“Deja Vu, All Over Again”: Every Day Is Groundhog Day For The GOP’s Obamacare Replacement
In a moment of irony not lost on observers, the GOP-led House Rules Committee will spend Groundhog Day considering the 114th Congress’s first destined-to-be-vetoed attempt to repeal Obamacare. Adding to the déjà vu is the fact that, despite promises to replace the health care law, Republicans still don’t have a firm plan.
The latest repeal bill, sponsored by Rep. Bradley Byrne, an Alabama Republican, doesn’t propose a replacement, but mandates that relevant committees “report to the House of Representatives legislation proposing changes to existing law.” Those proposals, in the language of the bill, should meet 12 provisions, all of which either rehash generic Republican priorities (“foster economic growth and private sector job creation by eliminating job-killing policies and regulations”) or repeat old conservative health care proposals, like medical liability reform.
Further to Byrne’s bill, Reps. Paul Ryan, Fred Upton, and John Kline are expected to lead a task force to create an alternative. “House Republicans’ most serious attempt thus far to develop their health care reform package,” Politico reported Friday.
Early last year, Republicans devoted considerable time to hyping up possible replacements. There was the proposal from Senators Tom Coburn and Orrin Hatch last January; then a March measure from the House Republicans, which The Washington Post described as a “conservative approach to fixing the nation’s health-care system”; and, a few weeks later, Louisiana Gov. Bobby Jindal’s Bobbycare.
And then in April 2014, Rep. Ryan released a budget for 2015 that repealed the law without endorsing any kind of replacement. When asked about his party’s plans, Ryan told The Washington Examiner that “we have lots of ideas of how to offer patient-centered health care… So you’ll see a lot of different comprehensive Republican alternative plans.”
Those alternatives never really solidified. The problem in 2014 was that Republicans couldn’t agree on one, or even on whether it was politically worthwhile to push an alternative that might distract from the Democrats’ Obamacare woes. The problem now is that the Supreme Court might completely gut the health care law in June by ruling that the three dozen states issuing Obamacare subsidies through federal exchanges are acting unlawfully.
Republicans have said that they want to be ready when the court decides—but they don’t seem to have a plan for that scenario. Then again, the Obama administration might not have a plan themselves.
By: Arit John, Bloomberg Politics, January 31, 2015
“Heading Towards A GOP Train Wreck”: You’re Going To See The Republican Party With All Their Clothes Off
Does anyone else see a train wreck coming for this Republican Congress?
House Ways and Means Chair Paul Ryan (R-WI) will lead along with two other top committee chairs a Republican task force to come up with a plan in case the Supreme Court strikes a blow to Obamacare later this year…
They will be tasked with working up an alternative plan if the Supreme Court invalidates tax credits in the 30-plus states that use HealthCare.gov, as well as a more general Obamacare alternative if the law were to be repealed…
Coming in the opposite direction is this train:
There is internal dissent on whether Republicans ought to come up with an alternative. One congressional GOP health aide, who was granted anonymity to speak candidly, said his party is as determined as ever to fight Obamacare, and will remain so as long as it exhibits failure. He said devising an alternative is fraught with the difficulty of crafting a new benefits structure that doesn’t look like the Affordable Care Act.
“If you want to say the further and further this gets down the road, the harder and harder it gets to repeal, that’s absolutely true,” the aide said. “As far as repeal and replace goes, the problem with replace is that if you really want people to have these new benefits, it looks a hell of a lot like the Affordable Care Act. … To make something like that work, you have to move in the direction of the ACA. You have to have a participating mechanism, you have to have a mechanism to fund it, you have to have a mechanism to fix parts of the market.”
Pushing on the accelerator of both trains is this:
Leaders in the GOP-controlled House and Senate see the court challenge as their best hope for tearing apart a law they have long opposed. If the court strikes down the subsidies, Democrats are expected to clamor for lawmakers to pass a measure correcting the language in the law to revive them. Congressional Republicans say there is no possibility they would allow that.
“No, no, no, no;” said Sen. Dan Coats (R., Indiana).
Rep. McDermott came up with a different analogy.
GOP congressional leaders haven’t coalesced around a specific replacement for the law should the court strike down the subsidies. Democrats say that makes them vulnerable, and plan to paint the GOP as responsible for taking away benefits that millions already receive.
“What you’re going to see is the Republican party with all their clothes off,” said Rep. Jim McDermott (D., Wash.) “They are standing out there naked as a jaybird and they are going to have to stand up and explain, ’Well, now we got rid of it – now what do we do?’”
It would all be humorous if it weren’t so terribly tragic.
By: Nancy LeTourneau, Political Animal Blog, The Washington Monthly, January 31, 2015
“Give Me Liberty And Give You Death”: How The GOP Embraced Being The Party Of Death
As part of their long-standing war on the Affordable Care Act, conservatives have filed a lawsuit willfully misreading the statute to deny upward of 10 million people subsidies to purchase insurance. This denial of insurance will almost certainly lead to significant amounts of preventable death and suffering.
