“It’s Good To Be A Bush”: How The GOP Presidential Candidates Will Talk About Obamacare
One of my favorite factoids from the 2012 presidential race emerged when Mitt Romney released his 2011 tax return. There may not have been much scandalous contained therein, but Romney’s sources of income were so varied and intricate that the return ran to a mind-boggling 379 pages. And it’s starting to appear that Jeb Bush may have a similarly complex financial life, which he’s starting to unravel as he prepares for a potential presidential run. There’s one particularly interesting source of income, as this article in the Los Angeles Times explains:
And on Wednesday, Bush resigned from the board of directors of Tenet Healthcare Corp., also effective Dec. 31, according to a corporate filing. The Dallas-based company actively supported the 2010 Affordable Care Act, and has seen its revenue rise from it, an issue that could draw fire in Republican primaries.
Bush earned cash and stock awards worth nearly $300,000 from Tenet in 2013, according to corporate filings. He also sold Tenet stock worth $1.1 million that year, the records show.
If it’s like other big corporations, the services for which he was paid $300,000 by Tenet probably involved little more than going to a couple of meetings every year. It’s good to be a Bush. But let’s try to imagine the fire he might draw in the primaries over his association with the company. Are politicians from the party of capitalism and business really going to criticize him for making a ton of money, even if it involved the hated Affordable Care Act?
Yeah, they probably will. Which raises the question of exactly how the 2016 GOP candidates are going to address the ACA, which even as it becomes further embedded in our health-care system is still on many Republicans’ minds. Chances are they’re going to talk about it in the most general terms they can, in a discussion that stays at a symbolic level and avoids any specifics.
That’s because there are many more Americans who have a negative view of the ACA as an abstraction than there are who dislike the things it actually does. Members of the public are about evenly split when you just ask them what they think of the law. (In the latest Kaiser Family Foundation poll, 45 percent say we should move forward with the law or expand it, while 43 percent say scale it back or repeal it.) But with the exception of the individual mandate to acquire coverage, the specific provisions of the law are all supported by strong majorities. Even majorities of Republicans support elements such as the creation of the exchanges, the expansion of Medicaid and the provision of subsidies to help people afford insurance.
So if you’re a Republican candidate, you have to seek safe harbor on the terrain of the general and symbolic. Otherwise, you’d end up like Mitch McConnell did during the last campaign, insisting that while he wanted to repeal the ACA “root and branch,” he also wanted to keep almost everything the law does.
At the moment, lots of Republicans remain psychologically trapped in the days right after the problematic rollout of Healthcare.gov convinced them all that the ACA would collapse in a matter of weeks or months. At the time, they could barely contain their glee. As Ramesh Ponnuru and Yuval Levin — widely considered two of the more sober conservatives on issues like these — wrote at the time, “As ObamaCare’s failures and victims mount by the day, Republicans have so far mostly been watching in amazement. They expected the law to fail, but even among its most ardent opponents few imagined the scale and speed of the fiasco.”
Even if that was your honest assessment back then, you’d have to be in the grips of a nearly psychotic level of denial to believe it today. Every result of the law may not be perfect, but it has been an overwhelming success. Just about every prediction Republicans made has turned out false. The economy hasn’t tanked, 10 million people were newly insured even before this year’s open enrollment, premium increases are slowing, overall health costs are slowing, and conservatives looking for specific evidence of the law’s failure don’t quite know what to say.
So criticizing something like the fact that one of your opponents sat on the board of a company that benefited from the ACA offers a way to tell voters that you still hate Obamacare with every fiber of your being — and that opponent obviously doesn’t — without having to talk about what the law has accomplished.
Now let’s imagine something fanciful. What if one of the GOP candidates said something like this:
I opposed Obamacare. I wish it had never passed. But now it has been implemented, and just repealing the whole thing isn’t an option anymore. Too many people are now on either Medicaid or plans they got through the exchanges, and it would be wrong to just toss them off their coverage. And there are some things in the law that both conservatives and liberals support. So here’s a plan to keep what’s right about it and fix what’s wrong about it.
