The GOP’s Apology Primary: Love Means Always Having To Say You’re Sorry
In the 2012 Republican presidential race, love apparently means always having to say you’re sorry.
On an array of issues, the field of GOP contenders is facing enormous pressure from an ascendant conservative base to renounce earlier positions that challenged orthodoxy on the right. Their response to those demands could cast a big shadow over not only next year’s Republican primary but also the general-election contest against President Obama.
The emergence of these pressures testifies to a decisive shift in the GOP’s balance of power. The ideas now drawing the most fire from conservative activists–including support for a cap-and-trade system to limit greenhouse-gas emissions, a mandate on individuals to purchase health insurance, and a pathway to citizenship for illegal immigrants–all flowered in Republican circles during the middle years of George W. Bush’s presidency, especially among governors.
In different ways, each of these proposals embodied the common belief that Republicans had to broaden their message beyond a conventional conservative argument focused almost exclusively on reducing government spending, taxes, and regulation. Intellectually, these initiatives reflected an impulse to redefine conservatism in ways that accepted a role for government in empowering individuals or promoting market-based solutions. Politically, they reflected the belief that to build a lasting majority, Republicans needed to attract more minority voters, especially Hispanics, and to loosen the Democratic hold on blue states by reclaiming more suburban independents.
At varying points, this tendency operated under different names, including “compassionate conservatism” and “national greatness conservatism.” But the shared belief “was the sense that the Republican Party, in order to revitalize itself, needed to … show that it had modernized,” said Pete Wehner, who directed the Office of Strategic Initiatives in Bush’s White House.
Behind that conviction, Bush and the Republican-controlled Congress in 2003 created an entitlement by establishing the Medicare prescription drug benefit. In 2006, with Bush’s support, 23 GOP senators voted with 39 Democrats to provide a pathway to citizenship for illegal immigrants.
In the states, this instinct produced health care reform proposals from Govs. Mitt Romney in Massachusetts and Arnold Schwarzenegger in California that centered on an individual mandate, as well as initiatives from many GOP governors to promote alternative energy and to impose mandatory limits on the carbon emissions linked to global climate change. Republican governors played driving roles in creating regional multistate alliances to limit carbon emissions in the Midwest (Tim Pawlenty in Minnesota); the Northeast (George Pataki in New York); and the West (Jon Huntsman in Utah and Schwarzenegger). Huntsman joined then-Gov. Janet Napolitano of Arizona in 2006 to produce a bipartisan Western governors’ plan that favored legalization over deportation for illegal immigrants.
Many hard-core conservatives always bristled at these initiatives. But in those years, they lacked the leverage to entirely suppress them. Now, though, the party’s most conservative elements have clearly regained the upper hand. The tipping point was the election of Barack Obama and his pursuit of an agenda that significantly expanded Washington’s reach across many fronts. His initiatives produced a powerful back-to-basics reaction among Republicans.
The result has been to revert the party’s message toward one focused almost solely on shrinking government. “Obama, by the way he governed, shifted the debate into a much more traditional Democratic-Republican divide over the role of government,” notes Wehner, now a senior fellow at the conservative Ethics and Public Policy Center. “That’s pushed to the side or capsized these other issues.”
That dynamic has left the 2012 GOP contenders facing multiplying demands to abandon and apologize for positions they took in what now looks like a brief period of Republican glasnost.
Pawlenty has already apologized for imposing carbon limits in Minnesota but hasn’t yet renounced his parallel support for requiring utilities to generate more of their power from renewable sources, which some conservatives have also demanded. Huntsman, as he considers the race, has abandoned his previous climate policies but not yet walked back his tilt toward legalization for illegal immigrants. Romney renounced his favorable comments about legalizing undocumented immigrants (as well as his earlier backing of abortion rights) during his 2008 run, but he drew a surprisingly firm line this month by reaffirming his support for his health insurance mandate in Massachusetts. Newt Gingrich, who has faced similar complaints about his earlier support for an individual mandate and efforts to control carbon emissions, hasn’t fully tossed aside either.
These maelstroms leave the candidates without many good options. To dig in behind earlier positions promises unending collisions with conservatives (as Romney has now done on health care). But abandoning too many positions under pressure could open the eventual nominee to effective attacks from Democrats. “If these candidates are now sliding back on things they once believed, it raises questions about whether they can be a strong leader,” says Bill Burton, the former deputy White House press secretary who is heading an independent Democratic campaign effort for 2012. If voters agree, the 2012 Republicans may feel sorry later for saying sorry so often now.
