“Another Train Wreck For McConnell”: Wow, Republicans Revolting Against The Elimination Of Medicaid Expansion. Imagine That!
You might remember that back in early 2010 Senate Democrats used a rule called budget reconciliation to by-pass a Republican filibuster and tweak their version of the Affordable Care Act to make it consistent with the one in the House. As a result, Republicans had a bit of a hissy fit, making the dubious claim that a simple majority vote in the Senate signaled the end of democracy as we know it.
In a move that should break all of our irony meters, Senate Republicans will soon attempt to use that same budget reconciliation rule in an attempt to dismantle the Affordable Care Act with a vote on a bill that has already passed the House. And we wonder why the practice of politics gets a bad name.
But hold onto your hats. This one is running into some trouble because, even with 54 Republicans in the Senate, McConnell is going to have trouble rounding up the 51 votes he needs.
The first problem comes from the Senate’s version of insurgents – Cruz, Rubio and Lee – who say that simply throwing a monkey wrench into Obamacare is not enough.
“On Friday the House of Representatives is set to vote on a reconciliation bill that repeals only parts of ObamaCare. This simply isn’t good enough. Each of us campaigned on a promise to fully repeal ObamaCare and a reconciliation bill is the best way to send such legislation to President Obama’s desk,” the three senators said.
The House version of the bill also contains provisions that defund Planned Parenthood – which is a problem for some Republican Senators representing more moderate states.
But if the Planned Parenthood provision is in the final bill — Senate Republican aides say no final decisions have been made — a handful of votes from the moderate wing could also break away. They include Murkowski, and Sens. Mark Kirk of Illinois and Susan Collins of Maine.
And now a third front of opposition has opened up.
“I am very concerned about the 160,000 people who had Medicaid expansion in my state. I have difficulty with that being included,” said Sen. Shelley Moore Capito, a Republican from West Virginia…
Sen. John Hoeven (R), who represents North Dakota, where an estimated 19,000 people gained access to Medicaid after Republican Gov. Jack Dalrymple decided to broaden the program, said he was unsure about repealing the expansion.
“I respect the decision of our legislator and our governor on Medicaid expansion,” said Sen. Steve Daines (R) of Montana, which has a Democratic governor. “I’m one who respects their rights and voices.”
Wow, Republicans revolting against the elimination of the Medicaid expansion. Imagine that!
When you risk losing Republicans from red states like West Virginia, North Dakota and Montana, just imagine what that means to incumbents running for re-election in places like Illinois, Ohio, New Hampshire and Pennsylvania.
Mitch McConnell proved himself to be a master at corralling Republicans into line to obstruct everything the Democratic majority tried to do for six years. But the job of getting them together to actually pass legislation has proven to be a much more difficult task. The fact that this particular effort will simply result in a presidential veto – even if successful – shouldn’t be lost on anyone. It is increasingly looking like another train wreck for McConnell.
By: Nancy LeTourneau, Political Animal Blog, The Washington Monthly, November 12, 2015
“From GOP ‘Con Man’ To Newly Elected Governor”: Health Coverage For Kentuckians Was On The Line, And They Appear To Have Lost
Under two-term Gov. Steve Beshear (D), Kentucky has been one of the best-run states in the nation. Not only is the Bluegrass State’s unemployment rate at a 14-year low, but Kentucky has been so successful in implementing health care reform, it’s cut its uninsured by over 40%.
Perhaps the state’s voters grew tired of success and decided to go in a different direction.
Voters in Kentucky elected Republican Matt Bevin as governor Tuesday.
Bevin beat Democratic Attorney General Jack Conway. Unofficial results from the Kentucky State Board of Elections had Bevin beating Conway 52.52% to 43.82% with all 120 counties reporting Tuesday night.
Independent Drew Curtis was also on the ballot, and garnered 3.6% support – not enough to affect the overall outcome. Statewide turnout was only about 30%, meaning that over two-thirds of the state’s voters didn’t bother to show up at all.
