“Running On Empty”: Republicans Can’t Repeal Or Replace Obamacare, And They’re Too Scared To Fix It
More than three million people have already signed up for health insurance as of last Friday through the exchanges set up by the Affordable Care Act (ACA). That number is growing rapidly, with 15,000 new enrollments a day in California alone.
And the Republican plan to deal with Obamacare generally remains what it has been since 2010 — repeal.
This means the millions of men, women and children covered under plans could either see their plans invalidated by insurance companies no longer required to cover pre-existing conditions or have their Medicaid coverage completely erased. Republicans who spent the last three months screaming about how terrible insurance cancelations are would have to explain what happens next for millions of uninsured Americans.
Repeal is a fantasy, a fundraising opportunity that all Republicans — except the few who take Senator Ted Cruz (R-TX) seriously — know would never happen. And if it did, they would end up owning every aspect of a crumbling health care system the same way Democrats are currently responsible for every splinter in every tongue depressor.
The Washington Post‘s Greg Sargent looks at recent polling and finds that though Americans are largely dissatisfied with the rollout of the Affordable Care Act, they generally support the federal government’s taking a role in getting people affordable health insurance. More importantly, most are still willing to give the law a chance.
“Only 37 percent support repealing Obamacare entirely,” he writes, “while 53 percent say there are good things in the law and that changes are needed to make it work better.”
Republicans are now in what Sargent calls “The GOP Repeal Trap,” which essentially requires them to vow repeal and pray that somehow the law collapses on its own.
While it may seem absurd to those who care about governing, it makes perfect sense strategically because ”replace” is an even bigger fantasy than repeal.
Until it became socialism incarnate, the ACA was the conservative reform to the health care system. So to replace it completely, conservatives would need to go further to the right and destroy the entire employer-provided health insurance paradigm that provides about 85 percent of working adults with their coverage.
That’s what the proposal John McCain ran for president on in 2008 would have done, canceling the insurance of about 20 million Americans, four times the number who had to find new coverage under Obamacare.
Are there conservative fixes that could be made to the ACA that Democrats would be willing to trade for reforms of their own?
Health economist Austin Frakt has listed more than a dozen possible conservative-leaning fixes for the law, starting with their all-time favorite, tort reform, which actually would do very little to lower health care costs but would be a huge win for the right in their never-ending war against trial lawyers.
So why doesn’t some brave Republican — say Governor Chris Christie (R-NJ) — step forward with a set of conservative reforms to the ACA?
The answer is easy: Republican primaries.
Michigan Senate candidate Terri Lynn Land suggested that the law would be fixed and was forced to flip-flop on that position in less than 24 hours, likely in fear that she might end up with a Tea Party challenger. Georgia Senate candidate Rep. Jack Kingston did nearly the exact same thing.
Christie is already saddled with being the only 2016 GOP frontrunner who accepted Medicaid expansion. If he became the face of fixing Obamacare, he would be appealing to the majority of voters but antagonizing if not actually declaring war on those in the base who refuse to accept that Obamacare is here to stay, and also refuse to consider any candidate who tells them what they do not want to hear. (Even if the governor could win the primary backed by the business and more independent wings of his party, he could end up inspiring a Tea Partier to run as a third-party candidate, virtually guaranteeing a Democratic victory in 2016.)
For the foreseeable future, Republican candidates — even those in states and districts President Obama won — are stuck running in the general election with the “problematic” stand of wanting to take health insurance from millions, some of whom may actually show up to vote.
And if they win, they can return to blaming President Obama for never making their repeal fantasy come true. It’s the only safe move.
By: Jason Sattler, The National Memo, December 19, 2013
“A Closer Look At Those Falling Into The Wingnut Hole”: Nearly 80% Of People In The Health Care Coverage Gap Reside In The South
Yesterday the Kaiser Family Foundation released some badly needed data on the characteristics of Americans who fall into what I’ve dubbed the “wingnut hole,” and that others just call the Coverage Gap. These are the people too poor to qualify for Obamacare subsidies for purchasing insurance in the exchanges, but too “rich” to qualify for the Medicaid benefits the drafters of the ACA assumed they would get but that their state governments blocked once the Supreme Court let them make the choice. Here’s the Kaiser Family Foundation’s take on the problem:
Medicaid eligibility for adults in states not expanding their programs is quite limited—the median income limit for parents in 2014 will be 47% of poverty, or an annual income of about $9,200 a year for a family of three, and in nearly all states not expanding, childless adults will remain ineligible. Further, because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults will fall into a “coverage gap” of having incomes above Medicaid eligibility limits but below the lower limit for Marketplace premium tax credits…. Nationwide, nearly five million poor uninsured adults are in this situation.
