“Bait And Switch”: Introducing Obamcare Lite; What The New GOP Health Reform ‘Alternative’ Really Tells Us
Plainly wounded by the Plum Line’s mockery, some congressional Republicans have finally unveiled a plan to replace the Affordable Care Act with their own health care reform. Is it serious? It’s certainly serious enough to examine and judge on its merits. Will it become the plan around which Republicans will unite? I doubt it, just because it’s hard to imagine Republicans ever uniting around a plan to do anything proactive on health care, though that’s always possible.
What’s really remarkable about this plan is that for all the claims we’ll hear about how it undoes the tyrannical horror of Obamacare, the Republicans’ version of health care reform has accepted most of the fundamental goals and regulatory paths of the law they so deeply despise. This plan — authored by Senators Richard Burr and Orrin Hatch and Rep. Fred Upton — is little more than Obamacare Lite. Though the devil is in the details — and there are some devilish ones — this tells us that Barack Obama has for all intents and purposes won the health care argument, at least as far as it concerns government’s role in health care.
Here are some of the provisions, which I’ve copied from their synopsis:
- Ensure NO ONE can be denied coverage based on their pre-existing condition;
- Prohibit insurance companies from imposing lifetime limits on a consumer;
- Adopt an age rating ratio that limits the amount an older individual will pay to no more than five times what a younger individual pays (5 to 1) as a baseline, unless a state affirmatively elects to have a different ratio;
- Require health plans to offer dependent coverage up to age 26, unless a state opts out of this provision;
- Ensure guaranteed renewability for patients to be able to renew their coverage;
- Create a new “continuous coverage protection” that rewards individuals moving from one health market to another — regardless of whether in the individual, small group, or large employer markets — by allowing them to get a similar plan at a similar cost and not be rated on health status.
In addition, they would reduce the availability of subsidies from their current 400 percent of the poverty level to 300 percent of the poverty level, and repeal the Medicaid expansion but allow poor people not on Medicaid to get subsidies. The subsidies also would no longer be tied to the actual cost of insurance, and they’d be a tax credit instead of a direct subsidy at the point of sale. There’s also a provision replacing the “Cadillac Tax” on high-value plans with a provision removing the deductibility of employer health care plans that cost over a certain level.
If all that’s making your eyes glaze over, consider it this way: Again and again in the Republican plan, what they do is take a provision or principle in the Affordable Care Act and essentially say, “We want to do that too, we’ll just do it a little less generously.” No denials for pre-existing conditions? It’s in there, but there are some important caveats (which I’ll get to in a moment). No lifetime limits on coverage? In there. Young people up to age 26 can stay on their parents’ plan? Yes, but a state could opt out. Subsidies for middle-class people? In there, just up to 300 percent of the poverty level. Coverage for the poor? Yes, just up to 100 percent of poverty instead of 138 percent. Tax on high-value plans? Yep, just in a different way. Government-set limit on how much insurers could vary premiums by age? Yes, but the ratio would be expanded from 3-1 up to 5-1. A mandated list of “essential health benefits” for all plans? Yes, but the states would determine the list instead of the federal government, with more flexibility.
In all these cases, they aren’t looking for some free-market alternative that will supposedly deliver even better results. They’re accepting government’s role in both regulating insurance and in helping people pay for it; they just want to make the benefits not so attractive.
There are a few exceptions. They would repeal both the individual and employer mandates, which by now even Democrats are not particularly enthusiastic about (at this point I think most Democrats would be happy to junk the employer mandate if they got something in return, though the individual mandate could be a different story). And most significantly, the plan abandons the fundamental coverage guarantee the Affordable Care Act provides, while essentially trying to convince you that’s not what it does.
This is a critical point. Under the ACA, no one will ever be denied coverage because of a pre-existing condition. Ever. Medical underwriting, in which insurers comb through your history to see if they don’t want to cover you or if they should charge you huge premiums, is over. The Hatch-Burr-Upton plan is presented as though it does the same thing. Note that bullet point above: “Ensure NO ONE can be denied coverage based on their pre-existing condition.” In their executive summary, this point is the one sentence in the document that is highlighted in bold.