Bevin’s road to the governor’s office was, for lack of a better word, improbable. A year ago, the right-wing candidate, who’s never served a day in public office, launched a primary fight against incumbent Sen. Mitch McConnell (R-Ky.). Republicans quickly labeled Bevin a “con man” who lies “pathologically.” The first-time candidate was exposed a man who lied about his educational background, and who even struggled in the private sector – his business needed a taxpayer bailout.
At one point, he even delivered a speech at a cockfighting gathering and then lied about that, too.
Bevin lost that primary. A year later, he’s a governor-elect.
The smart money bet against him. Indeed, even as this year’s race unfolded, the Tea Partier seemed on track to lose. In September, the Republican Governors Association scaled back its investments in the Kentucky race, and as recently as mid-October, Bevin’s own internal polling showed him trailing.
Complicating matters, the GOP candidate “created a nightmare for Kentucky’s political reporters” by lying – about a wide variety of issues – on an almost habitual basis, and then creating an “enemies list” of journalists who challenged the accuracy of his falsehoods.
And yet, voters in Kentucky yesterday overlooked all of this and handed Bevin a relatively easy victory.
What happens now is likely to have a major impact on many of his constituents’ lives. One of the central tenets of Bevin’s odd platform has been scrapping Medicaid expansion, which would have the effect of taking away health care benefits from many low-income families statewide. And because outgoing Gov. Steve Beshear (D) used executive orders to create much of the state’s health network, the new right-wing governor-elect will have the power to undermine the health security of a significant chunk of Kentucky’s population rather quickly.
The question is simple: will he? This sets the stage for the the first real test of whether far-right officials are prepared to hurt their own constituents, on purpose, to advance a partisan goal. It’s one thing for Republican state policymakers to block Medicaid expansion from taking effect, but in Kentucky, the Affordable Care Act has already been fully implemented – and it’s working beautifully.
Bevin’s stated goal is to roll back the clock, consequences be damned. Coverage for over 400,000 struggling Kentuckians was on the line in yesterday’s election, and as of last night, they appear to have lost.
By: Steve Benen, The Maddow Blog, November 4, 2015
“Romney Wants Credit For Obamacare”: Mitt, ‘Without Romneycare, I Don’t Think We Would Have Obamacare’
Given the Affordable Care Act’s striking successes, it’s not surprising that its champions would look for some credit for bringing health security to millions of families. President Obama, Nancy Pelosi, Harry Reid, and plenty of other Democrats have reason to be proud of one of this generation’s greatest policy breakthroughs.
It is a little jarring, though, seeing a Republican look for credit, too. MSNBC’s Benjy Sarlin reported this afternoon:
In a surprising move, Mitt Romney seemingly took credit on Friday for inspiring the Affordable Care Act – after famously running as the 2012 Republican nominee on a platform of repealing the law.
Romney championed and signed a comprehensive health care law in Massachusetts when he was governor. Known as “Romneycare,” it had strong similarities with Obamacare, including a mandate to purchase insurance, but he had long resisted comparisons between the two. In a Boston Globe obituary of Staples founder and longtime Romney backer Thomas Stemberg, however, the former Republican nominee finally embraced the connection.
“Without Tom pushing it, I don’t think we would have had Romneycare,” Romney told the Boston Globe. “Without Romneycare, I don’t think we would have Obamacare. So, without Tom a lot of people wouldn’t have health insurance.”
And as a factual matter, there’s certainly some truth to that. Romney approved a state-based law that served as an effective blueprint for President Obama’s federal model. The two-time failed Republican presidential candidate has a point when he says “Romneycare” helped pave the way for “Obamacare.”
But that doesn’t make his new boast any less jarring. Romney wants credit for one of the president’s signature accomplishments – which Romney was committed to tearing down just a few years ago?
Those who followed the last two presidential elections closely may recall that Romney’s position on health care got a little convoluted at times. The former one-term governor initially said he believed his state-based plan could serve as a model for the nation. Then he said the opposite.
By 2012, Romney was promising voters that he would – on his first day in the White House – issue an executive order to undo the federal health care law without congressional input, regardless of the consequences.