Who are they? Well, they’re mostly southerners:
The nearly five million poor uninsured adults who will fall into the “coverage gap” are spread across the states not expanding their Medicaid programs but are concentrated in states with the largest uninsured populations…. More than a fifth of people in the coverage gap reside in Texas, which has both a large uninsured population and very limited Medicaid eligibility. Sixteen percent live in Florida, eight percent in Georgia, seven percent live in North Carolina, and six percent live in Pennsylvania. There are no uninsured adults in the coverage gap in Wisconsin because the state will provide Medicaid eligibility to adults up to the poverty level in 2014.
The geographic distribution of the population in the coverage gap reflects both population distribution and regional variation in state take-up of the ACA Medicaid expansion. As a whole, more people—and in particular more poor uninsured adults— reside in the South than in other regions. Further, the South has higher uninsured rates and more limited Medicaid eligibility than other regions. Southern states also have disproportionately opted not to expand their programs, and 11 of the 25 states not expanding Medicaid are in the South. These factors combined mean nearly 80% of people in the coverage gap reside in the South
They’re also hard to define by race or ethnicity:
The characteristics of the population that falls into the coverage gap largely mirror those of poor uninsured adults. For example, because racial/ethnic minorities are more likely than White non-Hispanics to lack insurance coverage and are more likely to live in families with low incomes, they are disproportionately represented among poor uninsured adults and among people in the coverage gap. Nationally, about half (47%) of uninsured adults in the coverage gap are White non-Hispanics, 21% are Hispanic, and 27% are Black (Figure 3).
And they’re often the people left behind in wave after wave of incremental reforms based on expanding Medicaid and S-CHIP benefits to kids and their parents.
The characteristics of people in the coverage gap also reflect Medicaid program rules in states not expanding their programs. Because non-disabled adults without dependent children are ineligible for Medicaid coverage in most states not expanding Medicaid, regardless of their income, adults without dependent children account for a disproportionate share of people in the coverage gap (76%)…. Still, nearly a quarter (24%) of people in the coverage gap are poor parents whose income places them above Medicaid eligibility levels. The parent status of people in the coverage gap varies by state….due to variation in current state eligibility.
What doesn’t vary state by state is how outrageous it is to exclude the people who by the accident of a court decision fall into the “wingnut gap” of benefits available to people just above them on the income scale. They are for the most part the “working poor,” people with part-time or small-business jobs that don’t come with private health insurance.
They are ineligible for publicly-financed coverage in their state, most do not have access to employer-based coverage through a job, and all have limited income available to purchase coverage on their own.
You can argue that these people are those most in need of the Affordable Care Act, yet most likely to be excluded from its benefits.
These are also people with an unusually large personal stake in the outcome of the 2014 elections–the kind of people conservatives are thinking of when they conclude Obamacare has created a “tipping point” wherein actual or potential beneficiaries of government programs are essentially being bribed into voting Democratic. But if there’s been any growing groundswell of political mobilization of people in the “wingnut hole,” it has been very quiet. So they will likely become objects of anti-redistribution propaganda from the Right without becoming subjects of any major Democratic comeback.
The latest hope for people in the “wingnut hole” has been enthusiasm for securing Medicaid expansion by very broad waivers allowing states to work their will on the Medicaid program as a whole. To be very blunt about it, such “deals” have tended towards broadening the base of people eligible for Medicaid while degrading its benefits, with the federal government paying almost all the cost of implementation and sharing the political risk that it might fail. The situation is a reminder that about a hundred fifty years after the end of the Civil War, southern states are still fighting the “Reconstruction” potential of federal funds to interfere with the region’s grim perpetuation of inequality.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 18, 2013
“Waging A Hopeless War Against Demographic Shifts”: Fox News Has Already Lost Its War On Christmas
Take down the Christmas tree Holiday Conifer and pack up the Nativity set Biblical-themed diorama: The War on Christmas is over, and the secularists have won.
While Fox News was busy insisting that Santa (and Jesus) are white, a couple of new polls pointed to something that the network has been warning about for years: Christmas has gradually become less of a religious holiday, and more of a cultural one.
First up, a Public Religion Research Institute survey released Tuesday found that almost half (49 percent) of Americans believe stores should use non-denominational greetings like “happy holidays.” That’s up slightly from three years ago, when 44 percent preferred a less-religious platitude to the traditional “Merry Christmas.”
