“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 Healthcare.gov 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 Healthcare.gov 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
“Unsatisfying To The Media And Republicans”: Surprise, Obamacare Now Projected To Cost Hundreds Of Billions Less Than Expected
Amidst the dark skies of the Healthcare.gov 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
“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 coveringcaliforniahealthcareca.com. If that sounds suspiciously like coveredca.com, 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
“When The Worm Turns”: Republican Fallacies On Obamacare, The Greatest Hits
Before the holiday spirit makes Republican-bashing a little unseemly, it’s time to get in a last ornery blast at the party’s Obamacare stance. Republicans have enjoyed themselves immensely during the Affordable Care Act’s bungled rollout, but most of the claims they’re making are preposterous and phony. Since anyone able to take a longer view knows we’ll one day be well past Obamacare’s self-inflicted wounds, I’d like as a public service to catalog the GOP’s shabbiest arguments, so we’ll all have a handy reference once the worm fully turns.
The selective “humanitarian crisis.” Conservatives have warned of the “humanitarian disaster” that will ensue if several million people with cancelled policies are unable to secure new coverage before January 1. But this theoretical woe (which will almost certainly be avoided thanks to Web site fixes and policy extensions) pales next to the much larger humanitarian disaster of America’s nearly 50 million uninsured — a crisis that’s persisted for decades without conservatives caring a whit. I can’t be the only one who finds the right’s sudden concern for a small subset of the uninsured a bit rich.
The bogus oppression of the young and healthy. Another confused conservative trope bemoans the enslavement of younger or healthier Americans, who’ve supposedly been conscripted to subsidize their older, sicker countrymen. “Liberals justify these coercive cross-subsidies as necessary to finance coverage for the uninsured and those with pre-existing conditions,” the Wall Street Journal editorialized last Saturday. “But government usually helps the less fortunate honestly by raising taxes to fund programs.” Actually, the Journal has the American way of health subsidy exactly wrong. Most people aged 19 to 34 who have health coverage get it from their employer. And, as I’ve noted before, at nearly every firm, young people pay the same premiums as employees who are older and get more expensively sick. In other words, Obama’s scheme to rob Peter to fund health care for Paul already exists, at vastly larger scale, in corporate America. And while Obamacare is only hoping to sign up 2 million or so young people, 20 million Americans aged 19 to 34 get their coverage on the job. Where’s the Wall Street Journal’s rant against corporate America’s “coercive cross-subsidies”? And while we’re at it, when will we stop making all those people whose houses don’t burn down subsidize those whose do?
The “men and 55 year old women don’t need maternity care” fallacy. Well, yes, and people whose genes don’t predispose them to cancer (which tests will reveal soon enough) don’t need cancer coverage. As Bob Kocher, a doctor and former senior Obama health care advisor, explained, if one of our goals is to not charge women higher premiums than men, all plans have to cover maternity. Among younger women, moreover, maternity is the biggest driver of costs — so if you allow optional coverage, the plans young people buy would be super-expensive. “For insurance to work, you can’t allow people to opt into benefits like maternity right before they get pregnant,” Kocher adds. “When spread across the population, it’s not expensive.” Sounds like Insurance 101. Which in the social insurance context, conservatives can’t abide.
Insurance “bailout” baloney. Sen. Marco Rubio talks opportunistically (but I repeat myself) of Obama’s pledge to “bail out” health plans if the folks they sign up end up being unduly costly to treat. Once again, conservatives eat their own. Such “risk adjustment” — after-the-fact payments to reflect the actual vs. expected risk experience of health plans — has been a sensible staple of conservative insurance market reforms since George H.W. Bush proposed it in 1992. Little known but true: Before Romneycare begat Obamacare, Bushcare begat Romneycare. Rubio was only 21 then. He must not know. Or care.