Or to use Romney’s phrase, he vowed to scrap health insurance for “a lot of people.”
Three years later, however, Romney is apparently shifting gears once again, taking partial credit for the system he embraced, then rejected, then vowed to destroy, and is now re-embracing again.
And to think this guy struggled as a candidate for national office.
Update: MSNBC’s report added, “After an uproar on social media, Romney clarified in a Facebook post that he still opposed Obamacare, but did not backtrack on his apparent praise of the law’s expansion of insurance coverage and its ties to his own legislation.”
Romney wrote that “getting people health insurance is a good thing,” which he followed with some dubious criticisms of the ACA. To my mind, his online clarification changes very little about the substance of the story.
By: Steve Benen, The Maddow Blog, October 23, 2015
“For GOP, ‘Obamacare’ Is Inherently Bad, Even When It’s Good”: Focusing On Guns And Mental Health Means Talking About The ACA
In the wake of every mass-shooting – events that occur with heartbreaking regularity in the United States, but no other industrialized democracy – political rhetoric tends to follow a predictable trajectory. Democratic officials, in general, raise the prospect of new policies to curtail gun violence.
And Republican officials, in general, decry such efforts as anti-freedom, preferring to focus on practically anything else. For some on the right, mass shootings serve as an excuse to renew conversations about violent entertainment (though plenty of other countries enjoy similar cultural fare without violent consequences). For others, gun massacres are reason to start merging religion and public schools (as if the Second Amendment is inviolate, but the First Amendment is malleable).
But in recent months, a focus on mental health – which must have tested well with focus groups – has become one of the GOP’s principal talking points. Senate Majority Whip John Cornyn (R-Texas), the day of the mass-shooting in Oregon last week, urged President Obama to back Cornyn’s bill “to address mental health factor in mass violence incidents.”
In the Washington Post over the weekend, University of Chicago professor Harold Pollack described some provisions of Cornyn’s proposal as “helpful and constructive,” but highlighted a missing piece of the puzzle.
Cornyn’s proposal does not address the most glaring issue in American mental health policy: the Affordable Care Act’s Medicaid expansion. Medicaid expansion was always the public health cornerstone of ACA. It remains the single most important measure to expand access to mental health and addiction treatment, serving severely vulnerable populations such as the homeless, addressing the complicated medical and psychiatric difficulties of many young men cycling through our jails and prisons.
I suspect that for many Republicans, the idea of “Obamacare” playing a meaningful role in preventing mass-shootings must sound ridiculous. After all, “Obamacare” is inherently bad, even when it’s good, and all of its provisions must be rejected because, well, just because.
But Pollack is entirely correct, and if GOP officials are going to ignore gun-safety measures to focus on mental health, they should probably grow up and reconcile their mental-health rhetoric with their mindless, knee-jerk hostility towards Medicaid expansion through the ACA.
Indeed, Pollack’s Washington Post piece added:
In 2013, the National Alliance on Mental Illness (NAMI) released a report endorsing Medicaid expansion. The report argued that “States that decline to expand Medicaid will miss as good an opportunity as they may ever have to address this shameful void in access to mental health treatment.” Addressing the connection between mental illness and violence, NAMI concluded:
“In the aftermath of Newtown, many politicians and policy makers have promised to take steps to fix America’s broken mental health system. Expanding Medicaid in all states would represent a significant step towards keeping those promises.”
My suspicion, based on years of conservative apoplexy about expanding Americans’ access to affordable health security, is that when Republicans talk about mental health as a substitute for a debate about gun policy, they’re creating a smoke screen. Many of these partisans aren’t serious about expanding mental-health services, so much as they’re pushing a talking point to circumvent an even less pleasant conversation about the frequency of gun deaths in the United States.
They can, however, prove these suspicions wrong fairly easily. Pollack concluded, “If any other politician suggests that mental health rather than gun policy is central to reducing mass homicides, ask where they stand on Medicaid expansion. Their answer will be clarifying.”