At the same time, just under half of all Americans (49 percent) now believe the Biblical story of Christmas — virgin birth, angels, three wise man, and so on — is historically accurate. That’s a steep decline from a decade ago, when fully two-thirds of Americans believed the story was completely true.
So what happened to America? In a word: Aging.
Younger Americans are far less likely than older ones to view Christmas as a religious holiday. Much like how same-sex marriage, marijuana legalization, and other once-untouchable wedge issues have been blunted by the nation’s shifting demographics, the same phenomenon is evident in America’s changing views of Christmas.
A recent Pew poll bears out this point. In the survey, 51 percent of respondents say Christmas is “more of a religious holiday,” while 32 percent say it is more so a cultural one. But among adults ages 18-29, only a 39 percent minority say they celebrate Christmas as a religious holiday; among those 65 and up, 66 percent say the same.
Moreover, though seven in ten respondents in the survey say they typically went to religious Christmas services as children, only 54 percent say they plan to do the same this year.
The shift reflects America’s growing body of so-called “nones,” or the religiously unaffiliated, whose share of the population rose from 15 to 20 percent in the last five years alone. With that group on the rise, and with millennials beginning to skew the nation’s overall demographic makeup, an uptick in support for a more secular Christmas should be expected.
So Fox News is sort of right in saying that “Yes, Virginia, there really is a War on Christmas.” But the war isn’t one being waged by fanatical, intolerant liberals and foaming-at-the-mouth atheists. It’s one being waged by inexorable shifts in America’s demographics and beliefs.
By: Jon Terbush, The Week, December 18, 2013
“An Utterly Irrelevant Man”: NYT Mag Offers Inexplicable 2006 John McCain Cover Profile In 2013
In the last couple of years, every time something John McCain says makes “news,” my immediate reaction—sometimes on Twitter, sometimes just in my head—is, “Remind me again why anybody should give a crap what John McCain thinks about anything?” I’ve never been able to get a satisfactory answer to this question. And here comes star reporter Mark Leibovich, author of the well-received This Town, with a 6,634-word cover profile of McCain for next week’s New York Times Magazine. Do we need another one of these? I would have answered “no” before reading, but after, I’m even more sure.
If you’re doing this kind of profile, the first thing you have to do is answer, “Why?” Why do we care what McCain is up to? Did you learn anything important or interesting by following him around for a few days? Leibovich gives a shot to answering this question, and fails completely. He acknowledges all the clichés that have been attached to McCain over the years (maverick!), but then, without acknowledging it, indulges in the cliché that undergirds all the others: that whatever is happening now, John McCain is at the center of it:
McCain has another favorite Teddy Roosevelt phrase, “the crowded hour,” which I have heard him invoke several times over the years. It comes from a poem by the English writer Thomas Mordaunt, and T. R. used it to famously describe his charge on San Juan Hill. In McCain’s philosophy, “the crowded hour” refers to a moment of character testing. “The ‘crowded hour’ is as appropriate for me right now as any in a long time,” McCain told me as we walked through the Capitol. In some respects, this is just a function of public figures’ tendency to overdramatize the current moment and their role in it. But five years after losing to Barack Obama, after enduring the recriminations between his splintered campaign staff and rogue running mate, Sarah Palin, and after returning to the Senate and falling into a prolonged funk, McCain finds himself in the midst of another crowded hour, maybe his last as an elected leader.
And just how is John McCain in this ‘crowded hour,’ shaping critical events? How is his character being tested? Well let’s see. In the next paragraph, Leibovich tells us that McCain thinks Barack Obama is a foreign policy disaster. An opinion shared by most Republicans (Obama hasn’t even started any new wars, for pete’s sake!), but holding that opinion doesn’t constitute doing anything. Next, Leibovich tells us, “McCain also finds himself in the thick of the latest ‘fight for the soul of the G.O.P.’ against the Tea Party right.” “In the thick” of it, is he? And what does that mean? Will McCain have some large influence over that fight for the party’s soul? Of course not. Every once in a while he’ll give a surly comment, like when he referred to Tea Partiers as “wacko birds,” but he won’t be organizing any faction, or leading anybody, or doing anything at all that will determine the outcome of that fight. Nevertheless, Leibovich assures us, McCain does go on TV a lot. You might argue that makes him relevant (“I think the biggest fear John has is not being relevant,” says his little buddy Lindsey Graham), but spending a lot of time chatting with Wolf Blitzer is not the same thing as having an impact on developing events.