We all assume that if a candidate said that, he’d be condemned by his opponents as a traitor and all Republican voters would turn against him. The former would certainly occur, but the latter might not. He might be able to pull the other candidates into a discussion about the specifics of the law, where — if he were the only one with a plan actually grounded in the real world — he could win the argument.
But the truth is, that’s not too likely. If Romney, whose Massachusetts health insurance reform provided the model for the ACA, could win the nomination just shaking his fist at President Obama and insisting that his reform was nothing like Obama’s — which not a single person, Republican or Democrat, actually believed — then why take that chance? If you’re Jeb Bush, you can leave the board of Tenet and repeat over and over that your loathing for the ACA is as strong as anybody’s. In the primaries at least, that will probably be enough to neutralize the issue.
By: Paul Waldman, Contributing Editor, The American Prospect; Contributing Writer, The Plum Line Blog, The Washington Post, December 26, 2014
“Pretending They’ve Come To The Rescue”: Republicans To Play Blame Game On Obamacare Subsidies?
I’ve been saying for a while now that Republicans could be in a jam if the U.S. Supreme Court announces a decision in June invalidating the insurance premium subsidies for people living in the 36 states utilizing federally establishment exchanges under Obamacare, if only because the immediate impulse of rank-and-file conservatives will be to dance and sing even as millions are in danger of losing affordable health care coverage.
Perhaps behind the scenes conservatives are beginning to plan an education campaign to explain to The Troops via Fox News or other “trusted” sources why they can’t just let the subsidies die. Last week I noted that Ramesh Ponnuru had begun talking about Republicans agreeing to fix the subsidy problem while pivoting (presumably as part of some national “deal”) rapidly to an Obamacare “replacement.” But he didn’t sound terribly confident about selling this strategy to the GOP. Since we’re unlikely to find out where SCOTUS is going until June, there is time for sober reflection on the consequences of taking away the subsidies among a constituency that’s a lot more likely to include a lot of Republican voters than the subjects of a Medicaid expansion. The question is whether it can be effectively and quickly communicated to people who have been told since 2010 that the Affordable Care Act is the work of the devil.
Now one of Ramesh’s reformicon colleagues from National Review, Yuval Levin, has (with his collaborator on one of hte Obamacare “replacement” proposals, James Capretta) written a careful message to conservatives via the Wall Street Journal suggesting they get ahead of the curve:
In essence, if the court rules today’s subsidies illegal, those state officials could face a choice between creating a state exchange (and so reinforcing ObamaCare) or seeing some residents lose coverage they now have. ObamaCare’s opponents in Congress should give them a third option: a viable alternative to the Affordable Care Act.
The first step is to introduce legislation that would allow any state to opt out of all of ObamaCare’s mandates, regulations, taxes and requirements, and instead opt into a far simpler and more flexible alternative system. In that system, state residents not offered health coverage by their employers could receive a federally funded, age-based credit for the purchase of any state-approved health-insurance product—including those bought outside of any exchange and regardless of whether they meet ObamaCare’s coverage requirements.
Anyone who remains continuously insured in this system would be shielded from higher premiums or exclusions from coverage based on an existing condition. This would give consumers a strong incentive to buy coverage without a mandate to do so. All other insurance regulation, however, would happen at the state level.
States that opt for this approach would also be permitted to transform their Medicaid programs into premium-support systems for lower-income households. These would function as add-ons to the credit and allow eligible residents to buy the same kind of coverage everyone else can purchase.
The credit could be large enough to allow anyone to purchase at least catastrophic coverage—enabling the uninsured to be covered and everyone to be protected from the most extreme health expenses. Alternatively, it could be used to supplement the purchase of more comprehensive coverage. In essence, the credit would extend to everyone else the same benefit that many people have long received in the employer system. It would do so without disrupting the employer system, the coverage most Americans have.