Michael Strain of the American Enterprise Institute doesn’t deny any of this. Instead, he argues that some suffering and death may well be a price worth paying:
In a world of scarce resources, a slightly higher mortality rate is an acceptable price to pay for certain goals — including more cash for other programs, such as those that help the poor; less government coercion and more individual liberty; more health-care choice for consumers, allowing them to find plans that better fit their needs; more money for taxpayers to spend themselves; and less federal health-care spending. This opinion is not immoral. Such choices are inevitable. They are made all the time. [The Washington Post]
At a high enough level of abstraction, what Strain is saying isn’t wrong. Not all public policy can function on the basis of keeping mortality rates to the lowest possible number. Some lifesaving treatments might help so few people and cost so much that they might not be worth it. Even major infrastructure projects entail some risk of injury or death on the part of workers, but few people would argue that any such risk is unacceptable.
But the fact that the costs of the ACA might theoretically exceed the benefits doesn’t get us very far. What benefits, exactly, would accrue if millions of people were denied medical coverage because the ACA is seriously damaged or destroyed? It’s here that Strain’s argument falls apart.
One potential line against the ACA is the radical libertarian one, holding that any effort by the government to provide health care to the non-affluent represents an unacceptable level of state coercion. The problem here is that the “freedom” to die of preventable illnesses and injuries is not one the vast majority of people value very highly. A Republican Party committed to these principles would be transformed into an electoral coalition that would make Barry Goldwater’s 52 electoral votes in 1964 look robust.
Since the people responsible for the anti-ACA effort know this perfectly well, the constitutional arguments against the ACA have the advantage of not logically requiring the Supreme Court to rule the entire modern regulatory state unconstitutional. The disadvantage is that they ask the court to deny many millions of people health coverage based on liberty interests that are ludicrously trivial.
The litigants challenging the constitutionality of the ACA do not contend that the federal government cannot regulate national health-care markets. Rather, their constitutional argument boils down to an assertion that the government has the authority to assess a tax to compel people to purchase health insurance, but not a penalty. It’s pretty hard to argue that the fate of liberty in America hinges on this formal limitation on federal power.
The more successful federalist argument launched against the Affordable Care Act is similarly unattractive. Chief Justice John Roberts’ inept rewriting of the ACA’s Medicaid expansion allowed states to opt out. Republican-controlled states have eagerly rejected the large amounts of federal money on offer to insure more poor residents, something that is likely to result in the unnecessary deaths of more than 5,000 people a year.
I don’t think this particular protection of state autonomy is worth that many lives (or, indeed, a single life). But here’s the kicker: The Supreme Court’s decision does not even meaningfully protect state sovereignty. Under the court’s theory, Congress could have enacted the ACA’s Medicaid expansion by repealing the pre-existing Medicaid entirely. This, apparently, would be completely constitutional. There may be things worth 5,000 lives a year; an incoherent legal argument that doesn’t even really protect states’ rights isn’t one of them.
Strain’s arguments have similar problems. To his credit, he’s not a libertarian radical who asserts that the federal government cannot play any role in expanding health-care coverage. Rather, “universal coverage should concern itself with the catastrophic expenses associated with serious medical events that will affect a minority of the population.” The affluent, or people with good jobs, can get real medical coverage; the non-affluent might get some protection for disasters, but would have to pay through the nose for common medical procedures. Whether or not one prefers this policy alternative — which I think is far worse — there’s not a lot of meaningful protection of “freedom” going on here. The number of lives worth sacrificing so that people can choose between a few more insurance alternatives — or between the “freedom” to pay for checkups for their children or their electric bill — strikes me as “zero.”
And, of course, even this is too generous to the Republican reformers. The ACA isn’t unpopular because it provides subsidies that are too generous or because the exchanges offer insurance that cover too many things. The Republican alternatives Strain discusses will all disappear should the ACA be destroyed, because the trade-offs involved will outrage many voters. The actual Republican alternative Strain thinks it’s worth killing a lot of people for is “nothing.”
But, hey, the next upper-class Republican tax cut could be even larger, and it’s not going to be elite Republicans who pay the price. As the writer Roy Edroso puts it, Strain’s argument can be summarized as “give me liberty and give you death.” I think we can see why Republicans would prefer for the Supreme Court to do their dirty work.
By: Scott Lemieux, The Week, January 29, 2015
“What Happens If The Dog Catches The Car?”: GOP Faces Health Care Challenge It’s Totally Unprepared For
We don’t yet know what the Supreme Court will do in the King v. Burwell case, but we have a fairly good sense what will happen if the Supreme Court sides with Republicans. In effect, there will be chaos that could do considerable harm to insurers, families, state budgets, the federal budget, hospitals, and low-income children.
It sounds melodramatic, but the fact remains that if the GOP prevails, more Americans will literally go bankrupt and/or die as a result of this ruling.
With this in mind, I couldn’t help but find some sardonic humor in the House Republicans’ request for information from the Obama administration yesterday.
Senior House Republicans are demanding that the Obama administration reveal its contingency plans in the event that the Supreme Court scraps Obamacare subsidies in three dozen states. […]
“Specifically, we are examining the extent to which the Department of Health and Human Services (HHS), and other relevant agencies of the federal government, are preparing for the possible consequences of the Supreme Court’s decision in the case of King v. Burwell,” wrote the lawmakers.