So let’s ask: What are the standards we could use to judge whether a senator is an important figure, at least more important than most of his or her 99 colleagues? After all, nobody’s writing Times Magazine cover profiles of Mike Johanns or John Hoeven. How is it that they’re less important than John McCain? An important senator might be influencing critical legislation. No dice there: McCain never much cared about lawmaking (in his three decades in Congress, he authored exactly one important law, which was later eviscerated by the Supreme Court). He might later become a presidential candidate, which is why we pay attention to people like Rand Paul or Ted Cruz, even if they’re ridiculous. No dice there either; McCain won’t be running for the White House again. He might lead some important constituency, or exercise great influence over his colleagues. Nothing there either; McCain represents basically no one, and he has never been popular with other senators. He might be championing an issue that will grow in import in the near future. Nothing there either. He might have some truly profound ideas that will shape policy in years to come. Can you name an important idea John McCain is advocating for?
So all that’s left is that John McCain is important because he gets invited on Meet the Press a lot. If you’re looking for something beyond that, you won’t find it in this article.
Leibovich is a good reporter, which is why this piece is so puzzling. Not just in that he makes some of the same blunders so many other reporters profiling McCain have made, like credulously quoting McCain saying he never talks about his experience in Vietnam—not only completely false (he talks about it all the time*), but a transparent way of making sure that the reporter includes in his story both a tribute to McCain’s modesty and a lengthy description of his POW ordeal. But more critically, what boggles the mind is that Leibovich (not to mention his editors) thought there was something to be learned with yet another 6,600-word profile of John McCain that reads exactly like every other profile of McCain you’ve ever read, from the Vietnam tribute to the description of his full schedule to the admiring quotes from Lindsey Graham and Joe Lieberman to the awe at his mavericky maverickness. I’ll save you the trouble: there isn’t.
* I just want to add that it isn’t just Leibovich who says this, just like so many other reporters who have written about McCain. In another portion of the article, Liebovich discusses a luncheon Harry Reid organized to honor the anniversary of McCain’s captivity:
“John told a lot of little poignant stories,” Susan Collins of Maine told me. “When John was tied up in such a painful position, he talked about the one guard who would loosen the bonds. He told the story of being out in the yard on Easter, and how one of the guards drew a little cross in the sand, just to acknowledge the holiday, and then rubbed it out so no one would get in trouble.” Collins has spent more than a hundred hours on airplane trips with McCain, she says, and has never heard him tell these stories.
Really? Then Collins ought to pay more attention to the news, because I’ve seen McCain tell that story a dozen times. His 2008 campaign even made an ad telling the story. For the record, as I’ve said many times, McCain has every right to talk about Vietnam as much as he wants and get whatever political mileage he can out of it. But when he and other people claim he’s terribly reticent about ever bringing it up, they just aren’t telling the truth.
By: Paul Waldman, Contributing Editor, The American prospect, December 18, 2013
“Boehner’s New Enemies”: Tea Folk Are Largely Unaffected By Attacks From The Speaker And Other “Establishment” Republicans
I’ve spent quite a bit of time mocking the extraordinary Beltway joy over House Speaker John Boehner’s rebuke to “outside” conservative groups, as representing the millionth decisive setback for the Right in the so-called “civil war’ in the GOP.
But how’s about the grassroots membership of the “outside” groups? Are they in disarray?
Doesn’t much look that way, based on Stephanie McCrumman’s profile of Americans for Prosperity members meeting for dinner in Greenville, SC. If the Kochs continue to provide the money, activists seem to have the time. Here’s my favorite passage:
Dean Allen, who is writing a book called “Rattlesnake Revolution: The Tea Party Strikes!,” said it was people like him who are the future of the party.
“You’ve got to have people in this room excited,” he said, waving a biscuit. “It’s who will open their checkbook, who will put the signs on the road… When we are demoralized we get crap like Obama in the White House.”
Reading this piece, you get the sense that Tea Folk are largely unaffected by attacks from Boehner and other “Establishment” Republicans because they view themselves as perpetually being abused by GOP leaders even as they continue to provide most of the people power and much of the money essential for Republican electoral efforts. They’ll keep on keeping on, despite the general disbelief among political journalists that it’s possible to constantly launch primary purges against elected officials you plan to support loyally in general elections.
All Boehner’s outburst probably means is that grassroots wngnuts will feel invested in the next conservative challenge to the Orange Man’s leadership. And if he does indeed retire at the end of next year, his remarks about conservatives last week won’t represent much of anything at all other than a temporary speed bump in the rightward movement of the Republican Party.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, December 18, 2013
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