By: Ronald Brownstein, Political Director, Atlantic Media, The Atlantic, May 20, 2011
Health Reform in Massachusetts: Self-Serving For Mitt But Also True
Mitt Romney’s defense of the Massachusetts health care reforms was politically self-serving. It was also true.
Despite all of the bashing by conservative commentators and politicians — and the predictions of doom for national health care reform — the program he signed into law as governor has been a success. The real lesson from Massachusetts is that health care reform can work, and the national law should work as well or even better.
Like the federal reform law, Massachusetts’s plan required people to buy insurance and employers to offer it or pay a fee. It expanded Medicaid for the poor and set up insurance exchanges where people could buy individual policies, with subsidies for those with modest incomes.
Since reform was enacted, the state has achieved its goal of providing near-universal coverage: 98 percent of all residents were insured last year. That has come with minimal fiscal strain. The Massachusetts Taxpayers Foundation, a nonpartisan fiscal monitoring group, estimated that the reforms cost the state $350 million in fiscal year 2010, a little more than 1 percent of the state budget.
Other significant accomplishments:
The percentage of employers offering insurance has increased, probably because more workers are demanding coverage and businesses are required to offer it.
The state has used managed-care plans to hold down the costs of subsidies: per capita payments for low-income enrollees rose an average of 5 percent a year over the first four years, well below recent 7 percent annual increases in per capita health care spending in Massachusetts. The payments are unlikely to rise at all in the current year, in large part because of a competitive bidding process and pressure from the officials supervising it.
The average premiums paid by individuals who purchase unsubsidized insurance have dropped substantially, 20 percent to 40 percent by some estimates, mostly because reform has brought in younger and healthier people to offset the cost of covering the older and sicker.
Residents of Massachusetts have clearly chosen to tune out the national chatter and look at their own experience. Most polls show that the state reforms are strongly supported by the public, business leaders and doctors, often by 60 percent or more.
There are still real problems that need to be solved. Small businesses are complaining that their premiums are rising faster than before, although how much of that is because of the reform law is not clear.
Insuring more people was expected to reduce the use of emergency rooms for routine care but has not done so to any significant degree. There is no evidence to support critics’ claims that the addition of 400,000 people to the insurance rolls is the cause of long waits to see a doctor.
What reform has not done is slow the rise in health care costs. Massachusetts put off addressing that until it had achieved universal coverage. No one should minimize the challenge, but serious efforts are now being weighed.
Gov. Deval Patrick has submitted a bill to the Legislature that would enhance the state’s powers to reject premium increases, allow the state to limit what hospitals and other providers can be paid by insurers, and promote alternatives to costly fee-for-service medicine. The governor’s goal is to make efficient integrated care organizations the predominant health care provider by 2015.
The national reform law has provisions designed to reduce spending in Medicare and Medicaid and, through force of example, the rest of the health care system. Those efforts will barely get started by the time Massachusetts hopes to have transformed its entire system. Washington and other states will need to keep a close watch.
By: Editorial, The New York Times, May 20, 2011
The Truth About Waivers: Protecting Coverage For Millions Of Americans
Today, you might have seen news stories about waivers from certain provisions of the Affordable Care Act. There has been no shortage of confusion and deliberate obfuscation on this issue and we want to ensure you have the facts.
Under the Affordable Care Act, we have implemented new rules that phase out, by 2014, health insurance companies’ ability to slap restrictive annual dollar limits on the amount they will pay for your care. But between now and 2014, we also want to make sure workers are able to maintain their existing insurance, because on their own they would likely be shut out of the individual market or face unaffordable options. To do that, the Affordable Care Act allows the Department of Health and Human Services to issue temporary waivers from the annual limit provision of the law if it would disrupt access to existing insurance arrangements or adversely affect premiums, causing people to lose coverage. So far, we have granted 1,372 of these waivers to employers, health plans, and others in all 50 states, covering less than 2 percent of the insurance market and protecting coverage for more than 3.1 million Americans. We have been completely transparent about this process, announcing the waiver process in a regulation last summer, publishing clear guidance on the application process on our website, and posting a list of waivers we have granted on our website.
These temporary waivers will not be available beginning in 2014 when annual limits are banned and all Americans will have affordable coverage options. And millions of Americans – including many small business owners – will be able to shop for affordable coverage in new competitive marketplaces.