What they are describing is pretty much the Burr-Coburn-Hatch “PCARE” proposal offered early this year as a suggested Obamacare “replacement,” with some transitional rules that would let Obamacare subsidies stay in place through the end of 2015. And they think Obama would be forced to accept something like this “solution” since otherwise he, not Republicans, will look like the one standing in the way of restored insurance for the people afflicted by the Court.
It’s all pretty clever, but a comment from Ponnuru shows its central flaw:
My only quibble is with the headline, “Time to Start Prepping ObamaCare Reforms.” What they’re talking about is better described as preparing an exit ramp from Obamacare.
Reforms, “exit ramp,” whatever. Such terms are meant to obscure the fact that such plans would keep Obamacare in place until such time as a new system could be implemented–again, before “the base” can make it all moot by forcing GOP policymakers to celebrate the carnage instead of repairing it. And if I know that and you know that, so too would the president, and I think it’s very predictable that well before congressional Republicans could be united behind such a proposal Obama would let them know the only non-disruptive course of action is to restore the intended subsidy system and then talk about what’s next. Pretending they’ve come to the rescue of people in danger of losing their health insurance by eliminating all the provisions that make it good coverage at an affordable price isn’t likely to work. But nice try.
By: Ed Kilgore, Contributing Writer, Political Animal, The Washington Monthly, December 19, 2014
“Republicans’ Little Act’s Of Vandalism”: The Secret Swipe At Obamacare — And You
Underscoring how much mischief can result when Congress acts in haste and in secret, hidden away in the year-end omnibus spending bill being acted on this week is an attack on a key provision of the Affordable Care Act long targeted by the GOP.
The provision involves risk corridors, which are designed to stabilize insurance premiums in the first few years of the law. The year-end spending bill quietly erodes funding for the provision.
Republicans have chosen to label the provision a “bailout” for insurance companies. I’ve labeled that position the most cynical attack on Obamacare, because those who advance it — notably Sen. Marco Rubio (R-FL) — obviously know it’s a lie. They know it’s actually a consumer protection feature, so calling it “corporate welfare,” as Timothy P. Carney did this week in the Washington Examiner, is a neat bit of disinformation. Adding to the cynicism, the same provision is an essential part of Medicare Part D, which the GOP enacted in 2003.
Here’s another sick irony: One of the raps on the risk corridor provision is that it was “buried deep” in administration explanations of the bill, as Rubio put it. But in fact, the ACA was extensively debated and available for scrutiny by any legislator who chose. The attack on the provision, however, actually is “buried deep” in the year-end spending bill: it’s on page 892 of the 1,603-page bill, which has barely been debated at all.
Let’s see how risk corridors work, and how they’re undermined by the spending bill.
It was well understood that health insurers would have difficulty pricing their plans in the individual market in the first years of the ACA, starting in 2014. Not only would some insurers be entering that market in volume for the first time, but the market itself would be dramatically altered by the flood of new customers and such ACA rules as the prohibition on exclusions for pre-existing conditions. Some insurers will end up setting their premiums too low, and therefore will have to pay out benefits higher than they expected; others will set their rates too high, and will capture a windfall.
Without a safety valve, these miscalculations could have an impact on premiums the following year, as insurers tried to adjust. So insurers that set prices more than 3 percent below a set target get a reimbursement from the government, and those that overprice by the same margin have to pay some of the windfall to the government. Importantly, the arrangement is temporary: it expires after 2016, by which time it’s assumed that insurers will know what they’re doing.
Obviously, this isn’t a “bailout,” since it protects underpricing insurers only on the margins, while also providing a check on profiteering. The Congressional Budget Office, moreover, has projected that over time, the risk-corridor program will produce an $8-billion profit for the government, because overpricing insurers will be paying back more than underpricing insurers collect.
Some smart conservatives acknowledge that risk corridors are a good idea. As Yevgeniy Feyman of the Manhattan Institute informed Forbes readers in January, “Any conservative reform plan for universal coverage will have to use similar methods of risk adjustment. … If you want insurers to participate more broadly in the individual market, you’ll need to offer a carrot to offset the unavoidable uncertainties.”