But actually, it’s not quite true. Their plan has a one-time open enrollment period for the uninsured; if you don’t get coverage during that time, you’re out of luck, and insurers will be free to deny you coverage. If you have coverage now but lose it, say because you lost your job, you’d have a limited amount of time (they don’t specify how long) to enroll in a new plan; if that time expired, you’d also be out of luck.
They would probably argue that they’re putting the responsibility on individuals, and all they have to do is take advantage of it. But that’s a very different thing from a guarantee. And that may be the biggest difference between the Affordable Care Act and this plan. The ACA tries to achieve universal coverage, and this plan doesn’t.
Frankly, that isn’t all that surprising, because universal coverage was never a goal conservatives had for health care. In recent days some of them have been arguing for something similar to this plan — see Michael Strain or Ramesh Ponnuru — and what they say about the subject is that they want universal catastrophic coverage, meaning everyone should have access to a bare-bones plan that will cover them not for ordinary medical expenses but only when a major illness or accident brings those expenses to a level that almost no one could afford. Those catastrophic plans are usually paired with Medical Savings Accounts for people to pay for everything else — a more market-based approach.
But the Hatch-Burr-Upton plan says nothing explicitly about catastrophic plans, and it doesn’t claim universal coverage as a goal. Its approach is that coverage will be there if you’re on the ball enough to get it at the right time. And if you aren’t, tough luck.
So there is something of a bait-and-switch going on. On provision after provision, this Republican plan promises to give all the benefits of the ACA, at least the ones that score highly in polls. It accepts that government will regulate health insurance and help people pay for it, even if that help is substantially less helpful. Looking at that, we might say that Republicans have accepted the ACA’s foundation, and that part of the health care argument is over. But they still aren’t willing to move substantially toward universal coverage. The ACA doesn’t achieve universal coverage either (the reasons why are a topic for another day), but it tries much harder to move down that road. So the new GOP “alternative” to Obamacare tells us that some Republicans, at least, have ceded a whole lot of ground in the broader debate over government involvement in health care, but it appears that’s one bridge they aren’t yet willing to cross.
By: Paul Waldman, Senior Writer, The American Prospect; Contributing Writer, The Plum Line, The Washington Post, February 5, 2015
“Republican Ideas Haven’t Changed Since The 1970s”: John Boehner Should Try Listening To His Own Economic Advice For Obama
After President Obama released his 2016 budget on Monday, House Speaker John Boehner published a list of ten things that are “newer than Obama’s ideas.” Instagram, Angry Birds, Frozen, and the selfie stick all made the cut. Boehner’s office even created a clunky hashtag for the list—#NewerThanObamasIdeas. The irony is rich: Republican ideas have hardly changed since the 1970s.
It’s true that many proposals in Obama’s budget, like increased infrastructure spending, comprehensive immigration reform, and universal pre-kindergarten, were in his previous budget too. But there were many new ideas, as well. He proposed a new, 19 percent minimum tax on foreign corporate profits—a big move towards the GOP’s preferred territorial tax system. He also wants to expand a tax credit for child care while increasing the capital gains tax rate from 23.8 percent to 28 percent. He put forward a major overhaul of the unemployment insurance system.
None of these represent radical departures from Obama’s previous agendas. But Obama is a Democrat, not a Republican. He wasn’t suddenly going to abolish the Internal Revenue Service and repeal the Affordable Care Act, just as Republicans won’t suddenly wake up and support a single-payer system and higher taxes on the rich.
And Republican ideas on the economy have aged even worse than the Democrats’ stale agenda. Take monetary policy. Throughout Obama’s presidency, GOP lawmakers have frequently criticized the Federal Reserve for low interest rates and its recently-ended bond-buying program. Those policies, they have argued, would send inflation shooting upwards. That, of course, has not happened. Inflation has remained below the Fed’s 2 percent target for years. The greater risk is actually deflation—falling prices.