The fact that the GOP lawmakers didn’t appreciate the irony was itself unfortunate, but the simple truth is that the underlying question – what happens if the Supreme Court takes this stupid case seriously and guts the American health care system? – is one Republicans should be answering, not asking.
If we had a normal, functioning political system, represented by two mainstream governing parties, the solution would be incredibly simple. If the Supreme Court said the language in the Affordable Care Act needed clarification, lawmakers would simply approve more specific language before Americans felt adverse consequences. The legislative fix would be quite brief and the whole process could be wrapped up in an afternoon.
No one, in this scenario, would actually suffer.
But in 2015, Americans don’t have the benefits of a normal, functioning political system, represented by two mainstream governing parties. On the contrary, we have a dysfunctional Congress led by a radicalized, post-policy party that has no use for governing, and which welcomes adverse consequences no matter how many Americans suffer.
And the question for them is what they intend to do if, like the dog that catches the car, Republican justices on the Supreme Court rule their way in the King v. Burwell case. Sahil Kapur had a terrific report on this overnight.
Many Republicans would view it as a dream come true if the Supreme Court were to slash a centerpiece of Obamacare by the end of June. But that dream could fade into a nightmare as the spotlight turns to the Republican Congress to fix the mayhem that could ensue.
“It’s an opportunity that we’ve failed at for two decades. We’ve not been particularly close to being on the same page on this subject for two decades,” said a congressional Republican health policy aide who was granted anonymity to speak candidly. “So this idea – we’re ready to go? Actually no, we’re not.”
Republican leaders recognize the dilemma. In King v. Burwell, they roundly claim the court ought to invalidate insurance subsidies in some three-dozen states, and that Congress must be ready with a response once they do. But conversations with more than a dozen GOP lawmakers and aides indicate that the party is nowhere close to a solution. Outside health policy experts consulted by the Republicans are also at odds on how the party should respond.
Republicans could approve a simple legislative fix, but they don’t want to. Republicans could introduce their ACA alternative, but they don’t want to do that, either. They could encourage states to create their own exchange marketplaces, largely negating the crisis, but they don’t want to do that, either.
So what do GOP lawmakers want? They haven’t the foggiest idea.
Kapur talked to a GOP aide who works on health care policy on Capitol Hill who said, “Our guys feel like: King wins, game over, we win. No. In fact: King wins, they [the Obama administration and Democrats] hold a lot of high cards. And we hold what?”
Millions of families who would be screwed by Republican victory in this case will be eager to hear an answer to that question.
By: Steve Benen, The Madow Blog, January 29, 2015
“Even If It Worked, I Would Oppose It”: Republicans Too Often Prioritize Partisan And Ideological Goals Over Practical Ones
As hard as it may be to perceive right-wing neurosurgeon Ben Carson as a credible presidential candidate, he received a very warm welcome at Steve King’s “Iowa Freedom Summit” over the weekend, and Carson arguably delivered one of the more polished presentations of the gathering.
But on the substance of Carson’s remarks, one thing jumped out at me.
On the Affordable Care Act – which Carson has on several occasions compared to slavery – the famous former surgeon said he opposed any government intrusion in health care. “Even if it worked, I would oppose it,” Carson said of Obamacare. “It doesn’t.”
“I don’t believe in taking the most important thing a person has, which is their health and their health care, and putting it in the hands of the government,” he later added….
For a brief argument in a speech, there’s quite a bit to this. We know, for example, that Carson’s mistaken when he says the Affordable Care Act isn’t working; the evidence to the contrary is simply overwhelming. We also know that when it comes to his preferred model, Carson used to believe largely the opposite of what he’s arguing now.
What’s more, when Carson argues that government shouldn’t have a hand in matters related to health care, it would seem to suggest the Republican candidate is against the VA health care system for active-duty and retired military personnel, Medicare, and Medicaid. That’s not too surprising – a guy who draws a parallel between modern American life and Nazis isn’t going to be a moderate – but it’s a pretty extreme position for even today’s GOP.
But the true gem is, in reference to the ACA, “Even if it worked, I would oppose it.”
Regular readers know that I’ve referenced the Republicans’ “post-policy” problem on several occasions, and Carson’s eight-word line seems to summarize the larger issue nicely. While Democrats focus heavily on policy outcomes and the efficacy of policy proposals – as one might expect from a governing party – Republicans too often prioritize partisan and ideological goals over practical ones.
Whether or not tax cuts work, for example, isn’t especially important. Whether the evidence supports climate change doesn’t matter, either. Pick the issue – national security, education, immigration, et al – and for much of today’s GOP, empiricism and efficacy just isn’t that important. What matters instead is an ideological drive to shrink government, regardless of policy outcomes.
I rather doubt Carson intended his comments to be so revealing, but the fact that he’d oppose a Democratic health care reform package built on a Republican model, regardless of whether or not it works, says a great deal.
What’s the basis for a serious policy debate when one side of the argument doesn’t care if policies are effective or not?
By: Steve Benen, The Maddow Blog, January 26, 2015
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