Nevertheless, Congressional Republicans couldn’t resist taking a swipe at this little-understood provision in the ACA, and Democrats weren’t sufficiently attentive, or caring, to call them out on it. The year-end spending bill forbids the Dept. of Health and Human Services to use any outside government funds to pay out adjustments to insurers. On the face of it, the government can only use surplus coming in from overcharging insurers for that purpose. (That’s the interpretation healthcare expert Tim Jost gives to Dylan Scott of Talking Points Memo.)
For the moment, that makes the provision little more than a symbolic swipe at Obamacare. But that could change, and the CBO projections could be wrong. In that event, the Republicans’ little act of vandalism could end up costing ordinary citizens money. Nice work, GOP. Extra points for pulling it off in the dark.
By: Michael Hiltzik, The Los Angeles Times (TNS); The National Memo, December 16, 2014
“Why They Are Dead, Horribly Wrong”: What Democrats Whine About When They Whine About ObamaCare
Democrats have reacted to crushing losses in November’s midterm elections in the usual manner: with a circular firing squad. And one of the targets has been the signature policy of the Obama administration, the Affordable Care Act.
Sen. Chuck Schumer of New York took the lead earlier this month, arguing that it was a mistake for Democrats to pass comprehensive health care reform. Retiring Sen. Tom Harkin (Iowa) has come to the same conclusion for different reasons.
While it’s not surprising that this argument has intensified after the midterm bloodbath, it isn’t a new one. Massachusetts congressman Barney Frank was saying the same things in 2012, and former White House Chief of Staff Rahm Emmanuel urged Obama to abandon health care reform in 2010, after the election of Scott Brown to the Senate cost Democrats their brief filibuster-proof majority.
But whether made now or at the time, whether from the left, right, or center, whether driven by policy or pragmatism, all of these arguments have one thing in common: they’re dead wrong. Horribly wrong. Wrong about the ACA, wrong about what was possible in 2010, and wrong about American political history in general.
Before analyzing each variation of the claim that Democrats were wrong to pass the ACA, it’s important to start with this: the ACA has been a remarkable policy success. It has substantially reduced the number of Americans without health insurance, and in so doing has alleviated a great deal of needless suffering, anxiety, and financial stress. It has slowed the growth in health care costs. And its medley of wonky reforms has improved health outcomes.
Furthermore, had it been allowed to work as intended, rather than having its Medicaid expansion ineptly re-written by the Supreme Court and obstructed by Republican statehouses, the scope of the achievement would be even greater.
The ACA doesn’t represent optimal health care policy by any means — to find a better one you need only throw a dart at a map of Western Europe. But it’s a success that Democrats should be very proud of, one that can stand alongside the great achievements of the New Deal and the Great Society.
Arguments that Democrats should not have done health care face a very, very high burden of proof. And they don’t even come close.
Democrats should have focused on something else.
This is a recurring theme in the anti-ACA arguments being made by Democrats. Schumer says Democrats should have focused on the “middle class” rather than health care reform, while Frank argued that the Democrats should have emphasized financial reform instead.
The main problem with these arguments is that no alternative course of action would be remotely worth trading for the ACA. As Paul Krugman points out, “focusing” on the economy in and of itself has no value, and Schumer can’t point to any concrete policy that would have passed had the Democrats not pursued comprehensive health care reform. There was not going to be a second major round of stimulus no matter what. The Obama administration didn’t do nearly enough for underwater homeowners, but this failure was independent of the ACA.
The only alternative policy course that could have arguably been preferable to the ACA would have been legislation addressing climate change. But given the Senate’s heavy tilt towards conservative fossil-fuel states, cap-and-trade legislation was always going to be stillborn. The idea that two Democratic senators from North Dakota, two Democratic senators from Montana, Mary “I’m going to my political grave defending the Keystone pipeline” Landrieu, and other relatively conservative Democrats were all going to vote for major climate change legislation is fantastical. In addition, much of what cap-and-trade would have accomplished can be addressed through regulatory action, which is not the case with health care.
