“BobbyCare”: Jindal’s Generic Obamacare Alternative
If congressional Republicans need a fresh excuse to delay settling on an Obamacare “replacement” plan, Bobby Jindal’s given them one by throwing another plan into the mix. But on further examination, the Genius’ proposal is sort of the ultimate Generic Conservative Plan, complete with a Generic Conservative label, the Freedom and Empowerment Plan. It was released by Jindal’s pocket “think tank,” America Next.
Is there any hoary conservative health policy pet rock this plan omits? I don’t see any on a quick examination. You got your interstate insurance sales. You got “tort reform.” You got new incentives for setting up Health Savings Accounts. You got state-run high-risk pools for those with pre-existing conditions. You got a shift in the tax code from deductions for employer-sponsored health insurance to individually purchased health insurance. There’s a Medicaid block grant, and for extra measure, borrowed from the Ryan Budget, there’s Medicare converted to a premium support system for private insurance instead of single-payer government-supplied insurance.
There are a couple of wrinkles that stand out. Unlike, say, John McCain’s 2008 health care proposal, which BobbyCare resembles, Jindal would deploy not tax credits for insurance purposes but a new standard deduction. Wouldn’t that be regressive in its impact? No problem, says Jindal: po’ folks with little use for a tax deduction could share the state-run high-risk pools designed for those with preexisting conditions, providing an appropriately fenced-off health insurance ghetto for the poor and the sick (I’m sure that would fare really well in the federal and state appropriations processes).
Jindal’s plan is also a little vague about the transition to voucherized Medicare, though he suggests traditional Medicare should include a cap on “catastrophic” health expenses, presumably to reduce reliance on Medigap policies.
One provision isn’t vague at all:
[R]epeal of Obamacare will remove the law’s anti-conscience mandates, and the funding of plans that cover abortions. But true health reform should go further, instituting conscience protections for businesses and medical providers, as well as a permanent ban on federal funding of abortions, consistent with the Hyde Amendment protections passed by Congress every year since 1976.
BobbyCare is the work of a genius only if hunting and collecting past proposals is a brilliant endeavor (indeed, he seems concerned to take credit for Medicare as Premium Support away from Ryan by noting the 1999 commission he chaired proposed something similar). It will probably undercut support for more novel and politically feasible Republican proposals like the Coburn-Burr-Hatch plan. But no matter: the Legend of Bobby Jindal, Boy Genius, will get another layer of thin varnish.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, April 2, 2014
“SCOTUS Sanctioned Corruption”: In McCutcheon, Justices Advance Troubling Vision Of Democracy
The Supreme Court’s McCutcheon decision today dealt another serious blow to the regulation of money in politics. In its 5-4 decision, the Court struck down the federal aggregate contribution limits, which restrict the amount one person can contribute to all candidates, parties, and political committees combined. As a result, one person can now give more than $3.6 million to one party’s candidates and committees in a single election cycle (under the limits, one could give “only” $123,200 per election cycle). With a sufficiently sophisticated joint fundraising apparatus, this money could be given in response to a solicitation from a single party leader.
While this is troubling by itself, the more sinister part of the decision lies in the groundwork the decision laid for future money in politics cases.
The Court doubled down on its holding that corruption only includes contributions given with the expectation of receiving official action in return — essentially a direct bribe in the guise of a political contribution. The Court also acknowledged that contributions can be used to gain ingratiation with and access to government officials while not reaching the level of outright bribery. But the Court praised this relationship rather than condemning it:
“We have said that government regulation may not target the general gratitude a candidate may feel toward those who support him or his allies, or the political access such support may afford. . . . They embody a central feature of democracy—that constituents support candidates who share their beliefs and interests, and candidates who are elected can be expected to be responsive to those concerns.”
This vision of the Constitution is wrong. It elevates wealthy donors who can afford to buy influence over 99.99 percent of Americans, who have an equal right to representation. Although the Court may talk in the language of protecting constituents, the outcome is clear — big donors can give to however many candidates they want, regardless of whether they can vote for those candidates or would be constituents of those candidates. This case is about big money, not constituents.
Beyond this, the overtones of the decision suggested that contribution limits may be subject to harsher constitutional scrutiny in the future. If the Court changes this standard for review, it will be more difficult to successfully defend contribution limits from First Amendment challenges in future cases. The Campaign Legal Center’s Trevor Potter describes this danger in a blog post that predates the McCutcheon decision.
There are still meaningful ways to limit the power of big money in our political system. We need to enact disclosure laws to eliminate dark money, elevate the voices of ordinary voters through small donor public financing, strengthen rules against coordinated spending and the circumvention contribution limits, and ensure existing rules are enforced.
But until then, even more money will flow directly to candidates, further marginalizing average voters at the expense of the wealthy. While this is just the latest step in a long line of recent cases weakening our campaign finance system, the decision strongly signals that more is still yet to come.
By: David Earley, Brennan Center For Justice, April 2, 2014
“Laying It All Out On Medicare”: No Mistaking Paul Ryan’s Policy
The release of a new Paul Ryan budget plan is always the occasion for a lot of ridicule from liberals, for a whole bunch of reasons, and this year’s will be no different. Ryan’s budgets always manage to combine a remarkable cruelty toward poor people with a sunny optimism that draconian cuts to social services will result in a veritable explosion of economic growth, allowing us to balance the budget without taking anything away from the truly important priorities (like military spending) or, heaven forbid, forcing wealthy people to pay more in taxes.