Of course, in the 1970s, inflation was a very real concern. Then-Fed chair Paul Volcker raised interest rates, causing a recession, but stamping out inflation. Republicans, fearing pre-Volcker inflation, are trying to apply those lessons during a very different time, when the far greater risk to the economy has been a weak labor market. If the Fed had implemented them, it would have led to a disastrous economic contraction.
Or consider taxes. Most of the Republican Party has a laser-like focus at lowering the top marginal tax rates. But some reform-minded conservatives also want to finance a huge expansion of the Child Tax Credit (CTC)—a tax credit available to parents. They believe that the Reagan tax cuts in the 1980s that lowered the top marginal tax rate from 70 percent to 50 percent was a smart move. But they see far fewer benefits in lowering marginal tax rates now. “Let’s say we cut the 15 percent federal income-tax rate faced by much of the middle class to 10 percent,” Robert Stein writes in the reformicon’s new conservative agenda, titled “Room to Grow.” “Instead of keeping 85 cents for a dollar of extra effort, a worker would get 90 cents—an improvement of only 5.9 percent.… For these workers, cutting the 15 percent rate to 10 percent would make absolutely no difference in work incentives.” A CTC expansion would put money directly into the pockets of parents who need it. While a few prominent members in the Republican Party have adopted Stein’s tax proposal, most notably Senator Marco Rubio, the vast majority of the party would rather lower marginal rates further instead of expanding the CTC. In other words, Republican tax ideas are still stuck in the 1970s as well.
At the end of Boehner’s listicle, his office writes, “The simple truth is this: The federal budget shouldn’t be cobwebbed by the policies of the past. It should be focused on the future—a future where our kids and grandkids can grow up free from the fear of never-ending debt and a bloated Washington bureaucracy.” His party should listen to that advice.
By: Danny Vinik, The New Republic, February 6, 2015
“Stupid Pills”: The Politics of Fraudulent Dietary Supplements
One pill makes you smarter. One pill makes you thin. One pill makes you happy. Another keeps you energized. And so what if tests conducted by scientists in New York and Canada have found that the substances behind these miracle enhancements may contain nothing more than powdered rice or houseplants. If enough people believe they’ll be healthier, well, it’s a nice racket.
Nice, to the tune of $13 billion a year in sales. And here in Utah, which is to the dietary supplement business what Northern California is to marijuana, a huge industry has taken hold, complete with a network of doctors making unproven claims, well-connected lobbyists and entrenched politicians who keep regulators at bay.
If you want to know how we came to be a nation where everyone is a doctor, sound science is vilified and seemingly smart people distrust vaccinations, come to Utah — whose state flower should be St. John’s wort. Here, the nexus of quack pharma and industry-owned politicians has produced quite a windfall: nearly one in four dollars in the supplement market passes though this state.
We’re not talking drugs, or even, in many cases, food here. Drugs have to undergo rigorous testing and review by the federal government. Dietary supplements do not. Drugs have to prove to be effective. Dietary supplements do not.
These are the Frankenstein remedies — botanicals, herbs, minerals, enzymes, amino acids, dried stuff. They’re “natural.” They’re not cheap. And Americans pop them like Skittles, despite recent studies showing that nearly a third of all herbal supplements on the market may be outright frauds.
The labels say Ginkgo biloba, or ginseng, or St. John’s wort. But testing announced by the state of New York this week found that the Ginkgo biloba sold by Walmart, for example, contained no Ginkgo biloba DNA — it was a mixture of rice, mustard, wheat and radish.
Some of the country’s largest retailers are selling junk in a pill, a step removed from sawdust. Counting on the stupidity of consumers, the big chains don’t seem to care. As of Thursday, four days after Eric T. Schneiderman, the New York State attorney general, asked retailers to pull the tested products from their shelves in his state, you could still go to Walmart online and buy the allegedly fraudulent products.
So, there is Spring Valley echinacea — with a bold label reading: Immune Health — selling for $8.98 a bottle on Walmart’s website. It comes with a handy “customer review,” touting an “Excellent quality product!” This about a substance that contained no echinacea, according to the attorney general.