The “Obama is taking over one-sixth of the economy” ruse. In the Fox News cocoon, this truth is self-evident. But it makes as much sense as crying that Ben Bernanke is “remaking 6/6ths of the economy” every time the Fed touches interest rates. The fact that health-care spending is 18 percent of GDP doesn’t mean Obama is “remaking” or “taking over” anything. He’s tweaking a dysfunctional corner of the market where 5 percent of us get our health coverage. He’s also testing ideas that health gurus in both parties have long suggested might help reign in future costs.
Worse than these GOP fallacies is the party’s smug sanctimony. It’s as if conservatives have decided to parody the moral preening they loathe in liberals, except that the right is serious. As one pundit lectured, “the administration didn’t care enough to make sure the people of their country were protected. In the middle of a second age of anxiety they decided to make America more anxious.”
Yes, the rollout was botched. But what is this person talking about? Finally assuring that illness in the United States can’t be the cause of financial ruin is the very essence of “protection.” How galling that conservatives can make such hollow charges while putting forward no plan of their own to “protect” anyone from anything!
Or take the pundit who wrote that “extending enrollment periods does nothing but provide Americans more time to contemplate their miserable choices.” Only someone with no empathy — someone who has never tried and failed to get coverage in the individual market — could possibly say such a thing.
I’ve spent a lot of time over the years arguing that we can solve big problems such as providing insurance coverage in ways that honor both liberal and conservative values. It’s entirely doable — John Rawls and Milton Friedman can be reconciled, trust me. Apart from being sound policy, I’ve assumed such approaches would also be necessary, because with power closely divided in the United States, we’d need to strike big cross-party deals to make progress. The breathtaking intellectual and moral dishonesty of those driving the Obamacare debate in the GOP today makes me feel foolish for having tried.
By: Matt Miller, Opinion Writer, The Washington Post, December 4, 2013
“The Wages Are Too Damn Low”: Hiking The Minimum Wage Has Little Or No Adverse Effect On Employment
As I mentioned in the lunch link roundup, increasing the minimum wage is all the rage in lefty precincts today. DC is considering a raise, and Democrats generally are smelling a winning issue. (For a deeper look, Arindrajit Dube had a long piece on it over the weekend.)
Conventional economists tend to despise minimum wage laws, because they’re a form of price control, and that gives The Market a sad. Setting a minimum price of labor, according to Econ 101, should increase unemployment, because some people won’t have a marginal product above the wage floor. But as Paul Krugman pointed out in his column this morning, the evidence just doesn’t support this conclusion:
Still, even if international competition isn’t an issue, can we really help workers simply by legislating a higher wage? Doesn’t that violate the law of supply and demand? Won’t the market gods smite us with their invisible hand? The answer is that we have a lot of evidence on what happens when you raise the minimum wage. And the evidence is overwhelmingly positive: hiking the minimum wage has little or no adverse effect on employment, while significantly increasing workers’ earnings.
It’s important to understand how good this evidence is. Normally, economic analysis is handicapped by the absence of controlled experiments. For example, we can look at what happened to the U.S. economy after the Obama stimulus went into effect, but we can’t observe an alternative universe in which there was no stimulus, and compare the results.
When it comes to the minimum wage, however, we have a number of cases in which a state raised its own minimum wage while a neighboring state did not. If there were anything to the notion that minimum wage increases have big negative effects on employment, that result should show up in state-to-state comparisons. It doesn’t.
As others have noted, there’s good reason to believe that increased wages at large businesses would work out well for the businesses themselves. Businesses would both reduce turnover—the hiring process is expensive, and there is a great deal of churn at the bottom of the labor market—and increase their employees purchasing power, a hefty fraction of which would likely be spent at their own place of employment or somewhere similar. I’d guess that wages are held down out of class panic and a desire for increased profits for their own sake rather than some strict business reason.
Personally, if I had to choose, I would rather see more broad-based economic stimulus through fiscal and monetary action rather than a minimum wage hike. (Though I would still support one on its own merits.) But if they don’t like it, American elites have no one to blame for this but themselves. If the power structure can’t ensure full employment through normal channels, then demands for economic justice through more easily-understood channels will only become more common.
By: Ryan Cooper, Washington Monthly Political Animal, December 2, 2013
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