I’m sure there are other people preparing detailed critiques of the Ryan budget, but I want to focus on one thing this brings up: the question of how we talk about Medicare. As he has before in his budgets, Ryan proposes to repeal the benefits of the Affordable Care Act, like subsidies for middle-class people to buy insurance and the expansion of Medicaid, but he’d keep the tax increases and Medicare cuts that the bill included in order to pay for it all, which helps him achieve his “balanced” budget.
Yes, it’s true that when Ryan was running for vice president, he joined Mitt Romney in condemning those very Medicare savings. But nobody really believed he was doing anything at the time but being a team player. So we can give him credit for taking at least a step toward putting his money where his mouth is on Medicare. Sure, it may be couched in some misleading words (the document refers to “strengthening Medicare” no fewer than ten times), but there’s no mistaking the policy.
Because the rest of his party is, to put it kindly, of two minds when it comes to the program. On one hand, they will tell you, Medicare is unsustainable, a ravenous beast that will devour the entire nation’s financial well-being if we don’t find a way to suppress its appetite. In Washington-speak, this is translated as “doing something about entitlements.” We have to Do Something About Entitlements! If you don’t want to Do Something About Entitlements, you’re just not serious about our nation’s fiscal challenges.
On the other hand, Republicans believe that Medicare is utterly sacrosanct, a jewel whose every facet is so perfect that even the most modest attempt to curtail its costs should be met with howls of anguish and outrage. Or at least that’s what they believe at election time, when they’ll air one ad after another condemning Democrats for cutting the Medicare seniors so desperately need. Democrats all over the country have been subjected to ads saying, “Congressman Fnurbler voted to cut $716 billion from Medicare!” over a picture of an elderly couple sitting at the kitchen table, looking over their bills with an engulfing despair, then meeting each other’s eyes in a tragic look that says, “Thanks to Congressman Fnurbler, all is lost. If only we had been able to pay our gas bill so we could stick our heads in the oven and end it all right now.”
Republicans are so deeply opposed to the idea of cutting Medicare that they can’t even stomach anyone trying to see if Medicare is spending its money wisely. Mention the Independent Payment Advisory Board, a component of the ACA that was designed to restrain Medicare costs if they rose too fast, and steam will come out of their ears. (The IPAB would make recommendations to Congress on ways to save money, and Congress would have to act on them. But since Medicare spending has slowed dramatically in the last couple of years, the requirement has yet to kick in, and President Obama hasn’t bothered to appoint anyone to what is still a theoretical board.) They waged a virtual war on comparative effectiveness research, effectively saying that it was dangerous to even ask which competing treatments work well and which don’t.
In other words, most Republicans believe we must, must, must reduce the cost of Medicare—excuse me, Do Something About Entitlements—but are adamantly opposed to every step that has been taken to reduce the cost of Medicare. I’m sure that lots of them are sympathetic to Ryan’s vision, which is to essentially turn the program into a voucher system, in which the government helps you buy private insurance, and over time costs magically go down (and if you’re thinking that sounds a lot like what people are getting on the Obamacare exchanges, any Republican will tell you that it’s totally different because freedom).
So let’s give Paul Ryan some credit. Sure, his numbers might not add up. But when he puts out a budget, there’s no mystery about where he’s coming from and what he wants to do.
By: Paul Waldman, Contributing Editor, The American Prospect, April 1, 2014
“And Four Years Later?”: How Much “Repeal” Must “Replace” Involve?
If you’re wondering why it’s taking so long for congressional Republicans to unite behind an Obamacare Replacement plan when there are several of them out there, look no further than the North Carolina U.S. Senate primary, where “Establishment” candidate Thom Tillis has incautiously said not all aspects of Obamacare are bad, yet appears to be afraid to endorse the “replacement” bill originally cosponsored by the senior senator from that state, Richard Burr. WaPo’s Greg Sargent has more:
Tillis has so far refrained from endorsing the Burr plan. And similarly, in interviews, he has claimed that of course he would replace Obamacare with something that would protect people with preexisting conditions and others who need protection, without specifying what that replacement would be. Republicans appear increasingly aware that they can’t be just for repeal, and have to promise replacements that would accomplishment some of what Obamacare accomplishes….
As the case of Tillis shows…Republicans must also simultaneously remain vague enough about those replacements so as to avoid embracing the tradeoffs they would require — since specificity there risks angering the right. Indeed, Tillis’ embrace of even some of Obamacare’s general goals has drawn fire from his primary opponent, Tea Partyer Greg Brannon.
The Coburn-Burr-Hatch proposal is dangerous politically for a primary-challenged Republican because it simultaneously embraces aspects of Obamacare (an insurance purchasing exchange, albeit one selling “deregulated”—which means less generous—products; and subsidies for purchases on those exchanges by certain low-income folk) and aspects of more conventional conservative health care thinking that are wildly disruptive of the status quo at a time when Republicans are making big hay over Obamacare “disruptions” (notably the partial rollback of the federal tax write-off for employer-based plans). Indeed, messing with employer-based coverage has been a conservative policy pet rock for years, even though GOP politicians have been leery of it since John McCain proposed junking it in 2008, and left himself exposed to a “tax increase” charge.
There simply isn’t, and can’t be, an “Obamacare replacement” proposal that lets everyone who likes the status quo keep it, while dealing with pre-existing condition exclusions, expanding coverage, and holding down costs. This is why Republicans prefer to insist they want to repeal Obamacare and are stilling “working” on a replacement, four years after enactment of the Affordable Care Act.
By: Ed Kilgore, Contributing Writer, Washington Monthly Political Animal, April 1, 2014
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