surprisingly, there are no shortage of economists and pundits who believe that the ACA will prove inadequate to the task of controlling costs once the economy is in better shape.

Others are more hopeful, believing that the slowdown in costs are very much a result of hospitals and insurance companies understanding that something had to change given the unsustainable trends in rising costs. As a result of a desire to derail out-of-control costs before the costs derailed them, insurers and hospitals became involved in substantial systemic revisions designed to lower healthcare spending  even before the government required them to do so.

Discussing whether the current decreases can last when previous periods of cost-curve bending did not, Annie Lowrey writes in  her New York Times piece

“This time may be more durable. Insurance and hospital executives in Massachusetts, Illinois and California, among other places where reforms have gone the furthest, report a consensus that spending growth had become unsustainable, and that expectations that Washington would force changes to the system spurred them to make changes themselves.”

If this is true—and I believe the evidence reveals that it is—these self-imposed changes, in tandem with the changes brought about by elements of Obamacare that don’t receive nearly as much attention as the more hot button issues, may prove to provide lasting changes to the system; changes that will point our cost trajectory in the right direction.

Like most elements of the Affordable Care Act, these issues and results only go to prove that far more time is required before we can even begin to measure the real benefits or detriments of Obamacare.

While this reality may prove unsatisfying to the media, politicians and those in the public who are so emotionally committed to the failure and ultimate death of Obamacare—whether for political purposes or only so that the opponents can experience the satisfaction of having been right—anyone interested in realistic measurement of this dramatic change in our system better settle in for the long run.

It’s going to be awhile until we know how this story ends.


By: Rick Ungar, Op-Ed Contributor, Forbes, December 4, 2013

December 5, 2013 Posted by | Affordable Care Act, Media, Republicans | , , , , , , | Leave a comment

“Brazen Dishonesty”: California GOP ‘Reaches For The Bottom’

Health care policy can get confusing, even for policy experts who study the details for a living. It’s one of the reasons dishonesty in the political debate surrounding health care is so damaging – even the most well-intentioned people often don’t know how best to separate fact from fiction.

It’s why efforts from political officials – who know better – to deliberately confuse people are so disappointing. Michael Hiltzik reports:

Opponents of the Affordable Care Act never stop producing new tricks to undermine the reform’s effectiveness. But leave it to California Republicans to reach for the bottom. Their goal appears to be to discredit the act by highlighting its costs and penalties rather than its potential benefits.

The device chosen by the Assembly’s GOP caucus is a website at the address If that sounds suspiciously like, which is the real website for the California insurance exchange, it may not be a coincidence.

In theory, this is a site created by California Republicans to serve as a “resource” for those looking for additional information. In practice, the site “is worse than useless” – it didn’t direct users to the in-state exchange marketplace, and includes demonstrable falsehoods intended to deceive the public.

Like what? The site includes the ridiculous notion that the Affordable Care Act increases the federal budget deficit, which is the exact opposite of reality. It also claims the IRS will use the law to target conservatives; it says the law will discourage private-sector hiring; and it even hints in the direction of the death-panel smear by raising the specter of “rationing” for the elderly.

All of these claims are wrong. All of them are presented, however, on a website that presents itself as objective and non-partisan.

Stepping back, dishonesty on this scale is certainly brazen, but it raises anew a lingering question: if the Affordable Care Act is so awful, and will be as horrific as critics claim, why do Republicans continue to feel the need to make stuff up? Shouldn’t reality be damaging enough?


By: Steve Benen, the Maddow Blog, December 4, 2013

December 5, 2013 Posted by | Affordable Care Act | , , , , , , , , | Leave a comment

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