Some have raised questions about waivers that were recently granted to companies in California. So there’s no confusion, here are the facts:
- A company called Flex Plan Services is a third-party administrator that provides benefit administration services for employers in a number of states, including: California, Washington, Alaska, and Georgia. One type of plan they administer is known as a health reimbursement arrangements (HRA or employer contributions to a tax free account). Many of the company’s clients are hotels, restaurants and home health agencies, all of whom employ low-wage workers.
- On March 23, Flex Plan Services submitted 92 waiver requests on behalf of 45 employer clients. On April 4, 2011, HHS approved the request.
- HHS applied the same standard to the application from Flex Plan Services that it uses when reviewing any application for a temporary waiver. Waivers are only available if the plan certifies that a waiver is necessary to prevent either a large increase in premiums or a significant decrease in access to coverage.
- In addition, enrollees must be informed that their plan offers coverage with a restricted annual limit.
- No other provision of the Affordable Care Act is affected by these waivers: they only apply to the annual limit policy.
The Affordable Care Act puts an end to many of the worst insurance company practices including refusing to sell a policy to a family because someone had cancer or a child has asthma; cancelling coverage when a patient files claims because of an unintentional mistake in their paperwork; and slapping annual or lifetime limits on how much care you can receive. When these rules are fully in place in 2014, our country will be much better off and the cost of coverage will be within reach for the millions of Americans who now live day to day without coverage, worrying about an injury or an illness that could plunge them into bankruptcy. To get from today’s broken system to tomorrow’s patient-centered system takes time and patience through a reasonable transition period. But, together, we will get there.
By: Richard Sorian, Asst. Sec for Public Affairs, HHS, The White House Blog, May 17, 2011
Insurance Companies: Guarding Health Is Not Their Business, But It Is Ours
If for one moment anyone has the notion that for-profit health insurance companies are in the business of guarding the health (or wealth) of policyholders, that notion ought to be quickly dismissed in favor of the truth. For-profit health insurance giants guard profits.
I arrived outside the WellPoint annual shareholders meeting in a hotel in Indianapolis yesterday to be greeted by more guards (and some armed) than I have seen surrounding President Obama at times. Apparently just the prospect of having some of the legal shareholders question the business practices and ethics of the WellPoint board and CEO Angela Braly was very scary for the company and its elite leaders.
Some of the shareholders have in recent years put forward a resolution supporting WellPoint’s return to its non-profit roots. After last year’s meeting, the resolution earned 9.6 percent or 30,000,000 shareholder votes. The current leadership doesn’t like that nor do they like the efforts of the shareholders who keep challenging them.
One shareholder asked Ms. Braly at yesterday’s tightly controlled and guarded meeting, as a sort of speakers’ “shot clock” counted down her speaking time, “Tell me, Ms. Braly, could you please explain what you do that warrants a salary ($13.5 million annually) that is more than 375 public school teachers in Indiana earn?” Braly’s answer was a classic. No shot-clock running for the CEO as she explained that the board sets her compensation and it has to be competitive with the other comparable giants in the insurance industry. It is a breathtaking demonstration of greed and hubris.
I wondered how we have allowed this country to amble onward to the point where 1,275 Americans who carry health insurance go bankrupt every single day (if the courts stayed open seven days a week) while an insurance company CEO like Angela Braly pockets $140,000 for her day’s salary. Every day.
That’s quite a lot of money that doesn’t go to healthcare. That’s quite a lot of money for one person to earn in one day. That may be why such scary guards are needed outside WellPoint shareholder meetings – they wouldn’t want CEO Braly to have to mix it up with any of the policyholders or others who might question too directly what value the for-profit health insurance industry adds to the U.S. healthcare system. I also wondered how much money those guards cost. And the shot clocks to keep pesky questions to a minimum? And how about the pro-Angela and pro-profit softball questions planted in the room?
WellPoint, like the other major insurance giants, can claim the best profits ever this year. Times are good at the top. Things are not so good for millions of Americans who want for decent healthcare within a system that provides a progressively financed, single standard of high quality care. Medicare for all would be nice. The American Health Security Act of 2011, S915/HR1200 as offered by Sen. Bernie Sanders, I-VT, and Rep. Jim McDermott, D-WA, provides a model for moving forward. Public financing (yes, a single payer system) coupled with public and private delivery (not a single provider). No insurance giants paying huge board compensations and CEO salaries. No armed guards protecting the profit.
Outside the City Market in Indianapolis, in the rain and with no need for guards, the advocates of healthcare sanity gathered – and I was thrilled to be among the Hoosiers for a Commonsense Health Plan. We affirmed our commitment to the work ahead and to one another. We sang. We are shareholders in a society that values more than profit – we value behaving justly and humanely, and we’d like a healthcare system that reflects that.