Let’s start with Senator Cornyn, who fought tooth and nail to block Medicaid expansion in Texas, despite the fact that Texas has the highest uninsured rate in the entire country. Any chance he’ll consider a new, more constructive posture on the issue as part of his renewed interest on the issue of mental health?
By: Steve Benen, The Maddow Blog, October 5, 2015
“Ideology Standing In The Way”: How To Get Sicker, Die Sooner, And Pay More For It
It is painful that five years after passage of the Affordable Care Act, 19 states still have not taken advantage of its option to expand Medicaid. It becomes more so with each new report on the deeply flawed U.S. health system.
The latest, from the National Academy of Sciences, finds that rich people live about 13 years longer than poor people. The researchers note that consequently, rich people end up getting the lion’s share of Social Security benefits. Such inequity should be attacked at its root. At the very least, we could use available tools to help low-income people get health insurance.
The NAS report is far from the first to highlight problems in our approach and results. The Commonwealth Fund last year examined health systems in 11 western industrialized nations. For the fourth time in a decade, the United States system placed first in cost and last in what it delivers. Our system is less fair, less efficient, makes us less healthy and gives us shorter lives. All that for an average of $8,508 per person, way more than second-place Norway at $5,669. In case you were wondering, Britain’s socialized National Health Service was No. 1 at less than half the U.S. cost.
That information landed just as Allan Detsky published a New Yorker analysis of two 2013 reports on global health systems by the Organization for Economic Cooperation and Development and the National Institutes of Health. The study of the 34 OECD countries found an alarming trend: The United States ranked 20th for life expectancy at birth in 1990 and fell to 27th in 2010. On a measure combining level of health and length of life, we plunged from 14th to 26th.
The NIH report by the federal Institute of Medicine found that Americans fared worse than people in 16 “peer” countries in nine areas: infant mortality, injuries and homicides, teen pregnancy, HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease, and disability. Why? The authors cite a larger uninsured population than peer countries, worse health habits, more poverty, and more neighborhoods designed to require automobiles.
We have gained a few new tools since some of those studies were done. Some, such as Michelle Obama’s “Let’s Move” initiative and money for electronic medical records in the stimulus law, are nudging us slowly in a better direction. Among the most significant advances are the ACA’s new marketplaces (where individuals can buy insurance regardless of their health status) and the law’s expansion of Medicaid (even though the Supreme Court transformed it into an option that states could take or leave).
The Medicaid expansion is designed for people who make too much to qualify for traditional Medicaid but too little to afford even subsidized private insurance plans. In states that have rejected the expansion, nearly 4 million people are stuck in an absurd coverage gap. That’s even though the federal government is footing the entire bill for the additional enrollees until 2016 and will pay at least 90 percent for them after that.
If we’re already spending a huge amount on health care, why should we sink more into it? It’s a good question — yet we might not have to spend more if we were spending more wisely. We could start by slashing our astonishing medical pricing. It costs more than eight times as much for an MRI here as in Switzerland, a typical example from a study of nine countries released last year by the International Federation of Health Plans. Just this month, The New York Times reported on a 62-year-old drug that went from $13.50 to $750 per tablet overnight.
How can we get a grip on costs? In part by getting a grip on politics. Medicare, overcoming “death panels” alarmism, recently announced it will reimburse doctors for discussing end-of-life choices with patients. That may lead to a decline in expensive, painful and futile treatments. Next, we should lift bans on research into gun violence, the better to reduce shootings and their public health costs.
Ideology is standing in the way on guns, as it is in the 19 states refusing so far to expand Medicaid. The struggles of purple-state Virginia have been among the most epic. Democratic Gov. Terry McAuliffe has been repeatedly thwarted by Republican lawmakers in his push to expand Medicaid. Last year, a disloyal Democratic lawmaker resigned and threw the state Senate into GOP hands. This year Democrats are trying to win back the chamber and, along with it, the slim chance of a Medicaid deal. In the meantime, some 350,000 Virginians are stranded in the coverage gap.
And this, dear readers, is how you get to be last place in the developed world.
By: Jill Lawrence, The National Memo, September 24, 2015
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