Too bad it takes Canada, or the maverick work of someone like the New York attorney general, to get at the truth of this industry, because it is so well-insulated from federal government oversight. Schneiderman’s investigation was prompted by an article in The New York Times Science section, reporting on Canadian findings that some of the most popular supplements were nothing but cheap fillers.
To understand how we got here, you have to go back to 1994, when Senator Orrin G. Hatch of Utah midwifed through Congress a new industry protected from all but minimal regulation. It is also an industry that would make many of his closest associates and family members rich. In turn, they’ve rewarded him with sizable campaign contributions.
Even though serious illnesses, and some deaths are on the rise from misuse of these supplements, Hatch is determined to keep regulators at bay. “I am committed to protect this industry and the integrity of its products,” he told a gathering of potency pill-pushers and the like in Utah last fall.
In the past, Hatch has been remarkably blunt about helping his family and friends in the fake drug trade. “I do whatever they ask me to do many times because they’ve never asked me to do anything that is improper,” Hatch said in 2011. He was referring to the firm of his son, Scott Hatch, a longtime lobbyist for the supplement industry.
That’s the political side, an all-too-familiar story of mutual beneficiaries born in the halls of Congress. But what about the medical implications? These pills and powders can’t, by law, make specific claims to cure anything. So they claim to make you healthier. The consumer is left playing doctor, reading questionable assertions that course through the unfiltered garbage of the Internet.
“There’s a lot of wrong information out there,” warns the American Cancer Society, in its tutorial on these products. “Even for those who are usually well informed, it can be hard to find reliable information about the safe use and potential risks of dietary supplements.”
And there was this finding reported in the authoritative Annals of Internal Medicine: “Enough is enough: Stop wasting money on vitamin and mineral supplements.” Oh, those elites at the American College of Physicians, what do they know?
So, the industry keeps growing, with 65,000 dietary supplements now on the market, consumed by nearly half of all Americans. The larger issue is mistrust of authority, a willful ignorance that knows no political side. Thus, right-wing libertarians promote a freewheeling market of quack products, while left-wing conspiracy theorists disdain modern medicine in favor of anything sold as “natural” or vaguely countercultural. These are some of the same people who will not vaccinate their children.
Everyone wants to live longer, to be happier, to have better sex. And, if you think you can do it without exercise, or eating enough vegetables, or getting regular sleep, there are a thousand pills for you, sold not far from the candy counter. It’s all based on the honor system. If you trust them, go buy some possibly Ginkgo biloba-free Ginkgo biloba, and thank Orrin Hatch for the unfettered right to be a sucker.
By: Timothy Egan, Contributing Op-Ed Writer, The New York Times, February 6, 2014
“McConnell Decries ‘Obstructionism’, Irony Dies”: How Perspectives Can Change When One Moves From The Minority To The Majority
On literally the first day of the new Congress, Politico asked Don Stewart, Senate Majority Leader Mitch McConnell’s (R-Ky.) spokesperson, what McConnell sees as his biggest challenge. “Democrat obstruction,” Stewart replied.
Putting aside the fact that he probably meant “Democratic obstruction,” the response was striking in its irony. McConnell, arguably more than any senator in the nation’s history, mastered the art of obstructionism, taking it to levels with no precedent in the American experiment. For his office to suddenly decry McConnell’s own practices was a reminder of just how much perspectives can change when one moves from the minority to the majority.
A month later, the posturing is almost amusing.
Senate Majority Leader Mitch McConnell (R-Ky.) accused Democrats Wednesday of knee-jerk obstructionist tactics, flipping a script that Democrats used many times in recent years.
McConnell criticized Democrats for filibustering a motion to debate a House-passed bill funding the Department of Homeland Security that contained language blocking President Obama’s executive actions on immigration.
“And now Americans are wondering: What could possibly lead Democrats to filibuster Homeland Security funding?” he said on the Senate floor.
I suspect Americans aren’t really wondering that at all – the question is actually pretty easy to answer, as the Majority Leader probably realizes – but it’s the broader context that’s truly amazing.