Forgive my repetition of the theme, but health insurance is not healthcare. Health insurance is a financial product. Health insurance is a financial product sold to protect health and wealth which may well do neither. Health insurance is a defective financial product for millions of people who made what we felt were responsible decisions about protecting ourselves and our families from financial or health disaster with health insurance products that have loopholes and flaws big enough to leave thousands dead every year and hundreds of thousands bankrupt.
I will never have the salary or earnings of insurance CEOs like WellPoint’s Angela Braly. That’s OK by me because I’ll also, I hope, never need guards to keep those I have harmed and those I would harm from questioning me about why. But, my life and the lives of my loved ones, my neighbors and my friends are surely as valuable in terms of access to healthcare in America in 2011. The day will come.
By: Donna Smith, CommonDreams.org, May 18, 2011
Debunking The Right’s Health Waiver Conspiracy
Is House Minority Leader Nancy Pelosi helping companies in her district get around new health care rules? Conservatives seem to think so, but their evidence is spotty at best.
Last month, the Obama administration granted a reprieve to 204 businesses and policyholders from new health coverage rules under the Affordable Care Act, bringing the total number of waivers to more than 1370. Many of the waivers are for limited benefit or so called “mini-med” plans—controversial rock-bottom plans that provide a very limited amount of coverage (sometimes as little as $2,000 a year) to beneficiaries that are used heavily in low-wage industries like the restaurant business. New federal rules require such plans to offer a minimum of $750,000 of coverage annually, and the waivers exempt the mini-med plans from such rules on a case-by-case basis.
The Daily Caller reported on Tuesday that businesses in Pelosi’s district received nearly 20 percent of the waivers in April, pointing out that many of them went to high-end restaurants and hotels. Sarah Palin piled on in a subsequent interview with the Caller, calling the discovery “unflippingbelievable!” and “corrupt.”
Pelosi’s communications director, Nadeam Elshami, pushed back against the criticisms in an email to Mother Jones, denying that Pelosi’s district received any special treatment. Her office also denied that it was at all involved in the process of granting waivers for these businesses. “It is pathetic that there are those who would be cheering for Americans to lose their minimum health coverage or see their premiums increase for political purposes,” Elshami wrote Tuesday afternoon, emphasizing that health-care waivers “are reviewed and granted solely by the Administration in an open and transparent process.”
In fact, the recent waiver applications from businesses in Pelosi’s district were not even received by the minority leader’s office. Rather, they were submitted directly to the Obama administration through a third-party company, Flex Plan Services, which provides benefit administration to companies in the Bay Area, Washington state, and elsewhere in the country, according to a statement issued by Richard Solarian, an assistant HHS secretary. On March 23, Flex Plan Services submitted applications for annual limit waivers for their clients’ health plan, including 69 businesses in California, 20 in Washington state, two in Georgia, and one in Alaska, including restaurants, home health care providers, and other service-based companies. On April 4, the U.S. Department of Health and Human Services approved the waiver request for all of Flex Plan Services’ clients—not just the ones in Pelosi’s district.
Flex Plan Services never contacted Pelosi’s office about their waiver request, and her office did neither provided any information to the company about the waivers nor helped facilitate the request, according to her spokesperson.
In other words, the reason the waivers were clumped together was because Flex Plan Services—which is in charge of administrating all of these businesses’ health care benefits—had issued a waiver request for the entire group of businesses. Altogether, the Obama administration has granted 1372 waivers and has denied about 100 requests. The mini-med waivers are essentially a stop-gap measure designed to keep employers from dropping health care benefits all together. The White House explains that waivers are granted if conforming to the rules “would disrupt access to existing insurance arrangements or adversely affect premiums, causing people to lose coverage,” acknowledging that the low-benefits plans are sometimes the only option that some employers can offer. The Democrats’ rationale is that the other changes under federal health reform will eventually allow employers to receive better, more affordable coverage under the health insurance exchange, when it begins operating in 2014.
To be sure, it’s worth closely examining which businesses and policyholders have received waivers, as well as which ones have denied them, along with the Obama administration’s rationale for making such decisions. But, as the April waivers reveal, the very fact that reprieves have been granted to businesses residing in democratic districts doesn’t mean the process is unjust. And to assume that the rationale must be political or “corrupt” is to turn a real policy issue into a partisan bludgeon.
By: Suzy Khimm, Mother Jones, May 17, 2011
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