Democrats should have waited for a pony.
Harkin’s argument is somewhat different — and is superficially more appealing — than Schumer’s. Instead of arguing that health care reform was a misguided priority, Harkin argues that the ACA wasn’t good enough. “We should have either done it the correct way or not done anything at all,” he asserts. Democrats should have tried for “single-payer right from the get go or at least put a public option [which] would have simplified a lot.”
This is like saying that Democrats should have gotten “two weeks at the penthouse suite at the Ritz-Carlton in San Francisco…or at least a night at the Motel 6 in Tulsa.” It misleadingly conflates two very different policies with two different political possibilities. Single-payer would certainly have been a better policy than the ACA, but it would be hard to get 20 votes for it in the Senate, let alone 60. (It’s worth noting that Sen. Bernie Sanders’ 2009 single-payer bill had a grand total of zero co-sponsors.)
The question of the public option is more complicated. There are variants of the public option — most obviously a universally available Medicare buy-in — that would have been major reforms, representing a pathway to single-payer. But that is precisely why a robust public option was as DOA in Congress as single-payer itself. The public option in the House bill — which would not have been universally available or cheaper than private alternatives — was small potatoes that would not have made the ACA simpler, more popular, or significantly more progressive. And even so, there almost certainly weren’t the votes in the Senate to pass even the neutered version of the public option.
Should the Democrats have just given up then, as Harkin suggests?
No. Let’s put this in historical perspective. Harry Truman tried and failed to pass comprehensive health care reform. Lyndon Johnson, in extraordinarily favorable circumstances, failed to pass comprehensive health care reform. Ted Kennedy’s efforts under the Nixon administration failed. Bill Clinton’s efforts failed. The idea that Democrats will nationalize the health insurance industry the next chance they get is just the purest wishful thinking. And the idea that millions of people should be denied health insurance for such a long-odds gamble is not merely wrong but immoral.
Democrats would have avoided big losses in the midterms.
At the core of these arguments is the fact that the ACA is unpopular, which presumably played a major role in the Democratic Party losing big in the 2010 and 2014 midterms. This argument might be the least convincing of all.
Let’s set aside the fact that Democrats held on to the Senate in 2010 and 2012, despite the ACA’s unpopularity, as well as the presidency. The argument, at its core, is deeply problematic. It presumes that Democrats should maintain power as an end in itself. But it’s not an end in itself — the point of being elected is to do things that benefit your constituents. What’s the point of political capital if you don’t spend it?
Again, it’s worth putting things in historical perspective. The problem with waiting for the perfect, risk-free time to pass major reform legislation is that there’s never a perfect time. There have been three major periods of progressive reform legislation in Congress between the Civil War and 2008. (The fact that there have been only three should give pause to those who think that Obama, Reid, and Nancy Pelosi are worthless sellouts because they failed to completely transform the American political economy in Obama’s first two years.) In 1966, Great Society Democrats lost 47 seats in the House and three in the Senate, a preview of the crack-up of the Democratic coalition that would (with a detour created by Watergate) lead to the election of Ronald Reagan in 1980. In 1938, New Deal Democrats lost 72 seats in the House and seven in the Senate, and this tally doesn’t account for the failure of FDR’s efforts to defeat anti-New Deal Democrats in the primaries. In 1874, the Reconstruction-era Republicans lost 93 (out of 293) seats in the House and a net of seven seats in the Senate, effectively ending Reconstruction.
Does this mean that Lyndon Johnson shouldn’t have signed the Civil Rights Act? That FDR should have waited until he didn’t need Southern segregationists to pass New Deal legislation? That Republicans should have nominated Andrew Johnson rather than Ulysses S. Grant in 1868? Of course not.
The perfect response to these kind of arguments was made by Pelosi: “We come here to do a job, not keep a job. There are more than 14 million reasons why that’s wrong.” This is exactly right. The window for progressive reform in the United States is always narrow and treacherous — you get the best you can get when you have the chance. The unpopularity of the greatest progressive achievement passed by Congress in nearly five decades is unfortunate, but misguided Monday-morning quarterbacking isn’t the right response.