If we were to create some kind of electronic mechanism to measure hypocrisy on a dial, and we had the machine analyze Team McConnell’s whining, the box would have very likely caught on fire yesterday.
To be sure, when it comes to filibuster hypocrisy, there’s plenty of bipartisan chiding to go around. When a party is in the majority, its members discover the remarkable value of majority rule, a sacrosanct principle that senators ignore at the nation’s peril. When that same party is in the minority, its members magically conclude that tyranny of the majority is a scourge that must be tempered with overuse of “cooling saucer” metaphors.
It’s therefore quite easy to dig up quotes from Democrats and Republicans contradicting themselves quite brazenly as they transition between minority, majority, and back.
But McConnell is nevertheless a special case. In recent years, specifically after President Obama took office, the Kentucky Republican turned obstructionism into an art form. He abused institutional norms and rules in ways his predecessors never even considered, filibustering everything he could, as often as he could. McConnell operated with a simple principle: If a bill can be blocked, it must be blocked.
Following his lead, Senate Republicans not only spent six years refusing to compromise or accept any concessions on any issue, it also imposed filibusters on every key piece of legislation to reach the floor. Before the so-called “nuclear option,” the GOP minority even routinely filibustered nominees they actually supported.
It was all part of a deliberate (and occasionally successful) strategy in which McConnell would obstruct everything he could, making Democratic governance as impossible as he could make it, without regard for the consequences.
Some reflexive complaining from McConnell and his allies is to be expected – their own medicine apparently has a bitter taste – but self-awareness is an under-appreciated quality. If the Majority Leader wants to be taken at all seriously, he can either avoid complaints about “obstructionism” or he can hope for mass amnesia to sweep the political world.
I’d recommend the former over the latter.
By: Steve Benen, The Madow Blog, February 6, 2015
“The Product Of A Fringe Movement”: The Crazy Is A Resume Item For Rand Paul
At the Prospect today, Paul Waldman manages to remind us of two important things to keep in mind in contemplating the Rand Paul presidential campaign: first, some of the crazy things he’s said in the not-too-distant past (example: ruminations on the North American Superhighway Conspiracy in 2008), and second, why that matters more in his case than in others. The crazy stuff will drib and drab into public view for the next few months, and some people will notice and others won’t. So it’s the second issue most interests me, because it explains why we should notice:
[M]ost politicians who get to where Paul is work their way up by climbing the political ladder: they run for city council in their town, then maybe mayor, then they become a state rep, then a state senator or congressman, and finally run for the Senate. That experience makes you a creature of the place where you come from and party that nurtured you. Along the way your views will come to reflect their concerns and their consensus about policy.
But that’s not the path Rand Paul followed. Whatever his talents, he’s a United States senator because he’s Ron Paul’s son. Over his time in Congress, Ron Paul developed a small but fervent national constituency, made up of some ordinary libertarians and a whole lot of outright wackos. That constituency was greatly expanded by his 2008 presidential campaign. Despite the fact that Paul had plenty of interesting and reasonable things to say, it’s also the case that if you were building a bunker to prepare for the coming world financial crash and ensuring societal breakdown (and possible zombie apocalypse), there was only one presidential candidate for you. When Rand Paul decided to run for Senate in 2010, having never run for anything before, the Ron Paul Army mobilized for him, showering him with money and volunteers. He also had the good fortune to be running in a year when Republicans everywhere were looking for outsider, tea party candidates, so he easily beat the choice of the Kentucky GOP establishment in the primary.
In other words, Senator Rand Paul is the product of a fringe movement that has embraced all sorts of nuttiness from the theocratic urges of the Constitution Party to Agenda 21 to the North American Superhighway, in addition to its better-known eccentric obsessions with crank monetary policy. That’s his resume. You have to examine it the same way you examine what other candidates did just before becoming national political celebrities. Otherwise you buy into the idea that he sprang fully developed from the brow of his father before running for president himself.
By: Ed Kilgore, Contributing Writer, Political Animal, The Washington Monthly, February 6, 2015
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