By: Scott Lemieux, Professor of Political Science at the College of Saint Rose in Albany, N.Y.; The Week, December 11, 2014
“Democrats Against Reform”: Democrats Should Be Celebrating The Fact That They Did The Right Thing
It’s easy to understand why Republicans wish health reform had never happened, and are now hoping that the Supreme Court will abandon its principles and undermine the law. But it’s more puzzling — and disturbing — when Democrats like Charles Schumer, senator from New York, declare that the Obama administration’s signature achievement was a mistake.
In a minute I’ll take on Mr. Schumer’s recent remarks. But first, an update on Obamacare — not the politics, but the actual policy, which continues to rack up remarkable (and largely unreported) successes.
Earlier this week, the independent Urban Institute released new estimates of the number of Americans without health insurance, and the positive results of Obamacare’s first year are striking. Remember all those claims that more people would lose coverage than would gain it? Well, the institute finds a sharp drop in the number of uninsured adults, with more than 10 million people gaining coverage since last year. This is in line with what multiple other estimates show. The primary goal of health reform, to give Americans access to the health care they need, is very much on track.
And while some of the policies offered under Obamacare don’t offer as much protection as we might like, a huge majority of the newly insured are pleased with their coverage, according to a recent Gallup poll.
What about costs? There were many predictions of soaring premiums. But health reform’s efforts to create meaningful competition among insurers are working better than almost anyone (myself included) expected. Premiums for 2014 came in well below expectations, and independent estimates show a very modest increase — 4 percent or less — for average premiums in 2015.
In short, if you think of Obamacare as a policy intended to improve American lives, it’s going really well. Yet it has not, of course, been a political winner for Democrats. Which brings us to Mr. Schumer.
The Schumer critique — he certainly isn’t the first to say these things, but he is the most prominent Democrat to say them — calls health reform a mistake because it only benefits a minority of Americans, and that’s not enough to win elections. What President Obama should have done, claims Mr. Schumer, was focus on improving the economy as a whole.
This is deeply wrongheaded in at least three ways.
First, while it’s true that most Americans have insurance through Medicare, Medicaid, and employment-based coverage, that doesn’t mean that only the current uninsured benefit from a program that guarantees affordable care. Maybe you have good coverage now, but what happens if you’re fired, or your employer goes bust, or it cancels its insurance program? What if you want to change jobs for whatever reason, but can’t find a new job that comes with insurance?
The point is that the pre-Obamacare system put many Americans at the constant risk of going without insurance, many more than the number of uninsured at any given time, and limited freedom of employment for millions more. So health reform helps a much larger share of the population than those currently uninsured — and those beneficiaries have relatives and friends. This is not a policy targeted on a small minority.
Second, whenever someone says that Mr. Obama should have focused on the economy, my question is, what do you mean by that? Should he have tried for a bigger stimulus? I’d say yes, but that fight took place in the very first months of his administration, before the push for health reform got underway. After that, and especially after 2010, scorched-earth Republican opposition killed just about every economic policy he proposed. Do you think this would have been different without health reform? Seriously?
Look, economic management is about substance, not theater. Having the president walk around muttering “I’m focused on the economy” wouldn’t have accomplished anything. And I’ve never seen any plausible explanation of how abandoning health reform would have made any difference at all to the political possibilities for economic policy.
Finally, we need to ask, what is the purpose of winning elections? The answer, I hope, is to do good — not simply to set yourself up to win the next election. In 2009-10, Democrats had their first chance in a generation to do what we should have done three generations ago, and ensure adequate health care for all of our citizens. It would have been incredibly cynical not to have seized that opportunity, and Democrats should be celebrating the fact that they did the right thing.
And one related observation: If more Democrats had been willing to defend the best thing they’ve done in decades, rather than run away from their own achievement and implicitly concede that the smears against health reform were right, the politics of the issue might look very different today.
By: Paul Krugman, Op-Ed Columnist, The New York Times, December 4, 2014
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